77. Oral Hygiene Tips for Halloween, Helping Babies Latch to Mothers & What's the Deal with Fluoride? | Deep Shah, DMD

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Our guest today is pediatric dentist Dr. Deep Shah. Dr. Shah received his dental degree when the University of Pennsylvania School of Dental Medicine. He further trained in pediatric dentistry at the Children's Hospital of Pittsburgh. He is currently residing and practicing in the Philadelphia area. Our conversation begins with talking about tongue ties and what we can do to help babies better latch on when it comes to breastfeeding. We then transition into all things oral care. So whatever you can think of, we talk about it, cavities, brushing and flossing, mouthwash, and even the debate on fluoride. We hope that this episode provides a generalized but in-depth approach when it comes to not only taking care of our own oral hygiene, but also our children's. Enjoy. Deep, welcome to the show, man. What's up guys, thanks for having me. I'm so excited for this conversation and as we were talking about and kind of just preparing for this, typically we'd like to know a little bit about the person's journey and of course, I want to get to know your background as well. But I think the best place to start is your alias on Instagram. You go by the Superheater dentist and as a fan of superheroes and marvels and you're rocking the Superman shirt, you know, actually maybe the most pressing question here is, are you a DC guy or a Marvel guy here? It's a great question. I don't think I have an answer to that. I like, I like both. It's a great question. I need those. I'm going to come up. Yeah. Well, you chose to represent Superman, so that was the difference. Well, we can split the difference, right? Because I'm DC. You like Marvel all. So we have a combo here. Yeah. I know. That's it. There we go. Very contentious, thank you. So, what was the, you know, the reason behind that? Why do you choose to go by that? Yeah. So, I think for me, the Superheater theme was just something about in terms of kids just having kids be their own dot, dot, dot. And I was like, you can be your own fan. You can be your own advocate. You can be your own superhero. That's one of the things I think people really resonate with and kind of look up to in terms of a role model. I think there's a lot of them out there and I feel like you don't have to wear a cape to be a superhero and not all superheroes were capes, especially kids. And for me, I thought, you know, kids are the coolest people in my opinion in the world because they're so pure and they're so genuine and they'll tell you things as it is. And there's a lot of love behind what they do. And so I think they're the ultimate true superheroes. And so that's kind of where that kind of stem from is that I think it's what it's absolutely within all of us. You know, we're all governed by that. But I think kids really do a fantastic job of resonating that the best. I love that, man. And actually that reminds me a story that I'd like to share with you because I think it's applicable to today's discussion. Darcy, you'll appreciate this as well. This was my first ever 24-hour fast. So this is circa 2011, 2012. And Darcy, you probably know this, you do a lot is when you're fasting for a long time and especially if you're not, you know, hydrating appropriately, you're breath and just it smells it starts to be very, very interesting. And so this is me coaching and working with our kids from seven to 12 years of age. And I think I was working with maybe eight or nine year olds at that time in that class. And we were working and I was demonstrating a technique to somebody. And I got within a vicinity of one of my athletes on the table like, what was the last of your brush, your teeth? Now this was an eight year old and man, that cut really, really deep. And I just realized, oh, these kids haven't been taught how to lie yet or tell white lies. So with that, to tell the audience a little bit about who you are, you alluded to working with kids, but you know, what's a little bit about your journey, just so some people have some context. Yeah. So I like to say like, you know, I'm a human being, I'm a father, a son, I'm a brother, I'm a friend, I'm a colleague. And then I mean, that's kind of defines who I am, right? I love hiking, I love tennis, starting it into golf. And yeah, by the way, I'm also a pediatric dentist, but it doesn't define me. Being a dentist is what I love. It's what I'm passionate about, but it doesn't define who I really am at the core. My journey, though, started at an early age, in terms of what shaped me going to medicine. So I was a leukemia, quote, quote, survivor. I had ALL or acute lymphoblastic leukemia at the age of two. I've been in remission since the age of five, so it's been 30 years. But even though I don't remember too much of those early days, I do remember vividly the tail end of that, especially going into my early adolescence, going to see my chemo team and seeing the oncologist over at St. Christopher's, Dr. Halligan, who is actually still there remarkably serving the kids in that hospital. And I think just the love, the compassion, the empathy that I received, my family received really hit me, especially as I turned like 15, 16. You can't really start to appreciate certain things at a very young age, but as I started to make college decisions and think about what I wanted to do, I think going into these appointments and realizing, hey, I'm actually not hooked up to an IV poll. Like, hey, actually, I have my hair. I'm not bald. Hey, I actually will be able to reproduce, even though I didn't know at the time, and have kids. And there are some kids there that will never have that opportunity. And I think that really, really hit me hard at that point in time. And seeing was believing. You know, at first you go there, you're worried about the Nintendo games, they got a sweet system, they got a fish tank, and that's what you focus on. And as you get into adolescence, you're like, all right, let me start looking at my surroundings a little bit closely. And when you're able to take all those images and see these kids that are walking around with an IV poll, but the place that they're in is like almost like a beacon of light for them. That was really, really cool. And that's kind of what really taught me about getting back and kind of going to medicine but more importantly, serving kids. Yeah, I love that, man. So at what point do kids or children come and see you, like at what point is it, you know, in the infancy stage, kind of a little bit older, when do you start or what's your youngest patient, I would say? Yeah, the youngest one I've seen was a three day old, three days, for a tongue tie, got released in the hospital. Mom just knew the kids couldn't latch on and we did a quick lingual and labial release and got the child, you know, on the breast instantaneously. Usually, oh, go ahead, sorry. Yeah, now it's going to say there's some people might not be familiar with that term. You want to elaborate a little bit on that term. Yeah, absolutely. So a fornecdomy is kind of the removal of remnant tissue or excess tissue and humans, there's usually there's a couple spots you can have them. The most prominent ones are under the tongue called a lingual frenem, or you can have on right on the upper lip called the labial frenem. Other areas that are not so common are on the lower lip, which is called the lower labial frenem. You can have some against the cheek, which are calling buckle frenemes. But the first two that I had mentioned are the most common and they can really present an issue or problem in terms of the latch, a child would have on the breast or on the bottle. And as a result, they're not able to unrelate their tongue well and express milk, whether that be breast milk or formula milk. And it can lead to a lot of problems in the child, such as like aerophasia where they're taking an air and milk and you get this false sense of satiety. So these kids tend to cluster a lot more where they're getting hungry every 20, 30 minutes instead of having a solid feeding and then not being hungry for another two to three hours. They can present with blisters on their lips, they're just very irritable and quote unquote not happy babies is the best way to explain it. On the mom end, you can get a lot of discomfort and pain on the breast, whether it's an upper or lower part of the breast, you can get crackle nipples, sword nipples, bleeding nipples, stitis, which is clogged ducts, as a result, they can't express the breast milk. So there's an on slew of like different types of manifestations, negative presentations, so to speak, that can be presented both in the mother and the child. And sometimes relieving these tissues can help facilitate that process. Now what is the indication though, I know you mentioned some of the things that could go wrong, but at what point come easy, this is a surgical procedure, right? Yes. So of course it comes with risks and possible complications and so how do you weigh and what's that conversation like and what point does it make sense for somebody to do that? Sure, yes. I look at this from a functional standpoint, so everyone has a tie, otherwise your tongue would be, you know, you'd be like goofy from Mickey Mouse, and your tongue would just kind of come rolling out so that friend of really kind of keeps your tongue grounded in the floor of your mouth and same thing with the upper, you need one just to kind of have that nice aesthetic look to your upper lip. I look at it from a functional standpoint, so is the child, when they're infants, are they're able to latch, are they having a strong latch? Sometimes I'll use my pinky and I'll say that if they're able to undulate, I'll look at anatomy. So when the child's mouth is on either the mother's breast or on the bottle, it should kind of look like a C, but like a V. So you don't want it to be too much of a C where the lower and upper lips are impinging upon the breast, you want to be more of an open or a fishy mouth, I call it. So I'm looking at that, and I'm also taking into account the medical history and also just the symptoms and discomfort or kind of signs that the parents are seeing as well. And taking all that into consideration and doing my own exam to determine whether one is necessary. Sometimes both are, sometimes it's just one, sometimes it's neither and I think the child has a strong latch and it could be some other motor functions and kind of strengthening of the tongue exercises that might be involved with a my functional therapist. Yeah, I mean, that's a great point. Now, imagine, you know, breastfeeding and just that aspect of latching on. I mean, that's a very sensitive topic and it's near and dear to many of the new moms they're hard and it's challenging. It's very, very difficult having a new, you know, I'm not newborn now in infant, my first child, I know that there is, you know, you have to be prepared for that type of stuff. Do you find that will maybe functionally, it's not an issue where a child can latch on to the bottle perfectly, but it's really just the breastfeeding component where a new mom, because they have, I don't want to use the word, guilt, but, you know, they're really interested in doing the breastfeeding component because, you know, I think it's pretty clear at this point that evidence supports that there are a lot of, there are a host of benefits for that, right? 