#166 - Patricia Corby, D.D.S.: Importance of oral health, best hygiene practices, and the relationship between poor oral health and systemic disease
Dr. Patricia Corby, Associate Professor of Oral Medicine, discusses the critical link between oral health and systemic diseases. She provides actionable insights on optimal oral hygiene, including flossing, brushing, fluoride use, and tailored care for specific populations like cancer patients, to preserve overall health and longevity.
Deep Dive Analysis
18 Topic Outline
Introduction to Oral Health and Longevity
Dr. Patricia Corby's Background and Research Focus
Tooth Anatomy: Crown, Root, Enamel, Dentin, and Pulp
Function and Types of Teeth
Oral Cavity Environment and Saliva's Role
Oral Microbiome, Dysbiosis, and Flossing Research
Progression of Periodontal Disease and Caries
The Role of Sugar in Tooth Decay
Historical Oral Hygiene and Modern Practices
Importance of Fluoride in Toothpaste
Oral Health Challenges for Cancer Patients
Systemic Links: Inflammation, Cardiovascular Disease, Alzheimer's, and COVID-19
Managing Dry Mouth and Its Consequences
Teeth Whitening and Mercury Fillings
Fluoride Use and Children's Dental Care
Efficacy of Dental Products: Floss, Water Picks, Electric Toothbrushes
Recommended Daily Oral Care Regimen
Personalized Dental Care and Disease Progression
8 Key Concepts
Enamel
The hardest surface in the human body, a mineralized outer layer that protects the underlying tooth structures from damage and decay.
Dentin
A hypersensitive layer beneath the enamel, acting as a cushion and containing tubules that transmit sensations, making it painful when exposed to decay.
Pulp
The vital core of the tooth, containing nerves and blood vessels, responsible for the tooth's vitality, providing an early warning system for infection, and connecting to the body's immune response.
Periodontum
The complex system of tissues surrounding and supporting the teeth, including the gums, periodontal ligaments, and the alveolar bone.
Oral Microbiome Dysbiosis
A shift in the balance of bacteria in the mouth, where harmful species overgrow and suppress beneficial ones, leading to oral diseases like gingivitis and periodontitis.
Gingivitis
The initial, reversible stage of periodontal disease characterized by inflammation and bleeding of the gums, primarily caused by plaque accumulation due to inadequate oral hygiene.
Periodontal Pocket
A space that forms between the gum and the tooth when the periodontal ligament detaches and bone loss occurs, creating a perfect reservoir for anaerobic bacteria to thrive and cause further inflammation.
Biofilm
A sticky matrix formed by bacteria on tooth surfaces, allowing them to attach, grow, and metabolize sugars to produce acids that cause decay and inflammation.
24 Questions Answered
The pulp, with its nerves and blood vessels, is the vital part of the tooth, preserving blood flow and keeping the tooth alive, serving as an early warning system for infection and connecting to the body's immune response.
Incisors cut food, canines tear, premolars begin breaking down food, and molars are for chewing and triturating food, initiating the digestive process.
Saliva acts as a bio-fluid that constantly washes and flushes the mouth, maintaining homeostasis of the oral microbiome and preventing dysbiosis.
Not flossing can lead to elevated gingival inflammation and a rapid increase in abundance of periodontopathogenic bacteria, even in young populations.
Cariogenic bacteria metabolize sugar as an energy source, multiply, and secrete acids that destroy tooth enamel, leading to decay.
No, both are equally important; toothpaste is the main source of fluoride, which protects and hardens enamel against cavities, while brushing mechanically disrupts biofilm.
Yes, it is often recommended to floss after an initial brush (or after a final brush) to remove bacteria and food particles dislodged from between teeth, preventing them from recolonizing other areas.
Yes, cancer patients, especially those undergoing radiation to the head and neck, often experience severe dry mouth and immune compromise, leading to oral dysbiosis, fungal infections, and increased local and potentially systemic inflammation.
Initial enamel decay can sometimes be reversed with fluoride; decay reaching the dentin causes pain and requires restoration; decay hitting the pulp necessitates a root canal to remove the infected pulp and preserve the tooth's function.
There is no scientific evidence or research to support claims that root canals cause systemic diseases like cancer or Alzheimer's; such theories are considered unsubstantiated.
While strong associations exist between periodontal disease and conditions like diabetes, cardiovascular disease, and Alzheimer's, the causal link is still being investigated, with inflammation being a primary hypothesis for the connection.
The oral cavity has high expression of ACE2 receptors, which COVID-19 binds to, and poor oral hygiene in hospitalized COVID-19 patients (due to masks, dry mouth, lack of care) may contribute to pulmonary infections.
Dry mouth can be caused by systemic conditions, medications (e.g., anticholinergics), or radiation treatment; it can be managed by stimulating salivary glands with sugarless gum/lozenges and maintaining constant hydration.
