Lifestyle Dentistry - YLAM230009

SPEAKER A This programme presents ways to optimise health and wellbeing when considering lifestyle changes. Please consult with your health care provider to ensure they are suitable for you. SPEAKER B Hello and welcome. I'm Kaysie Vokurka. Oral Health. What does this involve? Brushing teeth, flossing, avoiding sugar. Is that all the care that's needed each day? Stay with us to find out more. SPEAKER A This is your lifestyle as medicine, a production of 3ABN Australia television. SPEAKER B It's so great you have joined us on this programme where we explore ways that you can shape your lifestyle as medicine. Today, I'm delighted to have Berenice Cheng with us as our special guest. Berenice is a dentist and public health practitioner and she is here to talk with us about the topic of lifestyle dentistry. Welcome to the programme, Berenice. SPEAKER C Thank you for having me, Kaysie. SPEAKER B You're very welcome. We are so excited that you have been able to join us for this programme. And now, Berenice, you've been a dentist for over a decade now. From your experience, what are you most interested in and passionate about in your work? SPEAKER C That's a great question, Kaysie, and yes, it has been over ten years since I started practising as a dentist. I think what really excites me is seeing families come through and as I see a positive dental experience, maybe, that a parent has, and how they pass that on to their children and how they build great habits for their future. It's really rewarding to see families come together and enjoy the benefits of good oral health. SPEAKER B Mmm, nice. So I guess by the time you've been in the field for that long, you do see the progression coming through as the children grow up and are enjoying the results of your work with them. SPEAKER C Yes. And I guess when I first started dentistry, I always used to think that it was just about the teeth. But the more that I practise and the more that I understand about this field, I realised that there are so many things about the way that we live, what we eat, the types of medications that we're taking, even such that our oral health is really just one part of our systemic or our overall health. And so I'm excited about the concept that what we do in our mouths and what we put into our mouths could benefit our overall health and vice versa. SPEAKER B That's very interesting. And that's certainly how it is with all different aspects of lifestyle, isn't it? That one area is all interconnected with the other and you, you really gotta look at the whole picture, don't you? SPEAKER C That's it. And, you know, even like what you were mentioning in the introduction, a lot of people think dental health means, okay, I've got to go to the dentist and get a checklist of, I don't have decay, I don't have gum disease. But there is so much to that. And dental health and longevity really relies on a balance of, I would say, four main factors. And so in my clinical practise, in a general setting, the four main things that we would see are, yes, obviously, decay, gum disease, but also now, more, more, we're starting to focus on things like mal occlusion, which means the jaw alignment, the teeth alignment, and also the wear of teeth. So that's the technical name for that is bruxism, or we might refer to it as grinding. And so, actually, we realised that between when you get your teeth as a six month old, to when you maybe lose your teeth in your eighties and nineties, the health of your mouth really relies on a balance between all four factors, because you need to have good tooth alignment to be able to clean them well. And also so that the forces that are being applied on the teeth as you eat and talk and chew and maybe even grind a little bit as well, are distributed evenly across your teeth. So it's important to consider all these factors. And as we think about that, it's a puzzle to me that tells me that lifestyle is a much bigger part of oral health than just the habits that we instil in our kids to brush and floss and to avoid sugar and soft drinks every day. SPEAKER B Yeah. So tell us a little bit more about, like, some of the most common things you see. I believe that would be, like, dental decay. Is that right? SPEAKER C Yes. I would agree with what you said, Kaysie, that probably the two most common diseases that we see every day in our dental practise would be dental decay. Or we call that caries and gum disease and we call that periodontitis. But the more that I practised, I realised that there are certain things that puzzled me. Like when I would see twins that have exactly the same genetics, and presumably they're eating the same thing in the same house, but one always gets more decay than the other. And that always made me wonder, is there another piece to the puzzle that I'm not seeing here? And our most contemporary understanding of dental decay, for example, is that it's a balance of four things. It's a balance of the bacteria that you have in your mouth. So whether they're good bacteria or decay causing bacteria, it's the quality of your saliva, specifically the ph of your saliva the strength of the layers in your tooth and how resilient they are from decay entering and also time. That explains why someone that