EP74 Myths of the Oral Microbiome with Quip's Chief Dental Advisor Dr. Burhenne

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I AM GPH EP74 Myths of the Oral Microbiome with Quip's Chief Dental Advisor Dr. Burhenne
EP74 Myths of the Oral Microbiome with Quip's Chief Dental Advisor Dr. Burhenne

Alexandra Arriaga: Hello everyone and welcome to another episode of "I AM GPH." My name is Alexandra Arriaga and today, we are going to talk to Dr. Mark Burhenne. Dr. Mark is Quip's dental advisor and you may be familiar with the name, "Quip." They have ads all over the city of really sleek toothbrushes that aim to improve people's oral health. Dr. Mark attended the University of the Pacific Dugoni School of Dentistry in San Francisco. In his bio, he writes, "In my 30 years of practice as a dentist, I've seen a lot of misinformation and people who have fallen through the cracks due to our healthcare system's failure to understand the oral-body connection," which is where his focus on whole body care really started. He's passionate about getting people the right information they need to be healthy. He founded askthedentist.com in 2010 as an avenue to advance that passion. Ask the Dentist promotes oral health for total wellness and empowers people to understand how the mouth is a window into the health of the rest of the body. If you would like to learn more about how to have a healthier mouth and therefore, a healthier you, please stay tuned. Hello, Dr. Mark. How are you doing today?

Dr. Burhenne: I'm doing great, Alex. Thanks.

Alexandra Arriaga: Thank you for joining us via Skype. Where are you located right now?

Dr. Burhenne: Well, I'm in the Napa Valley in St. Helena, but I've been practicing in the Silicon Valley for over 30 years, but the Bay Area essentially.

Alexandra Arriaga: Yeah. Wow. Amazing. California. Can you tell us a little bit about your background and your intellectual trajectory? More specifically, what drew you from one interest area to the next?

Dr. Burhenne: Well, I started off being a dentist and I still am, but that description will ensue in the discussion here, but that's changed on how I look at dentistry. Essentially, my father was a very well known physician and he wanted me to be a physician. He was a pioneer in radiology and I kept pushing back and realizing I could never fill his shoes. I was in college taking History of Art classes and enjoying myself immensely. Then halfway through college realized that may not be the best way to make a living or maybe I was missing out on something. So I started taking some science classes and microbiology. Invertebrate zoology actually fascinated me. There's a lot of artistic beauty in that alone, in evolution. I started broadening my horizons in college. Then I took, and again, this is 35, almost 40 years ago, at the college I was at, there was this very archaic CPU machine down in the basement with big seven and a half inch floppy drives. It was a personality test linked to a career tool. I was shocked as I filled it out. I was very honest and answering the questions. When the number one hit came up, which was dentistry, I was shocked. It just never occurred to me that that would be something that I would be good at based on my personality and what I like to do and what I find interesting. From there, I just immersed myself into pre dental courses, became a dentist, was educated on the West Coast at the University of Pacific Dental School and then did a lot of continuing education and clinical CE groups and just never looked back. It kept getting broader and wider and then I got into sleep, and dentistry and sleep are related, connected in so many different ways. Then of course the oral microbiome came along. Unfortunately, it came a little later than the gut microbiome, which is still pretty new stuff. Dentistry is a fascinating field and it's still about to expand even more in terms of facial development and all these epigenetic factors on what's constricting our facial development and changing how we look and how we can breathe. So it's been a roller coaster ride. I wrote a book. I've just kind of dived into so many different areas and I have a website on oral health that I cofounded with my daughter. My daughter, when she came of age, a skilled millennial in social media and having worked at Google and Facebook and Twitter, she said, "Dad, all this information you keep telling me at the dinner table, we gotta get out to the masses." So we created askthedentist.com. We get 12 to 15 million unique hits a year on that. So it's been fun. A long time ago my dad told me that the role of a doctor was nothing else but to teach and that's without even knowing it at first, that's what I've been doing for such a long time with my patients, with readers and people on the website, readers of the book, and podcasts, and just getting the information out. So it's been very exciting, a lot of fun.

Alexandra Arriaga: Yeah. No, that's fascinating and so many different areas that you've tapped into. That's quite impressive. I want to ask you about Quip and I know that a lot of people are probably listening right now and they're thinking, "Wait, that sounds kind of familiar. I feel like I've seen advertisements for that around the city." What is Quip and how did you first hear about them?