Tooth color is partly genetic but highly environmentally determined; whitening uses bleach and can be detrimental in excess or if done improperly, causing mineral loss and gum harm.
If mercury fillings are highly functioning with no underlying decay, there is no proven harm from them, and removal is generally not recommended.
Not all toothpaste contains the recommended amount of fluoride (1,000-1,500 ppm), and fluoride in drinking water varies by region and country.
Caries in baby teeth can be very painful and difficult to treat in young children, often requiring hospital sedation for treatment or extraction, or the use of specific fluoride applications that can darken the tooth temporarily to arrest decay and preserve function until exfoliation.
There is no clinical research evidence supporting oil pulling; tongue scraping is similar to brushing the tongue, but brushing with toothpaste is preferred for its antibacterial properties.
The type of floss doesn't matter as much as consistent use; the best floss is the one a person is most comfortable using, as the goal is mechanical disruption of biofilm.
The literature suggests that about half of the population flosses, but most do not floss every day.
A water pick is a beneficial addition for flushing toxins, but it is not a substitute for traditional flossing, which mechanically disrupts biofilm between teeth.
Both sonic and mechanical electric toothbrushes are efficacious; the choice depends on personal comfort and preference, as both effectively clean the mouth.
For average risk individuals, every six months is generally recommended; high-risk individuals (e.g., those with systemic health issues like diabetes) may benefit from more frequent visits, such as three times a year.
Systemic health plays a significant role; individuals with systemic issues like diabetes or other infections are more susceptible to rapid periodontal disease progression due to exacerbated inflammation.
31 Actionable Insights
1. Daily Floss for Oral Health
Flossing daily is crucial for preventing gingivitis and periodontal disease by removing anaerobic bacteria hiding between teeth, as evidenced by studies showing rapid inflammation and bacterial overgrowth when flossing stops.
2. Brush Teeth with Fluoride
Regularly brush teeth with fluoride toothpaste (1000-1500 ppm, ideally ADA-endorsed) to effectively remove biofilm, stimulate gums, and protect against cavities by hardening enamel.
3. Brush Thoroughly Before Bed
Brush teeth thoroughly at night before bed, and avoid giving children baby bottles overnight, as reduced saliva during sleep creates an ideal environment for bacterial growth and severe decay.
4. Brush First Thing Morning
Brush teeth immediately upon waking to remove biofilm that accumulates overnight due to reduced saliva flow and a closed, oxygen-deprived mouth environment.
5. Floss After Initial Brush
Floss after an initial brush, then rinse well or brush again, to remove dislodged bacteria and prevent them from recolonizing other areas of the mouth.
6. Brush Your Tongue
Incorporate tongue brushing into your routine, using a separate soft-bristled brush, to remove bacteria that accumulate on its surface and prevent colonization of other areas.
7. Regular Dental Cleanings
Get professional dental cleanings and check-ups every six months as a primary preventative measure to identify and address cavities and periodontal disease early.
8. Address Decay Early
Seek dental care for decay as soon as possible to prevent its progression to the pulp, which often necessitates a painful root canal procedure.
9. Chew Food Thoroughly
Chew food thoroughly to initiate the digestive process in the mouth, allowing saliva to mix with food and maximize nutrient extraction.
10. Minimize Sugar Intake
Reduce consumption of all types of sugar (glucose, fructose, sucrose, starch) as cavity-causing bacteria metabolize them to produce acids that destroy enamel.
11. Stay Hydrated, Stimulate Saliva
Sip water throughout the day and use sugarless chewing gum or lozenges (xylitol-based preferred) to stimulate saliva flow and keep the mouth hydrated, avoiding any sugar content.
12. Choose Electric Toothbrush
Select an electric toothbrush (e.g., Oral-B or Sonicare) based on personal comfort and preference, as both mechanical and sonic types are efficacious in cleaning.
13. Clean Your Toothbrush
Rinse your toothbrush with warm water and soap after each use and allow it to dry, as this decontaminates it and prevents bacterial growth.
14. Avoid Daily Mouthwash
Refrain from using mouthwash daily as it indiscriminately kills both good and bad oral bacteria, potentially disrupting a healthy microbiome; use only for short periods when brushing is not possible.
15. Intensive Care for Vulnerable
Caregivers for individuals with disabilities or cognitive impairment should be educated and provide intensive preventive oral care, including regular brushing and fluoride application, as these populations are often neglected.
16. High-Risk Dental Cleanings
High-risk individuals (e.g., with systemic health issues like diabetes, or undergoing radiation) should consider more frequent professional dental cleanings (e.g., three times a year) and prescription-strength fluoride toothpaste nightly without rinsing.