may brush more and eat less sugar may unfortunately still get more decay than someone that's just eating junk food the whole day. There are certain factors that we can control and some that are out of our control. But besides the sugar and the soft drink and the acid, there are a couple of factors I thought it might be interesting for us to consider today. So the first I thought that we might be able to discuss is that of micronutrients. So, specifically minerals and vitamins. And a lot of our nutritional advice that we focus on talks about macronutrients like sugars, carbohydrates, fats, proteins. But the development and growth of our teeth is equally influenced by some of these things, like vitamin A, for example. And vitamin A is really important in the differentiation of a type of cell that forms our teeth. Such that when you have a deficiency in that, you actually get layers of teeth that are weaker. And your gums can also be red and ulcerated and bleeding. Vitamin D, we also know, is really good for bone development because it helps with collagen. But collagen is also a really important part of our teeth. And so again, if you have a deficiency in vitamin D, it makes for weaker teeth that are more prone to having bacteria enter and causing decay. When you have a vitamin D deficiency, it also means that your teeth come out later or they erupt into the mouth in a delayed fashion. And that can increase the risk of you having null occlusion or crowding. And that leads to other issues later on. Vitamin C, as we know, is really good for the wound healing and things like that. But it's a really important thing in gum health. Again, it has to do with collagen. It also inhibits some of the bacteria that form decay. But when you have a vitamin C deficiency, you're more likely to have poor gum healing, you're more likely to have gum issues, loose teeth, and you can have irregular tooth structure as well. And the same goes for things like iodine. And we don't really think about iodine, but iodine is really important in the sequence of growth and maturation of our teeth. And so if you have a deficiency in iodine at very specific points of development, it can mean that your face structure, your craniofacial structure, doesn't develop optimally, and that can also lead to malocclusion or crowding. SPEAKER B So can I just ask, are these nutrients especially important? Obviously, when you're a child, are you growing up in those development years or is this something which could be an issue as an adult? And if so, if you've got a deficiency in an adult, if you remedy that, is that going to result in some changes? SPEAKER C That's a great question. And I think obviously the most important is when our teeth and our jaw structures are forming. And so prenatal and postnatal is where most of our focus is for these hormones. Unfortunately, with teeth, once they're formed, they're not dynamic structures, largely speaking. And so as an adult, if you were to start taking iodine supplements, for example, you wouldn't be able to change the shape of your jaw and the development of your craniofacial skeleton. But it is important for us to consider this in the context of how do we support mothers that are pregnant and also young children in their diet as well. But there are some things, some nuggets for adults coming on later on in our presentation today. SPEAKER B Sounds good. SPEAKER C Yeah. So again, you know, I think when you go to the dentist, you're not expecting them to ask the new questions about your iron levels or your zinc levels or your folic acid levels or even your vitamin k levels. But the list of minerals and vitamins that we had up there is certainly exhaustive and expensive. And the principle, I think, to take away from it is to realise that, number one, there are lots of micronutrients that we may not be aware of that benefit our teeth and gums. And also that you don't necessarily need to then go to the grocery store and start looking for things with niacin and vitamin a and zinc. But to remember that lots of these micronutrients, the best source of them are in fresh produce, so in fruit and vegetables, rather than in a meat and carbohydrate heavy diet. And so the principles of healthy living, as I'm sure you've discussed in other presentations in this series, certainly apply to good oral health as well. SPEAKER B That's really interesting. I was curious about that aspect because I was wondering, should we be thinking about some supplements for some of these, or should we just go for all the plant foods that are rich in nutrients and vitamins and minerals and just make sure the diet is full of that? SPEAKER C That's it. Yeah, I think a balance of both would be great. Obviously, mothers that are in their prenatal or postnatal period may benefit supplements, but definitely for the rest of us, maintaining good nutrition should be sufficient for the purposes of oral health in terms of these vitamins and minerals. But there are other things I realised in my research that actually impact the way that decay and gum disease develop. And besides minerals and vitamins, things like fibre are really important too. So the bacteria in our mouth, they metabolise what we eat, either as a fast metabolizer or a slow metabolizer. So if you put a