100%. Do you find that that can be an, is that an indication at that point that even though they're latching well, functionally, it's not an issue. You're still, you know, getting the appropriate nutrients and that kind of stuff, but really just for the breastfeeding. Is that ever an indication? It is. I'll ask parents what they want at the end of the day if the mom just wants to have a better latch. A lot of times they go hand in hand, so the child is not latching well. There is some type of kind of sign or symptom that presents itself. We rarely will a child, you know, be able to latch on and express them properly. There's no, and if there's no issues, like you'll know, if the child latches on well, you have a great seal, and because there's a good seal, all the other manifestations don't present themselves. But if I'm answering your question correctly, if a mom wants it just to help her on her end, the child's being okay, but the mom is having some discomfort, is that what you're alluding to? Well, it could be either way, right? I mean, maybe I was thinking that sometimes kids have a difficulty with the breastfeeding component, but they can bottle feed just fine, right? And so that, so just from that aspect of it. Yes. So that's actually a great point. So that's actually a really, really good point. My, in my opinion, in every situation is different, like some parents just have to go back to working two months, and they can't sit there and continue the breastfeeding journey as if they want to. I think bottle feeding gives a very false sense of security in terms of the latch, because it takes away a proprioception that the mother otherwise usually has, and that proprioception of the child's mouth on the breast gives a lot of information, and that's the biggest key and the biggest indicator between moms who have breastfed and those who haven't. Once again, there's no right or wrong way, but I know a lot that would like to feed a, just from the context standpoint, and B, from the health benefits, which are tons as you are alluding to. In the event, we don't catch this early on. The good thing here is that the situation or kind of the presentation will catch up with the child down the road. And so just because we miss it, let's say at the early infancy stage, if you still have a pretty prominent tongue tie that was undiagnosed or not caught, the child, for example, may start having a little bit of speech issues as they start to master a phonation and dictation, which is generally around the age of seven or eight. So for example, what I mean by that, you're lowered your tongue when you're saying words like thunder, 31, 32, or rabbit, their tongue will make contact with your upper teeth. And those kids who have a strong or prominent phantom won't be able to say thunder. They'll say thunder, 31, 32, 33, and you get more of an Elmer Fudge type of sound. Roger Rabbit turns into Roger Rabbit. You get a W substitution. So kids are really remarkable. They're great at substituting certain things. But you will really start to understand you'll be able to catch speech and phonation right away. Now the other thing you might notice is mouth breathing, and a lot of kids will mouth breathing. I always say is tongue up, lips closed, healthy breathing through the nose. And everyone should be breathing through their nares and their nasal passages just to promote like I said, nitric oxide, vasodilation, all the good stuff that comes with that. You'll see a child possibly looking mouth breathing a lot, which is kind of one of the reasons also in today's day and age. You get a lot of these kids who start growing longer, they get more of an elongated or very dolegal cephalic facial profile with mouth breathing. And those are some things that you can catch early on. Sometimes the tonsils might be very inflamed constantly just from the amount of bacteria and mouth breathing that's going on. And sometimes parents will just hear them snoring or catch and mouth breathing. So these are the questions I would ask them as well in the event they were bottle fed and or they were misdiagnosed or not caught early on. Wow, that's fascinating. So what's the ideal time frame where you want to be able to get that? I know that seven or eight would be kind of late, but are you trying to get it within the first year of life? Yeah. I mean, in terms of sleeping, I'd probably say that within the first two to four years if I can. So the other part of your question, which I asked is, when do you want to see a dentist? Usually I call it the rule of one. By the time you get your first tooth or it's your first birthday, whichever one comes first. And that's more for twofold, to create a dental home. So a place where a child can come where we're able to keep up with our oral health, keep an eye on things and give the parents and to call it anticipatory guidance, which is we kind of tell them about, hey, this is what you can expect from a physiologic and development standpoint. Sometimes at that age, it's really hard for kids to catch it that early because when you're born, that lower mandible is very retrognathic, and which is why babies just kind of look like aliens or look a little bit non-human, so to speak in the beginning. And just as they develop as a facial profile kind of takes shape, you'll get a better understanding of the physiology and the pathway and the airway. So I would say a lot of times, I would ask parents to monitor their child's breathing around the age of three, four, and that gives me a good indication if I have to release the tie at that point. We'll do a little version, do a little oral consciousness and help alleviate the symptoms and the situation that way. So I just want to ask, I'm curious to know, you know, you said the rule of ones. I know probably for all three of us growing up, when we saw a dentist, it probably wasn't a specialized pediatric dentist, right? I mean, we either probably just saw a general dentist. I would assume that pediatric dentist now is a growing field, more and more people are becoming aware of it, and I'm sure even like pediatricians and, you know, us in medicine are also promoting parents to say, hey, now that, you know, you have your first tooth or you're one year old, when years old, go see a specialized pediatric dentist. Is it a fair assumption to say that it's still lacking access to, you know, the general population, like across the board, or are you seeing like a higher socioeconomic, you know, family coming to see you? And the reason I asked that, you know, I just want to tie this into my next question, is that, you know, a lot of people, let's say, you know, what they say right now in medicine is like a white four year old female, they're the ones who are really going to be interested in functional, holistic, integrated medicine. When it comes to tongue ties and, you know, doing surgery, I'm sure a lot of parents are like, whoa, whoa, whoa, what? You're going to, you're going to cut off something and they, quote unquote, might want to do it the natural way, especially when it comes to something. So, what's the word I'm looking for? So, pure, when it comes to breastfeeding, right, natural, what's the conversation you have in that sense? So, sorry, it's kind of two questions, one is kind of the access, and then the second is the conversation you have for parents that might say, I don't know if I really want to do this. Yeah, it's good. So, the access questions tough, I think the access is not an issue, I think, in cities, you know, like, you know, I know we're both like the Philadelphia suburbs, DC area, you know, you're big metropolitan areas, I think you're fine, I think where it gets a little bit tougher is when you go to some of these areas that are some more suburban. For example, I mean, I work for part of what I do is I'm the chief dental officer for our dental organization, and we have offices in Tampa, and I go down there quite often to meet with some of the doctors, and we have some general dentists who work solely on kids, because the area in that region of Florida, we can't get a pediatric dentist to come out there. And so we're relying on general dentists who really like working with kids to see them. And it's kind of a stuck between a rock and a hard place, because we still want them to be seen by somebody, and I'm not saying unfortunately, because some of our dentists are really fantastic, and they love what they do, and they're good at it. But in some situations, it's tough, because the scope of practice and the depth of knowledge of not going to residency can't hinder