17. Oral Hygiene During Illness
Prioritize and maintain excellent oral hygiene, including brushing and flossing, especially if hospitalized or dealing with infectious diseases like COVID, to prevent systemic complications like pulmonary infections.
18. Address Dry Mouth Causes
If experiencing dry mouth, consider medication side effects and consult a doctor, as a lack of saliva can lead to a shift in the oral microbiome and opportunistic infections.
19. Minimize Teeth Discoloration
Reduce consumption of substances known to discolor teeth, such as black tea and red wine, to lessen the need for whitening procedures.
20. Cautious Teeth Whitening
If whitening teeth, consult a dentist to ensure you are a suitable candidate, follow correct timelines, and use FDA-approved products to avoid potential demineralization and gum harm from excessive use.
21. Prefer Breast Milk
Choose breast milk over formula with added sugar for infants to significantly reduce the risk of early childhood dental decay.
22. Fluoride for Children
Ensure children are exposed to fluoride through brushing with very small amounts of fluoride toothpaste (after their first tooth appears) or consider fluoride drops/varnish every six months as additional prevention.
23. Preserve Natural Teeth
Prioritize preserving natural teeth over extraction and implants, as natural teeth provide superior function and implants, being metal, come with their own potential issues.
24. Microscope-Guided Root Canals
If a root canal is necessary, seek an endodontist who performs the procedure under a microscope for a more precise, aseptic, and effective outcome, reducing the risk of complications.
25. Toothpicks Not Substitute
Using toothpicks is benign and can stimulate gums, but it is not a substitute for proper flossing, which cleans around the entire tooth surface.
26. Keep Mercury Fillings
Do not remove well-functioning mercury fillings if there is no decay underneath, as there is no proven harm from them, and replacement can sometimes lead to complications.
27. Disregard Root Canal Pseudoscience
Disregard unsubstantiated claims linking root canals to systemic diseases like cancer or Alzheimer’s, as there is no scientific evidence to support such associations.
28. Oral-Systemic Health Link
Understand that oral health is intrinsically linked to systemic health, and poor oral hygiene can exacerbate overall inflammation and disease progression in the body.
29. Own Oral Health Responsibility
Recognize that oral health is often neglected by medical doctors, making personal responsibility and proactive care crucial for overall well-being.
30. Mask-Wearing & Oral Health
Be aware that prolonged mask-wearing can contribute to dry mouth, reinforcing the need for diligent oral hygiene to counteract potential negative effects.
31. Mechanically Disrupt Biofilm
Understand that the primary goal of brushing and flossing is the mechanical disruption of the biofilm/plaque matrix to prevent its accumulation and subsequent harm.
7 Key Quotes
If your mouth is not in good health, I think your quality of life is quite compromised.
Peter Attia
The heart of the tooth is actually the pulp. You see a lot of nerves and they all connect to the body. That's why you have a lot of tooth pain is one of the most detrimental types of pains that we have.
Patricia Corby
Every single surface of your mouth, you find different bacteria. So your tongue has a different colonization from your buckle, from the floor of mouth, from the throat.
Patricia Corby
It's hard to say in a nice way, but I think it's a total nonsense. It's been for, it's a hundred years ago that all those focal theories that they said that would exist, there is zero evidence, there is no research, there is nothing that can prove that this is true.
Patricia Corby
If you have COVID, you have to have excellent [oral hygiene]... No one is doing that.
Patricia Corby
The thing that I just like with mouthwash is that it kills every single, it just wipes out all your microbiome, including the good ones, because they're all antibacterial.
Patricia Corby
I still think that flossing is even more important than brushing because it's all the research that I did. People can stop brushing and you recover health easily. People stop flossing, it's the gingivitis. Inflammation comes so quick.
Patricia Corby
2 Protocols
Ideal Daily Oral Care Regimen
Patricia Corby- Brush teeth upon waking up to remove overnight biofilm.
- Brush teeth after eating (e.g., after breakfast, after dinner).
- Floss between teeth after dinner (or after the last meal of the day).
- Brush teeth again after flossing (or rinse mouth well).
- Brush the tongue using a soft-bristled toothbrush.
- Rinse toothbrush with warm water and soap, then dry it after each use.
- Use fluoride toothpaste (1,000-1,500 ppm).
- Stay hydrated by sipping water throughout the day.
- Consider xylitol-based gum or lozenges after meals if brushing is not possible.
Intense Oral Care Program for Head and Neck Cancer Patients Undergoing Radiation (Dr. Corby's Study)
Patricia Corby- Perform mechanical debridement, including subgingival cleaning, of the periodontium.
- Clean all oral surfaces: oral mucosa, gums, tongue, and teeth.
- Provide weekly dental hygienist visits to reinforce brushing and flossing techniques.
- Apply highly concentrated fluoride (e.g., Prevident) once every night, brushing it on and not rinsing, for high-risk caries patients.