tablespoon of honey or something, that's a really simple sugar into your mouth. The types of bacteria that we call fast metabolizers just gobble that stuff up and they spit out acid, which then goes on to erode the layers of your teeth and lead to decay. But if we have rich foods and fibre that have complex kind of sugars that need to break down, then that favours the balance of the bacteria in your mouth towards slow metabolizers. And they don't turn this into simple acid that sticks to your teeth and forms a hole, necessarily. They turn these into fatty acids, and then that can change the balance of what happens in your mouth and hopefully avoid decay as well. So that's something that an adult can be aware of, that, yes. While your teeth have formed in a certain way, and some of us may have stronger teeth than others, for whatever reason, you know, the types of sugars that you consume are important as well. And we want to remember that bacteria is not necessarily the enemy, because all of us have about 700 odd million types of bacteria in our mouth, and we just want diversity in that balance. We don't want all bad bacteria, and there's no such thing as all good bacteria either. So the more diverse we can make our bacteria, having those slow metabolizers, that will kind of balance out the fast metabolizers, the more healthy our mouth can be. So that means including vegetables, nuts, seeds, whole grains into our diet, so that our gut bacteria and our oral bacteria can be more complex. And the less easy it is for our oral bacteria to break down the carbohydrate immediately, the better for your teeth. SPEAKER B That's really interesting. SPEAKER C Yeah, it's kind of fascinating, isn't it? All these things that we think just belong to the grocery store. But really, I mean, it'd be great if every dentist was having this kind of discussion. The other thing that has come into focus more recently is the concept of probiotics. And prebiotics, again, to do with that balance of oral bacteria, the lactobacillus in fermented foods such as kimchi or miso, has this element of lactose and other sugars that converts it into lactic acid. That is a natural preservative that inhibits the growth of some of the bad bacteria that we talked about about. And it preserves enzymes and vitamins that help in digestion. And so with those fermented foods like miso or kimchi, it also aids in the synthesis of vitamin B and k. And those are things that are really good for balancing out that microbiome in your mouth. So foods that you might find probiotics and prebiotics in are things like garlic, onion, apple, oats, flaxseeds, wheat brands, seaweed. And those prebiotics, sorry, those are prebiotics and they encourage good bacteria to grow. And then we have the probiotics that also help to balance the good and bad bacteria. SPEAKER B That's so cool that you're sharing about that because I think there's been a huge focus on the microbiome in your gut in the last decade. But I don't think I've, I've rarely heard people talking about the microbiome in your mouth and how important that is for your teeth to stay. Well, so that's really interesting. What else do you have? You had a few other lifestyle points there. SPEAKER C That's it. So stress, sleep and exercise, even though we don't think about, we think about that improving mental performance, but they actually have an impact on bacterial biodiversity as well, in your mouth. So if you are stressed, if you're not sleeping enough, if you're not exercising enough, the balance of oral bacteria changes. And so much so that malnutrition, if you're not thinking about the types of things that you're putting into your body, is actually, strangely enough, associated with crowding in your teeth. There's a three times greater risk of you having crowding or malocclusion or incorrect bite relationship if you have malnutrition and if you are well nourished. So certainly something for us to ponder under. SPEAKER B Yeah, that's very interesting because I don't think we like, I don't think we normally think about that as being a connection between your teeth alignment. We think about your teeth health in terms of decay and your gums and that. But in terms of the alignment, I don't think there's a lot of thought. So tell me a little bit more about how that happens that you get, well, for example, the malalignment of your teeth. SPEAKER C Yes. So, you know, traditionally, our understanding of alignment is just, well, you're dealt the hand that you're dealt with. The teeth are a certain size. Your drawer is another size. And if they don't fit then off you go to the orthodontist. They'll probably tell you to take out a couple of teeth, stick some braces on, and two years later you've got a nice smile. But we've come to understand now, in dentistry, that tooth position is very much a function or a result of jaw and muscle structures in the head and neck. Meaning that when your jaw and your face is developing, it's a plastic structure that undergoes change in response to the demands of eating, of talking, of breathing and so forth. As our children develop, the muscles in their body are strengthened and they grow because they're being used and exercised. And in the same way, our jaw joints just here, our temporomandibular joints, need