that ability, like you're mentioning, they're actually in terms of access, and they're not seeing a specialist or seeing someone who's trying to do their best to fill that void. The second part of the question, I think in today's day and age, I haven't had many issues in terms of talking to a parent, in convincing them if they need to do the for anectomies. A, I think the days of using a 15 blade and a scalpel and the scissors and blunt dissection are gone. I use a CO2 laser, which is fantastic, it's just quick, easy. It takes me three seconds to release a tongue tie, and it cauterizes the nerve ending, so there's no discomfort, no pain. You could have orange juice or stick a squeeze of lemon there, and the kids are not going to react to the discomfort, and the healing is so quick. And so I think having that, and a lot of the actually the parents come and seek that, because they know that we have a laser. In the hospitals, the ENTs are still using the scissors and the scalpel, and they're intubating the child. They're putting the child under GA to do these procedures in a hospital setting. And so that's the other thing here is that I don't have to intubate them, or something that's so quick, and it's not a right or wrong, it's just I think the scope of medicine where they're working with the throat and like you know the whole nasopharyngeal area. If they're under GA, I think it makes their life easier, the kid's not a moving target. And you really, in the world of ENTs, you really don't use a laser because of the risk of airway fires. And so using a laser, I don't think it's something that ENTs prefer to use, given their scope of practice and a lot of things that they do, that we're using a laser as more of a hindrance. But in my field, it's fantastic, because I'm not working back there. I don't have to worry about any airway fire. And so I think it's just kind of the knowledge, which I think a lot of parents surprisingly are aware of. So is this procedure, I know we're spending a lot of time on this specific, but there's other things we want to talk about, and we will, we'll promise for those listening. But is this procedure primarily bread and butter for pediatric dentistry versus ENT? Like who does more of this? Good question. I think it's definitely shifting more to pediatrics now, pediatric dentists, and the other thing, the ones that do it. I know in the Philadelphia area, there's a couple of us who are predominantly the ones that do this now. I think it's just for that fact of you don't have to take a child and put them under GA to do this. Whereas if you go to ENT, no doubt, I think they'll do a great job. But the problem with snipping, and this is the way I learned it too, when I was in residency, I learned how to use a scissor and a 15 blade, and you just cut. The problem with that is if you have a deeper tissue, now you have to suture. And when you're trying to approximate tissue on a kid that's bleeding profusely, good luck. It's going to be really difficult to do that. And B, you're really not doing anything in terms of taking care of kind of obliterating that tissue. So what happens? You can get a reoccurrent, or you can get reattachment at a higher rate. When reattachment happens, you're back at square one. And this is where the laser and laser technology has really kind of helped shift the entire process where it's quick, it's easier, it's pain free, and you don't have to worry about that tissue regenerating to its original form. Yeah, I mean, much like anything else in medicine, heading more to less invasive procedures is the way to go. And so it's just somewhat of a novel, the CO2 laser novel procedure, that they haven't quite caught up yet, or like, what are other risks, I suppose I'm trying to understand them a bit better, why more people aren't doing this? Yeah, I think it's a question you had actually earlier, in terms of risk, there's really no risk. I mean, the only thing with CO2 is if you go crazy, you don't know your anatomy, and you're just kind of, you know, thinking you're like cyclops and going had it, I mean, you can really hurt some of the underlying tissue. Now granted, the good thing with these fandoms is everything's visualization. So it starts off as like, you have this like, you know, little tissue that hangs out, sometimes looks like Spider-Man shooting out his web from the bottom. And as you cut, this kind of becomes a diamond. So it's almost like you form a diamond, and it's very, very hard to miss. It's one of those things that, you know, as you're kind of tissue, you'll just, you'll feel it. There's a lot of proprioception as you're using the laser. You'll just feel the tongue also and just roll out, you're like, awesome, like I got enough. And so the only risk here is if you're not sure of what you're doing, you're just going deeper and deeper and deeper, now you're going to someone like, you know, the muscle tissues of the tongue. And even at that range, I mean, you're in such a highly vascular area, hopefully this doesn't present as too much of an issue, but I've had no risk. I have yet to have a kid, you know, development infection, chance of infections, what's going to extremely low, because you're not going, it's quite, it's quite a superficial procedure in surgery. And you have so much vascular that kids aren't, they're not only resilient, but you're working in an area of the mouth where the vascular really helps you because you're getting a lot of blood flow to help facilitate the healing process. Awesome. Alright, so let's shift gears a little bit. We spent a lot of time talking about this. What are other common issues that you end up dealing with in your practice other than this for neck to meet this procedure specifically? Yeah, I would say like your bread and butter or nowadays, it's called the key to uncail dentistry, which is, you know, your, your cavities, I think that's, you know, the most chronic prevalent, you know, childhood disease is dental carries. And that is, I think it's only gotten worse, I think a lot of that just has to do with our society. Halloween is around the corner. Kids are going to be kids. We're going to have candy. It's part of being a kid. We've all gone through it. But I, it's also, I think kind of just the food industry in terms of what's being put into foods in terms of ingredients. And I always say, if you look at Europe, if you look at the US, Europe bans close to 900 ingredients that we're still using here in the US, whether it be like, you know, blue four, you know, red 40, blue five, yellow, three, whatever, all those things are, you know, they don't use that some of their products and we do here. It works back in the 1970s, had three, three flavors and now I think it's got like seven or nine different, you know, artificial flavors and ingredients since then. And so I think we're going into this process of where everything looks like I can be. And kids love that stuff because it's blue, it's red, and we all love that stuff, right? And the benefit for us is we've got adult teats or a mammal is a little bit thicker and we can kind of brace that punch a little bit better, whereas these kids, thinner and more like a mammal, you know, you're not, it's just, it's a lot tougher. It's a lot tougher. So diet today, I think is definitely paying a lot of a bigger role in terms of advancements, I should say, rather of the cavity and of the microflora and the microbiome. Why would the thickness of the enamel be important in terms of carries? Yeah, in terms of re-mineralization. So the enamel is actually the strongest part of our body, stronger than any other thing that we have in our body. So it does a great job of buffering against acids, foods that we eat. So there's one formula for, I'd say like, you know, listeners to take away, it's sugar plus bacteria equals acid. And it's the acid in our teeth when it turns into an acidic environment, the pH drops. That's what starts eating away and causing holes in the mouth, and that's what causes the cavities. When you have adult teeth, that outer enamel can have a higher chance of re-mineralization. So you have, it's almost like you have a lot more leeway space for that cavity to break through and start the process of going into the next layer of the tooth called the dentine and then getting to your nerve. Kids don't have that ability because the baby teeth, they're meant to just be short-lived. So they have an enamel, they're just not, it's not as potent and as a result you get less of a barrier, so to speak. So what's the cavity starts forming? Is there any way to reverse it or is it now just a progression that can only get worse? Yeah, great question. You can actually reverse cavity. So there's a zone called the E1, E2 zone. Think about if you were to take the enamel and draw a dotted line at the halfway point. Anything on the outer half is reversible. Anything that encroaches within the 50% or greater than 50% line will start to kind of pick up momentum and speed. So in the dental world, if you're within the E1 area, the E1 lesion, we can watch that. You can re-mineralize that, whether it's with toothpaste, whether it's flossing. And once it crosses that point, you can, you have a little bit of time. It's not going to just kind of overnight explode on you. But now you're looking at, it's like all like a snowball effect. You have a snowball, a snowball, and now you're going to start to get an avalanche. A snowball's picking up speed as it goes downhill. The goal here is to not take that process and make it a black diamond. You want to keep it a bunny slope. And the way you keep it a bunny slope is obviously good oral care. But once again, a lot of water and diet. I think diet is one of the most underrated things. Genetics obviously plays a role. But back in the day, everyone attributed brushing your teeth and cavities as a really, really big process. If you brush your teeth two times a day, two times every time you brush, and say you brush twice a day, which is the average time, that's four minutes out of 