Dr. Burhenne: Quip, it's an interesting name. To be honest with you, even though I was affiliated with the company in its earlier stages, I'm still not quite sure how they came up with that name. But of course, how do you come up with the name, "Twitter," and things like that. So it's a wonderful company. It's a startup based in New York. I think Simon, the CEO reached out to me and he had read my website and he realized that we both had the same idea and we were aligned in terms of how we thought about biofilm management, which is a fancy word for flossing and brushing. So he was fascinated by what I was saying. It was not necessarily what the profession of dentistry was saying to the letter. So we hit it off and we visited each other and then he hired me and we helped get the company off the ground. He reached out to me and I was flattered and excited to be part of it because he really had a unique way of reinventing the toothbrush, which I think he essentially did. Toothbrushes have been out for decades. Right? He came along and really... He's an industrial designer. Again, I've always been fascinated by industrial design, and how things look and feel, and how they function, and how they interact with humans in our lives. He basically took the notion that industrial design combined with behavioral reinforcement of good habits basically leads to better therapeutic results. The toothbrush hasn't changed in a long time. It needed a refresh and that's essentially what he did. So I was very, very happy with the design. He's done that now recently with the flosser, the flossing device. I would definitely check it out. It's a novel way of being able to keep floss nearby and clean and handy. So that's kind of how we got connected. It was through the website and he was on his journey of...He's English. One of the myths of dentistry is that the English have bad teeth. I didn't rib them about that, but he asked me, he said, "Listen, the Americans are obsessed with teeth, so this is where I'm going to start my toothbrush company. Why start it in England?" That's how we kind of got together. We both kind of had the same idea of what a toothbrush needed to be and if you've looked, I'm sure you've shopped for a toothbrush lately, it is overwhelming. Oh my goodness, the selection.

Alexandra Arriaga: It is so overwhelming. It wasn't until recently that I figured out that the bristles had different types of softness or harshness. I don't know if this is everyone. Maybe it's just me, but I had actually never noticed. Then I started noticing that some were soft, medium and I was like, "Wow. Okay." Then a friend of mine who actually is a dentist told me that the soft ones are the best ones.

Dr. Burhenne: That's correct.

Alexandra Arriaga: Okay.

Dr. Burhenne: But also, a lot of people don't realize that. I would say the majority of people just think a nylon bristle's a nylon bristle and it's not. There are high quality and low quality versions. There's a process called end rounding. If you think about it, the way the toothbrush is made, it's a nylon stick or handle. While it's soft, a machine comes in and drops in hundreds or thousands of bristles and that's important too, the count, the count of bristles and then to level that off to make it all nice and straight and flat, there's a machine that comes and cuts them. A freshly cut nylon fiber is quite sharp if you think about it. It's like the sharp ends of a cylinder. So then there's a machine that has to end round and polish and make those little nylon tips, hemispherical and smooth. That way, it doesn't abrade denton. The hardness of a nylon bristle is almost the same hardness of denton. You can literally wear your teeth away if you're using a cheap toothbrush or if you're using a worn toothbrush. That's another nice aspect of Quip. They automatically... Simon got it right away. You've got to replace your toothbrush. How do I get people to do that? People forget, they don't know how long it's been. So he has this reminder system where if you sign up for it, it's a subscription service of course. I subscribe to it, I just don't even think about it anymore. It's wonderful. I just get this little foil package in the mail. It's got my new toothbrush head in it and I just pop off the old one, throw it away and pop on the new one.

Alexandra Arriaga: What's actually the ideal time to have a toothbrush for?

Dr. Burhenne: Well, it depends. I think it depends on the quality of the nylon bristle. I think there's some toothbrushes out there that you want to throw away after a few weeks of use. A high quality toothbrush, I would say two to three months is ideal, but it depends on how often you brush and do you soak your toothbrush in white vinegar? That can damage the bristle perhaps. How do people clean their toothbrushes? Do they brush after drinking lemon juice? That's acidic. That has an effect on the nylon bristles. So there are a lot of factors. But to be safe, I would say every two to three months.

Alexandra Arriaga: Okay. What would you say are some of the biggest myths about oral health that people still subscribe to?

Dr. Burhenne: Boy, I think the big one is flossing and brushing; that it is everything in dentistry in terms of preventing decay. I don't rank flossing and brushing as the number one prevention for example, gum disease, decay, cavities. The way I rank it, it's dry mouth, then diet, then biofilm management, which is brushing and flossing and then genetics and perhaps epigenetics. I think that's a myth. I think you can eat... People think they can eat whatever they want as long as they're brushing and flossing. That is definitely a very widely held myth. So really, that probably is the biggest myth that people have. They can eat whatever they want as long as they brush and floss, and there's so many other factors at play. They don't realize that for example, if they had a dry mouth because they can't breathe through their nose, they have a cold, that this creates a dysbiosis of the oral microbiome. It's not just that one bug causes a cavity and if you have that bug in the mouth, it causes a cavity. Then some dentists will tell you that you feed that bug, you feed that bug a lot of sugar, then more acids are created and that causes a cavity. It's way more complicated than that. A dry mouth will lower the pH in the mouth. That causes a dysbiosis of this biome. So it's not just brushing and flossing. My point is, is that you have to know a lot more than brushing and flossing and you can over brush. I don't think you can over floss, but you can over brush. That's possible.

Alexandra Arriaga: What do you think is the best combination of habits that one can have to have the healthiest mouth possible?