stimulation to grow in the right way. Most of our craniofacial, our head and neck structures are pretty much set by the time we're about age twelve. But the jaw here continues to develop until you're about 18, and then there are slight changes after that, but pretty minor. And what we know about jaw growth in the head and neck is that it's mainly appositional, which means that it increases in thickness, such that patients that grew up on farms or are eating a high fibre diet and a high produce diet have thicker and more robust jawbones. And we also know that babies that are breastfed and use their tongues to push the nipple up onto the roof of their mouth, that action actually helps to broaden, flatten the palate and make space for the upper teeth. So children that aren't breastfed are more likely to have a narrow and high or vaulted palate and the teeth just don't fit. So there are certain elements of lifestyle choices that mothers and young families might be making, and also the types of ways that we're using our jaws and types of foods that we're eating that can impact how they develop. SPEAKER B That's so interesting, especially about how the, like, it sounds like we need to eat more crunchy foods, you know, to give the jaw exercise when you're growing up, you know, all those carrots and things, apples, what have you, so that you're getting that strength building up, which. That's really fascinating that that is something so important, because I, I know when I was growing up, I didn't think about that affecting how my teeth aligned. I mean, I ate a lot of those foods, but it's just amazing that that is such a plastic part of the body in that development phase. SPEAKER C So, yes, I mean, definitely diet is one thing, but we, we also need to be aware that you know, if we all ate crunchy food, certainly that might put some excessive forces on our teeth, but certainly diet and the way that you use your jaw, the type of physical forces that the musculature has to support. So, not only in terms of chewing, but also exercise, heavy breathing that helps to open up the airways are really important. So on a slide, I've listed a couple of things there. Nasal breathing, rather than mouth breathing, is really important to help to broaden the top jaw and to make it wide so that all the teeth can fit and it flattens the palate. And in turn, it affects the way that your mandible develops. So basically, that means that our top jaw is meant to fit over our bottom jaw. So the broader the top jaw is, the wider the bottom jaw can be. When you have a wide enough bottom jaw, it means that you're avoiding issues later on, like sleep apnea. That's why we encourage all our kids to actually breathe through their nose rather than mouth breathing. Encourage deep breathing through things like exercise and physical activity, getting sources of fresh air, so that deep breathing is good for the lungs as well. We encourage mothers to breastfeed for at least up to one year and to avoid habits that might restrict the growth of the palate, like thumb sucking and pacifiers. And of course, being mindful of malnutrition as well, to avoid obesity, where the excess weight actually collapses on the airway. And that increases the risk of obstructive sleep apnea or an episodes that might trigger mouth breathing too. And one of the important things to consider is also that alcohol, or specifically alcohol, foetal alcohol syndrome, is where kids are born small for their gestational age and they have dysmorphic or poorly shaped faces, eyes, hearts and joints. And because of this, we see that as an example of the effects of that narrow jaw shape. They tend to breathe through their mouth in infancy, and they have high rates of jaw and null occlusion issues later on. SPEAKER B So that's so interesting. So if in the development phase of the child's life, whatever, they are experiencing some things which are probably going to be not good for their alignment and their jaw development, if you intervene and change their lifestyle at that point, so that the rest of their growth years are. Have a lot of things supporting their development, is that going to make a big difference? SPEAKER C Absolutely. So, you know, nowadays we're starting to screen kids for some of these airway breathing issues much earlier than we used to. It used to be traditionally, okay, you're getting to about age twelve to 14. Should we send you off to the orthodontist or not. But now we're starting to look at kids as young as three and saying, hey, mom, are they using a pacifier at home? What's the shape of their jaw? Are there things that we can do to enhance the sideways growth of the jaw so that we have enough space? How's nutrition going? What kind of things can we talk about here? So, yeah, definitely there is room for modulation in this realm. It's not just you're born with the jaw that you're born with. SPEAKER B That's so interesting. I mean, those things have a lot to do with, in some respects, the child's quality of life as they're growing up, you know, with the development job, but also whether or not they need braces, that's a big thing. Like this is like prevention strategies, so that you don't have to worry about that when you're a bit later on, when things are all set in concrete. So