1,440 minutes in a day. It comes out to less than 0.3% of your day. You're spending brushing your teeth. Did you do that math right now, or have you done this before? I kind of did that right now. Anyway, something on yours is not ballpark. And so that kind of tells you right there that brushing is great. It's important. But being less than 0.3% of your day, is it really that important? In my opinion, no, it's not the number one most important thing. Your diet, what you're drinking, how often you're feeding and snacking is so important. And the reason I bring that up is if you're going to brush, I'll say, if there's most important time to brush your teeth, it's night brushing. People do not miss night brushing. Don't do it. It's the most important time to brush your teeth. Because when you go to bed at night, if you're mouth breathing or if you're sleeping and your body's relaxing, you are starting to slow down salivary production when you sleep. And if you have food remnants or particles left in your mouth, that's one that sugar plus bacteria equals acid. And that acid really starts to really take effect at night, especially in a drier environment. So this is why the last thing you want to do before you go to bed is brush your teeth. If you need to drink something, have water. Because you really don't want to have anything, carb, sugary, anything that related after your brush. There's also something called the Stevens curve, which is a pH curve. So anytime you put something in your mouth or sip on something that is not water, that has acid, that has carbs, sugars, all this stuff, your pH will drop and it'll stay at an acidic level for 20 minutes. Which means you eat something at 8 o'clock and it's 8.19 and you take another bite of the sandwich. You got to wait another 20 minutes now for that pH to rise. And so if you're someone who likes to be a frequent snacker or someone who sips on their beverage, it's actually not a good thing because you're keeping your mouth at an acidic level throughout the day. Wow, that's interesting, man. You mentioned earlier that at least in Europe, they have a lot of the things that we have in our food system, pretty much ban all these ingredients. Do we have a sense, or are you familiar with any evidence that suggests or any studies that have been done that the incidence of carries, that the carries is lower across the pond versus the states, anything like that? Sorry, I'll tell you, you broke up a little bit. I wasn't able to hear your question completely. So I was asking if you're familiar with any evidence or any studies that have just kind of epidemiology looked at whether the incidence of carries in Europe are lower because of the diet, just the structure of the diet is vastly different than what we eat here. That's a good question. I have not actually. I should be a great say to you, but no, I have not come across anything of that nature. And I think it's hard. And the reason I think it's a great question. The reason I think it's hard is because there's so many factors alone, right? I look at it as like you could be exercising every day and working out, but after your workout, if you're not eating healthy, it kind of gates your workout, so to speak, or if you drink alcohol, there's so many other factors that could lead to you, either losing weight or putting muscle mass on, rather than just going to the gym. And the mouth, it's kind of the same thing. You can do X, Y, and Z, but if you're not doing A, B, C, D, E, there's just too many factors and from a genetic component and epigenetic component, which I just feel would make that study really difficult. I think it's an awesome thing. I wish we had the ability to do that. I think I'd be able to do such a cool study, but I just think there's too many external factors for someone who even were to do that study to outright claim, hey, this is exactly the findings. Awesome. So let's talk about what A, B, C, R, right? You kind of already emphasized that diet is the most important thing, and that's just the insults, the amount of insults that, if that increases, then really no amount of prevention or treatment is going to be able to help that. So maybe just give us some insight into how exactly is it that sugar or carbohydrates, you know, or I mean, you gave a little bit of a primer of how this acidity kind of breaks down through the animal, but what specifically is it about sugar? Is it all sugars? Is it, you know, fructose, sucrose, or are there some type of sugars that the tea tolerated a little bit better? Yeah. So fructose sucrose, lactose, the teeth do not discriminate, they'll take and pull from anything. So for the tooth, sugar is sugar, whether it's coming from, you know, honey, whether that's coming from carbohydrates, they really won't discriminate where they're getting that from. For them, it's just an energy source. So whatever they can use as fuel for energy, that's what they'll use. A lot of bacteria, the biggest bacteria are the streptococcus mutants. That's kind of the biggest streptococcus mutants are the ones that you hear associated with bacteria. I mean, you got ectenomycosis. There's lactobacillus. There's tons of different bacteria that also play a role in the process. If you have periodinal disease, then you get a little bit of a paradigm shift in terms of now, which ones are more aerobic or sorry, anaerobic because they're going to a deeper level where you're not getting oxygen. And so things will shift, but on the surface level, that's pretty much your main one is your streptococcus mutants. And it'll just, it'll use anything and everything as a fuel source to feed the fire. You know, one of the things that's so hotly talked about right now is that the gut microbiome, the microbiota, really, essentially. And most people are somewhat familiar with the concept that the GI tract really begins in our mouth, right? The process of massification starts to transition. So I imagine that there must be some healthy bacteria as well, right? I mean, so what's, is that, is that the case or is that great? Yeah, absolutely. Yeah, you're right. Because at the moment you even think about food, you start to salivate, right? And that's exactly that's the gut back to your priming the mouth. So you're, the lot of the immunoglobulins that you find in your saliva are actually great. And they'll actually fight and prevent against cabins. And it's actually really cool because you brought that up because I'll see siblings all the time. And a lot of the times they'll, they're at home, they'll eat the exact same thing. He had Doritos, she had Doritos, he had a Oreo cookie, she had Oreo cookie. But he has eight cavities and she has zero. And it's really, really interesting how that happens. And I think a lot of that has to do with genetic component of just a salivary makeup of individuals from a case to case basis. And how much saliva they're producing, how thick is the saliva, components of the saliva that can all help in that process. Nice. So let's, let's start talking about oral care, right? And what parents can do for children and what we all need to do from a pediatric standpoint as well as adults. So one of the things you mentioned was brushing right twice, twice a day, once in the morning, once at night. You recommend electronic over just a manual or is there really a difference? Yeah, good question. I think if I like the electronics, I think they're easier to use. I think they do a lot of the rotary stuff for you. Obviously, no kids just don't have very good dexterity. So if they can get something in there that kind of goes at a higher RPM, I think they'll just facilitate and help really get the carries, I don't even carry the plaque around the posterior mold. There's a lot better. I use a manual right now with my boys as well, just because they like to move. So if you got a younger kid, they say stay away from the electronic ones, just because they're moving around, got for it, but they fall. You can get a pretty nasty kind of trauma to that, that oral area. But as long as you're going in a circular motion with the manual brushes and kind of getting down, angling that toothbrush and keeping it clean, I don't think it really matters. By studies do show that the spin brushes work, they're a little more efficacious. But that flossing, I think, is great. Once a day before you go to bed, just to get in between your teeth, one of the best things I've ever heard in my life, it's like flossing is like toilet paper. You want to use toilet paper so you really clean everything in between the cracks. This is kind of the same way you really want to clean in between the teeth. Some people say it's actually more important than brushing because you're reaching areas that the bristles of the brush can't get to. And some degree I think that is true, but the brush and the bristles do play an important role, especially if kids or adults have deeper grooves on their teeth to be able to get back there. And the last thing I like to use to add to that, brushing and flossing is what people think about. You can use a water pick that's fine. One of my biggest adjuncts is a mouthwash. And to me, that is the best thing you can do. Once a day, just before you go to bed, I am not a big fan of listerine. I want to bring this actually a really cool thing that you brought out there because a lot of people think of listerine and being, I won't get cavities. Listerine is an anti, you know, it's for halitosis or bad breath. But the problem with listerine is if you look at the ingredients, there's 22.6% alcohol in listerine. So what does it do? What ultimately just refers to? Got bacteria. It will kill the bad bacteria in the mouth, but it's also killing the good bacteria in the mouth as well. So anything with alcohol, I'm saying no to. And so for that reason, listerine, I'm not a big fan of listerine. I like to use anti-cabbie mouthwash. So act is a totally fine one. Now for those people who are big on ingredients, probly and glycol was found, you know, in some can be an ingredient and act. If you're against that, then you can use something a little bit more natural. There's one called phyrabreath, which is the one I recommend with my patients. It's fantastic. It's great. It's all natural, organic. And it got from a video where to swallow a little bit of it. It'll do okay. You know, there's just less, less harmful ingredients, so to speak. If your child can't swish and spit, you can just drizzle a little bit on their brush after they brush their teeth and just brush with it. And that does a great job because what the phyrabreath has is two components. It has a little bit of fluoride, which is almost like a brick wall. So it helps the tooth from not the cavities from not penetrating the tooth, but also has something called xylitol, which is an alcohol sugar. So xylitol is very sweet. The body loves it. The bacteria love it. There's one problem. They can't digest it. So it physically kills off the number of bacteria in the body. So now you're hitting the tooth with a nice one to punch. And so it's better than just using act, which has only fluoride, for example in it. Yeah. So I want to go back to the flossing for a second. We talked about the different types of brushing and what might be better. Are there certain types of flaws? I know that you've got the one that you typically get from the dentist in this little packet that you get with the back. You know, it's got the wax in it. And then you have another one that's kind of like almost a ropey thing that I've seen before. And I was like, oh, this is interesting. And then the one that I use because I'm lazy, it's one that looks like a tooth brush and has a little pick at the end. And every time I tell my dentist that I do that, and they always kind of give me this judgmental look. But it's the only way that I'm going to do it. Are there some that are better than others or what's the best one if there is one? That's a tough call. I like to say the best one is the one that you can get compliance with. That's my honest answer. You got cocoa floss and these other product, which are fantastic. They're great. They're also marketed three times, but the market price of a regular floss. And so my end thing is, you know, just use something that whatever works best for you in your family, use it. And you know, you're flossing, using a pick floss is better than using no floss at all. Now it comes down to teeth. If your teeth are tighter together, sometimes the handle floss, as you'll notice, don't have enough tension on them. So it'll be a heart. It might be, it probably feels a lot harder to push those through your teeth. And if you have kids, they're always going to kind of do this knee jerk reaction push back on you. In those cases, I would say take conventional floss, wrap it around your finger. Now you can make that as taught as you want and you get some good tension. So you can just go pops right through, you floss, and instead of pulling the floss out, which I hate because a lot of times some people dislodge fillings or it gets caught underneath an area that has, you know, that's, you know, tough to finagle out of. Let go of the one side and pull the floss right out and it's just an easier way to floss. I'm just a big fan of wrapping around and going that way because I think you get just better control, the tension, especially in adult teeth, you want those teeth in the back and in the front to be perfect or they're touching when I say perfect. I mean side by side by side and adult teeth, that conventional floss is just the best way to go in terms of making sure you're able to break that look and go through the contacts, snap through the contact, clean both sides and just take that string out. What about order does is floss and then toothbrush or vice versa, what's the preferable way? I like to, I like to floss at the, I like to brush first and then floss. Some people say floss and then brush. For me, I just, I just use the mouthwash at the very end, so if you're using a mouthwash, I just say it doesn't matter what it is and then with the mouthwash and I'll go through everything. If you want to use a water pick or high speed, like you know, kind of like a water compressor, that's great too. They'll dislodge things. Really, no, no, through the only thing you don't want to do is you just don't want to be brushing side to side and pushing, you know, there's a method to the madness in terms of brushing. If you have plaque along the gum line, you don't want to be shoving that plaque back up or brushing side of it, just why they say gentle, circular motions and flicking the brush down. So you're bringing on the plaque downward rather than just piling it upon each other. That's the only thing on that end, but in terms of which one comes first, I'll take it as the chicken or the egg concept, you know, take your pick. I don't think it really makes much of a difference. Now some people would argue that really the benefits from brushing comes in just from the mechanical breakdown of, I guess it's the biofilms that build up and the plaque build up kind of what you're talking about. And they would say maybe the role of the toothpaste isn't that important yet. I forget what book I read it where maybe it was the power of habit by a dude who talked about how the ADA made like tooth brushing because of toothpaste selling, anyways, that's the side of the point. But I guess I'm trying to get your take on, you know, how important is toothpaste and people market all different types of toothpaste, fluoride, non fluoride, whitening, what, or is it really just the brushing? That's the most important aspect and the toothpaste really doesn't matter that much. Yeah, I think you nailed it. It's kind of a taboo topic of dentistry in my pain. That's kind of kind of common. I love it. I think these are things that we should not shy away from. Everyone's going to get a different take. This is where I just, I really resent dental school. I mean, never going to chance to speak dental school again after saying this, but I think everything becomes, everything is so dogmatic in dental schools where, you know, there's only certain companies that come in to do lunch and learn. There's only certain products that you try. And I hate to say it. It's all crest and cold gate because they monopolize the market and their stuff is cheap. But I look at this as any other product that you get, whether you get whole foods, Walmart, Target, or Trader Joe's, you know, the price point in a way matters in terms of the ingredients. I think in toothpaste, it's quite the same thing. The one analogy I always give my residents is that if you have someone who's having a heart attack in your office, like, what are you giving them? And they say nitroglystering. I was like, bingo. What is the route of administration of nitro? And it's sublingual. And so I tell them why you're giving something for the heart, sublingual, because there's permeability. And I think that holds true in terms of dental products as well. There are toothpaste out there that had SLS. And for some kids and some adults who are susceptible and sensitive to SLS, it will cause ulcers on their gums and other cheeks in their mucosa. And the moment you take that SLS away, they'll never get one again. If you have cariginins, you've got trichocins, you've got parabins and artificial sweeteners and colors. And so it just comes down to just how clean you want to be. But in my opinion, you know, I think ingredients do matter. And the biggest one is fluoride. And this is, I think, the hottest topic. I would comfortable to say that if you ask like 100 dentists that came on this podcast, I'd probably say upper 90s would probably say fluoride, fluoride, fluoride. Whereas I'm more of the fact that you only get fluoride once the kit can spit. And the reason for this is if you look at the back of any crest or colgate or armen hammer, what does it say? If swallowed, cold poison control. So why is that have to be on there? Because of fluoride ingestion and how sick it can make you. And if you know anything about kids, if they love the toothpaste flavor, and if that's not high enough on the counter, they will go through that. And this is the reason why a lot of vitamins for some, for some, for some of the vitamins I know kids vitamins don't put iron in them because if the kids get into it, you just don't want to have toxicity, whether it's iron toxicity, in this case, you're looking at fluoride toxicity. So I love fluoride. I am not anti-fluorid. I love it. I just love it when kids can spit. Because other than that, it really doesn't do any harm to your body. We talked about how diets and number one factor. And if you're brushing twice a day, less than 0.3% of your time, like how much does fluoride really going to play a role if you're constantly snacking and eating and drinking? So I love fluoride. I love the topical fluoride, especially when kids come to see us in the office. Because that has 26,500 parts per million, which are a very heavy dose and concentrated dose of fluoride that we're just applying topically. So I tell parents, you know, if you go to your pediatricians, and this is where I think hopefully we can do a better job of bridging the gap between medicine and dentistry, pediatricians will recommend fluoride drops or fluoride tablets. And I'm not very, I'm not a big proponent of those. Because once again, I think topical fluoride and research does show that topical fluoride is preferred over systemic fluoride. Now I guess I'm trying to think about this. Dars, maybe you know this because we've talked about water quite a bit before. At one point, did we start putting it into the water because I imagined once we're taking and gesting it systemically, the importance of it in our toothpaste is far less, right? Do you know when that might be the case? I'm not sure actually. I don't know. I don't know. I don't know. No, and this is tough because this comes down to dosage and concentration, which is another point, which is very, very I think misleading. We are so worried about