that's really, really helpful to know that there's things that you can do about it early on that can influence that. That's really empowering. SPEAKER C Absolutely. And I think, you know, some of us, especially as we get older, we realise, well, you know, this is just. I inherited mom's teeth. That's what I hear a lot, and there's nothing I can do it about. I'm just destined to this fate. But I think our understanding of dentistry is really expanding to understand lifestyle as a key factor. And one thing, Kaysie, that we saw a lot of in Covid was people coming into the dentist with cracked teeth because they were grinding more or clenching more to the stresses of, you know, all sorts of things during COVID And people started to realise, well, I really have a lot of stress that I carry in my jaws and in my neck, and that translates to something quantifiable, which means I crack a tooth, even though I've never had a feeling in my life and now I'm having to have teeth extracted because they're irreversibly cracked. And so, especially in this day and age, the issue of bruxism, or grinding, as we call it, is a significant one because of all the stress that we have in our lifestyle. And strangely enough, we see it a lot in young females that are otherwise very healthy, have great teeth, no decay and are quite slight and slender as well as, you know, other people that are chronic grinders that are really flattening their teeth out to tabletop flat kind of surfaces. And the reason being that we start to see this connection between the narrow vaulted pallets and narrow mounds that we talked about earlier, and this grinding too. So there was a team of researchers from Stanford that actually researched this syndrome called upper Airway resistance syndrome, which is common in those young, kind of young professional female age group that I mentioned. And they typically have that narrow vaulted palate for whatever reason. And it comes with the small jaw issues. They otherwise always have a chronic runny nose or stuffy nose. They have sinus pain, they have headaches, migraine tension headaches too. And the classic teeth grinding issue, which then means that a lot of them have to have their teeth out when one day, unexpectedly, a tooth cracks irreversibly. So, you know, some of this is genetics, some of this is also the kind of ways that we manage our stress and understand that, okay, my jaws have developed in this way. If I'm younger, I can do these things to help prevent that. But if I'm older and my jaws are more narrow and vaulted, and I do know that I'm predisposed to kind of putting stronger forces on my teeth, what kinds of things can I do? And the first thing I would ask us to consider is some of the medications that are known to be associated with heightened levels of grinding and bruxing. Some of us might be taking these medications for other reasons, things like antidepressants, antipsychotics and ADHD drugs. And these drugs are medically proven to increase your grinding and bruxing. And so when we think about the issues underlying these medications, it's important to realise that, you know, stress management is really important if you need support in this area. Dentists can now make these sleep appliances that help prevent wear of your teeth when you're unconsciously or subconsciously grinding throughout the night. But also being aware that maybe some of us might benefit from. From physiotherapy and massage in that area too, to try and relieve the stresses on our jaw musculature and in turn, our teeth. SPEAKER B That's so interesting. And, I mean, stress, obviously is something which can affect us in so many different ways. And to apply it in this context is very interesting. And, yeah, to realise how impacting that is on your teeth and how important it is for. For correcting that. Yeah. So thank you so much for sharing. From your wealth of knowledge, is there any other quick tip you can share, just as we close for today? SPEAKER C You know, I think we've touched on so many things, Kaysie, but I guess what I want our viewers to remember is that, yes, by all means, brush and floss your teeth, avoid those sugars. But there are definite things that we can do to improve our oral biome or our balance of bacteria. We talked about some of those micronutrients, probiotics, prebiotics and just the principles of healthy living that you might not even think have anything to do with your teeth, like deep breathing, exercise, stress management. Go a long way in making sure that you don't have to see people like me too often in a dental practise. And we can all benefit from the good oral health that we can enjoy. SPEAKER B Berenice, thank you so much for sharing with us. It's been absolutely fascinating. We've been talking with dentist Berenice Cheng about lifestyle dentistry. You know, someone once said, when you take care of your teeth, every word you speak, every smile you share becomes a testament to your health. Today, we've seen just how connected our dental health is with our overall well being. If you have questions or comments about this programme, contact us on [email protected]. Remember to shape your lifestyle as medicine. SPEAKER A You've been listening to Your Lifestyle as Medicine, a production of 3ABN Australia television.