dosage of fluoride or sorry, concentration of fluoride that we're not looking at dosage, which I think is equally important if not more important. So in the US, like some areas can be concentrated, water can be concentrated from 0.7 to 1.2 parts per million of fluoride. Well, that's a big difference. If you're getting like 1.2 and I'm getting 0.7, all of a sudden, now we know the concentration but now dosage matters, like if you're drinking 0.7, you can get away with drinking maybe a few more cups of water than I can before I reach a toxic level. And so that stuff is just like I said to me that there's a big, big misunderstanding and misleading part of this where people don't look at both equally or to focus on the numbers and the concentration rather than the dosage. Yeah. Are you ever worried about like fluoridosis? Is that something common you see more now with like children, you know, given the systemic effects? I know that's something a lot of dentists who are, you know, quote unquote anti-fluoride may talk about where I think it might be Japan who doesn't chlorinate their water. And I don't know, don't quote me on this all the time if you want to look it up, but I think they have like less cases of like, you know, obviously fluoride toxicity but also just fluoridosis and children over there compared to the states. I think you're right on that because I did read something very similar to that before. I would say I see a lot more fluorosis I have seen it. I have seen it a lot more of the Asian populations of the Indians and the Chinese that are relatively just moved into the country. I'll get a lot of South Asians that have just moved to the area. I'll see a lot of kind of fluorosis or in the hype of mineralization on their teeth. And people from South America, the Brazilians, Colombians, where fluoride is more naturally occurring in their water. So instead of like one part per million, they might have three parts, you know, 3.2 parts per million of fluoride in their water. And this is another example of like, you know, where less is more, you know, less fluoride is doing more for your body. And in case like this where these guys are having more and it's doing less for their teeth making those teeth have fluorosis. So I see it a little bit time to time. I see more hypoplasticity or some areas of the teeth that are a little bit more wider or hypocalcified. Hard to say whether it's due to trauma, whether that's due to maybe the mom ingesting a lot of fluoride. It could be from the baby having what's it called formula. And I see other thing here, the biggest takeaway here is formula has so much fluoride that our bodies are smart. Our bodies know how much is enough is enough, but with having formula, you have a lot of fluoride added fluoride in formula. And once again, coming down to concentration versus dose, these kids are getting dosed almost a hundred times more fluoride than their body needs. Yeah. So I know something with toothpaste, right, especially if it's anti-fluoride. Some of the toothpaste will have something called nano hydroxyapatite and then silver or something. I can't think of that second word. Can you explain what those two areas are? Yeah. Yeah. Oh my gosh. So you have silver, nano hydroxyapatite is actually one of the toothpaste that I use is called rise well. There's another one called boca. There is another one called coral, which has a silver kind of the silver nitrate. Silver is an antibacterial. So when you have like nano silver particles in the toothpaste, it really helps against bacteria forming bugs or bacteria forming variants like trying to stay in the tooth or cause cabbages of the teeth. I love hydroxyapatite. It mimics a tooth structure the most closely. So it's about 97% or so in terms of mimicking hydroxyapatite, which is kind of the natural formulation of the tooth. And so that is that toothpaste is kind of up and on the rise because of the properties that it has to natural tooth structure. Yeah, absolutely. I mean, I've been using coral. Coral is one. Yeah, I've been using corals as he told me and like I've actually noticed a pretty difference in like my shade, you know, getting whiter without you having to use any type of white each products out like dress strips or anything. So I can definitely vouch for that for that company at least. That's the one I've really tried. I do want to ask you one of the things that I wish as our generation growing up was allowed to chew gum in school, right? Especially because a lot of them now have xylitol and you just touch on xylitol and how that can be helpful, but also from the point of mystication, right? And James Nester talks about this in his book, Breath, where in the beginning of this podcast episode, you talk about how, you know, we're getting elongated structures. We're not getting as dense as bones either because we're just not chewing our food as much as we used to. Evolutionarily, everything is processed, it's softer. So take us through like how gum can help. And if that's something you actually recommend to parents or their children. Yeah, so I actually do recommend gum at an age where, you know, it doesn't become a hazard and a swallowing risk. So five, six for some kids a little bit older, but I do like gum for the fact of what you mentioned. It releases xylitol. Now, once again, just like any other ingredient or any of the food, you gotta look at the ingredient, not all gum is created equally. So your ice break or your mentos, your trident are going to be your choice over your juicy fruit, double decker, bazooka, the stuff that we grew up on. So you definitely also want to read the ingredients when it comes to gum, but I am a big proponent of it. For that fact of just kind of, it bays the saliva, it actually helps to increase your salary component throughout the day. And if you can't get water in there, at least your saliva is producing and churning and it's going to bathe your mouth and keep it clean. In terms of massification, it's a good question. I just don't think like back in the day, we're getting our member stories of our parents like chewing on tree bark. And that's hard. That's really hard and taught. And I think chewing and knowing on that, because of the way you're chewing and the density of that material, compared to gum, which is a lot softer, I don't see gum, you know, playing a very big role in terms of strengthening and changing the dynamics of the jaw, where if you look at these skulls that are coming from Africa, they're able to fit all 32 teeth because of their diet. So I don't think that just chewing gum alone is going to completely change the look of the structure of the mouth. I think that's going to just be a whole kind of revolutionary diet change in terms of less processed foods that we're eating. But I do see it, I do see the health and I do see that the role it plays in terms of decreasing cavities from that standpoint. You mentioned earlier how the oral mucosa essentially serves as a conduit to other organs in our body, right? The heart, especially, what do we know about the role of our oral mucosa, oral health and other systemic illnesses, like comorbidities or just really metabolic health, diabetes, that kind of stuff? That's a good question. I know that plays a role, depending on, you know, for me, it's not something I delve too much into, just kind of be given the population I work with with kids. The only thing I don't really worry about is the, for me, the heart's the biggest thing because I see a lot of kids with Down syndrome. I'm not dealing with much of the adult population, but some of my general practitioner colleagues do see, you know, and they have to make sure that from a diabetes standpoint, you can have your, so when you think about diabetes, about healing in the body, healing in the mouth is just the same. If you have an ulcer or you have a sore, your gums are going to bleed more. And so from that standpoint, there definitely is a correlation between systemic illness and oral illness. What you will see depends upon what illness we're talking about, but things you will see can include inflamed gums, more bleeding gums. You can have more sloughing of your tissue. You can have a higher chance of getting a squamous cell carcinoma, especially if you're a smoker. And so there's definitely, there are absolutely correlations that you'll catch. You can potentially catch right off the bat. It's just in terms of the specific illness, I don't know, I'm not your best resource in terms of which illness is associated with which causation, just because I think you're going to see a lot of these more comorbidities in an adult population rather than kids. But there absolutely are a lot of different factors and things that you absolutely will see though. Yeah, old I think. Yeah, no, I just want to be. I mean, I think, as far as I was going to say, I think Rhonda Patrick actually just recently put a tweet out about the risk of like the oral microbiome with cardiovascular disease. There might be a new paper out on that. So I'll try to find it and link it to the show notes at least so we can all take a look at that. Perfect. Yeah, I mean, it's conceivable like we talked about since, you know, you've emphasized the role of diet and we've done our fair share of that as well. But again, I think it would really be, it would be hard to tease out, but I imagine there are some studies and, you know, if we can find that study, that would be really awesome. You know, one of the things that we felt to ask you is we talked a lot about brushing our teeth, but we didn't talk about the tongue. We started off talking about front neck, but during oral care, is that something that, you know, you're advising to like tongue scraping and that like they make these tongue scraper is out there, which is just disgusting looking things, but how do you advise patients to do that? Yeah, absolutely. And yeah, and of course, we're saying endocarditis is a huge thing with the biggest, the biggest kind of biggest correlations or hold the endocarditis or the two big ones that you'll hear over and over again, especially prosthetic valves and things of that nature. I love tongue scraping. I think clean the tongue is huge. I think our tongue has its own little biological niche of microorganisms. And so I think getting a tongue scraper is possibly the best thing that you can do for your tongue. You don't need to be aggressive, but you do, you know, I think it makes a big difference in terms of removing that biofilm that you get on the tongue when you wake up in the morning. You can brush your teeth. A lot of toothbrushes now have a little backend that's a little bit of a scraper, but I do want to tell people, you know, like you think about the mouth and saying, oh, okay, well, the mouth and the tongue have the same bacteria, but actually vastly different in many ways. And so the tongue will harbor its own set of bacteria, which can lead to bad breath. It can lead to the pill on the tongue being more inflamed. And so it's scraping the tongue in a gentle fashion, taking care of the tongue world hygiene is super important in my opinion. Now we talked a lot about sugar and diet and that kind of stuff. And you mentioned the pH and acidity previously. So that actually reminds me, I got to ask you about coffee and tea and just because I have a challenge to cut back on those things is, you know, how much do those types of things affect just essentially the integrity of our teeth and, you know, is that a conversation that you find yourself having, probably not much in the pediatric realm. But I suppose, you know, you do have this conversation as maybe they become teenagers or a little bit older than that. I do. Yeah. I mean, I think the worst thing, like your soda is anything acidic, I think it's tough. Hey, that's not why I live there's definitely benefits from caffeine too. There's definitely, you know, having black coffee definitely has benefits as well. The best thing to do is taking a straw and sipping it so it goes right to the back of your mouth. You're not going to do that with a hot cup of coffee though. But that ideally would be the best way to drink your coffee, which is like cold coffee sometimes is in a way more preferable, preferable, preferable, but because of that, you're able to take a straw and kind of, you know, said the less contact with it. A little tongue tie there, man. And you got a tongue tie that was right. It's only fitting. It happens. You took it right out of my mouth and said you took it right out of my mouth. We're just going on puns here, so I think all that stuff is you just got to look at I think duration. Are we going to have coffee? Yeah, we're going to as a society. We're going to have juices and coke like sure. Hopefully, like I said, you're making more of a healthier choice when it comes to those beverages. If you're having, for example, tea, hope you're having, you know, iced tea without sugar or at least amount of sugar as possible, because now not only you're having an acidic beverage, you're having one that has sugars, you're adding like a double lambie to it. At the end of the day, I think it just comes down to duration. You know, if you're going to have coffee, try and finish your coffee with an unreasonable time frame. You don't want to sip on it. You don't want to keep that mouth acidic the entire time. Same thing. Let's say if you have a child and you want to give them juice or milk, give them six four to six ounces of milk or juice at meal time. And don't mix it with water. I think one of the biggest things that people will do is they'll mix things, right? They'll take this much juice and they'll mix it with like this much water. Like, oh, I'm giving my kid like, you know, less, you know, it's not as sweet. Well, it's not as sweet because you diluted it, but guess what you didn't change the amount of juice, the amount of sugar concentration. It's still the same. The only thing you did it, the only thing you did is you added more water so you've increased the volume. So it's take longer time to finish the same concentration of sugar, which is why I will tell parents if you're going to want to give them something, give it to them straight like a shot. Let them go at it for like breakfast, lunch or dinner. And then throughout the day, let them sip on, you know, on water. Well, I guess that's how you could work if you just diluted it enough that the child just can't consume the entire volume, right? Then maybe I haven't tried this one yet, but I will report back to you once I give that a go. You know, the other question, you mentioned black coffee and that is my preferred method. But the issue with staining of teeth, right? That's another one. So what are your thoughts about? So, you know, one of the ways to kind of fix that is, of course, teeth whitening. There are some mixed messages out there and people have different feelings about it. So where are you on that? And is there a right way to do it? Is that something that you do? Yeah. So if you're going to have coffee, the one thing I'll say is don't brush your teeth right afterwards. I just want to make that very clear. A lot of people drink coffee or sick beverages and they go, I'm going to brush my teeth. Now what you're taking is you're taking the acidic component of that and now you're rubbing it all against your teeth. Because guess what? It still takes 20 minutes for the pH to go back up. So what you want to do is rinse it out with some water, drink some water, wait 20 minutes and then brush your teeth. That will make sure that that stain doesn't penetrate into deeper. You're not abrasive, having abrasive effects of your teeth and eroding some of that enamel, which can happen a little bit quicker because the acid is still present. So you know, that's the big thing I just want, you know, your listeners to take away with this. Hey, you're going to have good things as part of life, try and be mindful and let the science guide you in terms of, hey, let me wait 20 minutes until I brush my teeth. I've got to come down to share. Brush my teeth in the morning. Should I eat breakfast first? Right? That's the other hot topic. Take your pick. But if you're going to eat breakfast first, just don't brush your teeth until 20 minutes later. When it comes to the whitening kits, yeah, I've definitely had Zoom, which is like in office whitening done before, there's, you know, some of the kind of just comes down to what your flavor is and what you like. Some people love the crest whitening products. They work pretty well. If you get them from over the over the counter, they're cheaper, they actually do a pretty good job. The only problem with the crest whitening strips is they're not made to conform to your gums. So they'll also go up to your gums and they're not going to just solely stick to your teeth. You want the whitening to be on the tooth exclusively. If it gets onto the gums, it will burn and irritate your gums, depending on the level of carbon-meat proxide that's in the agent. So if it's like 5%, 10%, the harder concentration, the more cost it can feel to the gums. No right or wrong way just comes down to what method you prefer in terms of cost wise. But I do feel that the in office zooms are the best. They last the longest. It only takes an hour, so it's usually it's broken up at 20-minute sessions. And then once you're all done, you can stop after the first 20 minutes if your teeth are too sensitive. You can go onto the second set if you're doing great and if you make it all the way to the third set, you'll notice an instant, instant change and coloration of the teeth. And it'll last you longer. You can last for about eight months with good care. The problem is over time, if you're just a heavy coffee drinker, tea drinker, acidic drinker, it will wear down and you'll get discoloration again. But I think in terms of the most bank for your buck, I do think it's the zoom. But are you, so once you whiten, right, you're kind of losing that shade of enamel, right? So that's why it's getting more like translucent or white. So if you drink coffee or wine, you know, on top of that, are you causing more staining actually in the end? You can. A lot of the times what these whitenings do is they take the enamel and pour and they open up the pours more so internally. So this is what kind of gets this acid-based system that you're using to penetrate that part of the enamel, different than the acid that a wine has. So if you finish your whitening and you go and do wine right off the bat, yeah, you might get a little bit more kind of that goes into the pours and things of that nature. But over time, as soon as you're done with this, your dentist might put a little bit of fluoride garnish on there, help to protect the barrier of the tooth a little bit more. And so naturally speaking, you're not going to get that level of penetration like you're getting with the whitening because this is a whole system that you're using a blue light that hardens the tooth as well. So you're putting an acid primer on there, you're edging the tooth, you're priming it, you're putting this infiltrant that goes and opens the pours. And now you're curing it with a blue light that really hardens the tissue now again. And that hardening has got one prevents these wine stains to speak from really penetrating that area. So you're not going to get too, too much of that at all. Gotcha. Yeah, I've used the Opalescence toothpaste once in a blue moon now, maybe like two days in a row and that seems to do it without the cold water hitting you and really be sensitive there. Cool. Well, man, we covered a lot here. I just really want to ask you just so the listener is going to understand, too. What's your current practice like? I know you're traveling a lot, but you're also seeing patients. So what's kind of the breakdown of what you're doing? Yeah, so it's fun. It's like a three-headed monster. I just got back at academia, actually. So I am in private practice, not my own practice, but I work out in the Philadelphia suburbs and I'm there one week, a couple days a week. The following week I am on the road. I'm on the Chief Dental Officer of Oak Dental Partners, which is like an up-and-coming DSO, which stands for a dental service organization. So if you think about like your Aspan and your specifics of the world, we're just a smaller scale. Our philosophy is also a little bit different in terms of way we want to go about certain things, but we're essentially a dental service organization. And then I'm also at Penn and I'm working with the residents, which I kind of really missed that. It took a little hiatus in May. So not too long of a hiatus, but I run their World Conscious sedation program and help with the laser usage, with the residents and the exposure to that stuff. And it's fun. It's just really neat. It keeps me on my toes. I like to see kind of where the private practice world is transitioning. It's kind of neat to see where medicine's going out in the real world, but it's also good to have that foot in the door with academia and just kind of see the academic and the science behind where things are going. And then to be able to shape young minds that are coming out and for them to become their own superheroes, it's kind of neat. So it's a little trifecta and it keeps me on my toes. It's a lot of fun. Nice. Can I suggest a fourth idea here? You can maybe give some trust to Tom Brady. He could use a little blue 40 play action, maybe a yellow five as well. It just, it makes me so happy he's lost four or five and that the alkaline diets crap, which Lane Norton also tweeted, so I just had to talk to Tom Brady over here. So yeah, you might need a new trainer or diet coach. So deep, that's there. That's your fourth gift right there. I'm ready. Like you're nice. Blue 40! Exactly. I got you. You can use it. So this is going to be a release on Halloween. So it's going to get into the hands of a lot of people out there who may have kids. And so can you just give us like three of your pearls that parents should watch out for or take action with their children when it comes to Halloween and the candy? Yeah. That's great. That's a good question. I just say the one that comes to my mind is if it's sticky, it's icky. So try and avoid things that are super sticky for your teeth, right? Simple, easy and fun. It's something that your kids can kind of recite with you. If it's sticky, it's icky. Two, moderation, let, I mean, let kids be kids, I think we all grew up that way. So candy's part of the process, part of the fun, it's part of just enjoying life was keeping the moderation. Don't let your kid go in there and just like empty out half of their candy that night. So keep an eye on things, read the ingredients so to speak, and just if you're clean about that, you care about that stuff, I should be very vigilant and mindful of what they're eating. And then the last thing is this at the time, you know, I love you guys, but part of my job in healthcare is I don't want you to keep coming back to me with cavities. Halloween is what keeps my doors open three or four months down the road because it takes time for these cavities to kind of kind of matriculate and mature in advance. Brush your kids teeth and floss, you know, important, super, super important, especially night time. So that night time brushing like a reiterated, it's the most important time, but especially on Halloween night, make sure moderation after moderation is brushing floss and use a mouthwash to kind of keep things at bay, or at best as you can at bay. Perfect, perfect, awesome man. Well, anything, anything that's coming up for you, like what's next? I know you just, you know, you're back at Penn, you're, you're pretty busy, but is there anything that you're looking forward to within the next, you know, a couple of months or anything? Oh, there's a question. Nothing really. I mean, let me set that point right now with my boys. It's been a lot of fun with them. They're five and three and they're kind of understanding and, you know, it's kind of more playful. So spending more time with them is great. Maybe a vacation or so coming up in the near future just to kind of get away looking for a babysitter, actually, that's what we have to do. It's been hard picking to find a babysitter or a good babysitter. So I'm really looking forward to getting a babysitter just so, uh, can enjoy life a little bit more, um, outside, outside of the kids as well, for sure, with the misses. Well, I'm not there yet, but all you could probably understand that a little bit at least you definitely will in the, in the upcoming years. Cool, man. So where do the listeners find you? Tell them that your social media, um, any other websites, anything else they should check out. Yeah, so, um, Instagram is kind of only kind of social media platform I really use besides Facebook, but it's at the superhero dentist on Instagram, deep shot on Facebook. And then I'm pretty good about, like, responding to email. So, um, doctor deep eye shot at gmail.com, um, is my email. So any one of those three is totally fine. The best way to get, get, get hold of me. Perfect. And speaking of superheroes, what are you going to be for Halloween? Spider-Man. We're doing a Spidey family. So the boy is, uh, one of these Spider-Man, uh, Dwayne, um, I watch, she's going to be the white Spider-Man and she's, I've been girl in the TV show and then I'm just like, black Spider-Man. You guys got it. You guys are going to take the class and we're, uh, picture, everyone's pointing at each other. And that's exactly it. Yes, it's me skin, skin tight, like nylon suit. So we'll see how that holds up in, like, three degree weather until it all gets wet. That's awesome. Well, deep, this has been incredibly informative, man. I've learned a lot and honestly, I've got another hundred questions for you, but just for the sake of time today and, um, I know you've got a big travel day tomorrow. So we'll keep it brief and maybe we'll do a part two in the future. Uh, but thank you so much for coming on, man. I've learned a lot and I really appreciate you. And before we let you go and ask you this last question, you talked a little bit about how we have to kind of bridge the gap between medicine and dentistry and, you know, pediatrics and pediatrics and dentistry. And so, you know, the question that we like to ask everybody, because again, dentistry is a part of health, oral health. We talked a lot about that is, you know, how do we, how do we add the health back to health care? Yeah. I love that question, actually. Well, I have a lot of answers to this, but I think if there are, if there's two things I could share really quickly, one, I think is connection over correction. I think as healthcare providers are very quick to correct, uh, I think I've come from a sense of ego. We went through school. We put all this work and time into mastering our craft. And so we just want to give our knowledge back, but I think you have to realize that every situation is different. If you really, really want to make an impact on somebody, you got to learn to connect with them before you make those corrections in their lives, to really understand where they're coming from and understand what fasts out of their life truly is worth changing and what just they may not be ready for it, at least for now. And I think once you get, once you build that connection, the correction will come because they're going to start to view, you know, because you're coming across more empathetic and genuine. And I think those, that's the best way I found to make change in my guests and my patients that I've served. Uh, and the last thing I think I saw this, uh, I was actually a Tim Tibo talk and I loved it because he talks about success and significance. And I think initially often our careers were so worried about being successful, but if you think of the word, you know, successful in medicine, it can become a very egocentric word. It's about your success and how you're doing and how you're growing, but the moment you shift that success into significance, now you have an impact on people that you're serving. And I think the one big thing in terms of bridging medicine and dentistry is how can we become more significant providers where we're more mindful of, of what our patients need that's best for their health and sure what, what, what, what we're doing is important and it drives our success. We also want to be significant in terms of being mindful and fostering that connection with them so that we can, you know, look at healthcare as a whole and that patient's healthcare as a whole rather than just the component that is a tribute to what we do. Cool. Thanks for that. It's perfect. It's important topic. Absolutely. Thanks, guys, for having me. All right. Well, there you have it. We really hope that this episode provided a lot of knowledge in terms of a topic that's not really talked about much and that we often take for granted, you know, as we look towards health span and lifespan when we reach 70, 80, 90 years old, the things that we're going to want to enjoy is communication with other people and, you know, we need to make sure our mouths and teeth are healthy enough to do that, that we don't have to require dentures, right? Even when it comes to eating food. So small things that you can do on a daily basis will definitely go a long way when it comes to older age. Now if you are going to go trick or treating tonight, definitely want to wish you all a very safe and healthy, fun activity tonight. Definitely take those tips that Dr. Shaw was talking about and make sure that we can teach our kids that, hey, it's important to have fun, but that there has to be balance. If you enjoyed this episode, please go ahead and share it with other parents, other students, other people who might be even interested in dentistry. And again, as our medical disclaimer, everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No physician, patient, place should be formed and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific cultural issues. Happy Halloween.