Dr. Burhenne: The key is, is to respect this oral microbiome. We essentially are a super organism. In other words, we're not just humans, and this is the whole concept of this oral microbiome. This is one of the big changes in dentistry I was referring to earlier, which is so exciting I think. Everyone knows what the gut microbiome. It's been around for what? 12, 13 years. The word microbiota is a relatively new word. I think it's only been in use for 15 years, but the oral microbiome, which is another biome, there are biomes everywhere in the body. There's a biome in your armpit. There's a vaginal biome. There's maybe a biome in the brain. These are microbiota. These are bugs. These are bacteria, viruses, fungi, even for example, it could be a simple yeast cell. These are all living inside of us for a purpose, for a reason. They are essentially a community. They're ecological communities of bugs inside of us. So I look at these bugs and again, I refer to super organism. We're not just human. We are more than that, I look at this as a partner. This is a partner that partners with us that helps us have better health. It prevents disease. It determines so much in terms of longevity, even cognitive behavior, how we act, happiness. These bugs are very important. They're commensal, they're symbiotic, they're pathogenic; those are the bad ones of course. If they're not treated well, if you don't respect the oral microbiome, in other words, if you're using a mouthwash with a lot of alcohol in it, you are putting down some bugs. You are essentially carpet bombing the mouth and for 10, 15, 20 minutes, all these bugs die off. I mean, not completely. You cannot sterilize the mouth. This is a disinfection and then they all grow back. Well, they may not grow back the way it was supposed to be in terms of this communal ratio of all these bugs to each other because they're all doing things. Even the bad bugs are there for a reason. We don't quite understand how and why, but we know that if we kill off a certain bug and we're very selective in killing bugs, that that's not always a good thing. So I would say anything that helps this organism in your mouth, which by the way is related to the gut microbiome as well, remember when you have bugs in your mouth, you're swallowing probably over a liter of saliva a day. In that liter, liter and a half of saliva; there are trillions of bugs that you are seeding the gut microbiome with. So you better have good bugs in your mouth. This could affect the gut microbiome and we all know how important the gut microbiome is in terms of overall health and preventing disease and the immune system and the gut brain access and all that. So the oral microbiome; respect of it, not abusing it, not over brushing, not killing all the bugs with all the ingredients of toothpaste and mouthwash that are pretty much in every single mouthwash and toothpaste out there. Now, the mainstream mouthwashes and toothpastes are quite bad for you. They disrupt this oral microbiome, and in doing so, they predispose you to gum disease and to cavities.

Alexandra Arriaga: Oh my God. So they're almost causing the problems that they claim to fix.

Dr. Burhenne: That's what I keep telling people. You have to have respect for the mouth. It's really, really important. Otherwise, you're going to have issues. Of course, diet is part of it. Prebiotics are important. If you keep eating a lot of sugar, that's going to change the pH in the mouth. If you take a lot of pharmaceutical drugs or if you take a lot of antibiotics, these are all things that would... All the things that take down the gut microbiome can also affect the oral microbiome. If the oral microbiome is not functioning properly, then you're going to have issues. You're going to have bad breath, you're going to have higher rate of getting cavities, for example.

Alexandra Arriaga: So it seems to me that obviously understanding the oral microbiome is going to be very important when we think about how to stay healthy and how to keep healthy teeth. Now I'm wondering what type of ingredients should we look for in our toothpaste, for example?

Dr. Burhenne: Right. Anything that is used to manufacture toothpaste in large quantities, like surfactants, emulsifiers, when you make, when you mix a big vat of something, you want to make sure it mixes properly. So you add all these chemicals or substances that help it to mix and stay mix so it doesn't separate. Those things actually will have an effect on your mucosa, your oral mucosa, which by the way is one of the subsets of the oral microbiome. There's a biome on the side of your cheek, there's a biome on your tongue, there's a biome in your saliva. You're disrupting those microbiomes because you have a surfactant, you've got a chemical that's not there for you, for your health; it's there to make a bigger batch of toothpaste and that can disrupt and dry out the mouth, for example. Also alcohol; toothpaste manufacturers have been using that for a long time. We even have some pesticides in our toothpaste and very low levels like triclosan, bacterial sidles, we've got detergents, we've got soaps in all these oral products and these are things that are not good. I take blame for this because dentistry was behind all of this for a long, long time. I think that thinking is changing. We need to instead of disinfecting and knocking down a healthy oral environment, we need to be nourishing it. We need to be feeding it so that it can continue and maintain itself and do what it's supposed to do and that is to protect from immune attacks in the mouth. The mouth is very susceptible to infection. It's the only area of the body that has a hard tissue like bone, which is like a tooth similar to a tooth, teeth sticking out of this barrier. The body's always trying to protect itself by the skin, the gut, mucosa. These are all designed to let some things through, but if they get leaky they can cause infections, bacteremias and the mouth is doing that every day and it needs biofilm; that's the plaque layer that we've been told to brush and remove and polish away. We need a proper biofilm. We need a good mucosa. We need good nasal tissue mucosa in the nose to produce bugs that help produce substances and chemicals that help prevent infections in the mouth. Imagine having teeth in your gut. The gut’s leaky enough as it is right? And the teeth in the mouth, they stick out of this barrier. How do you keep those areas clean? How do you prevent bacteria from outside of the body, which is in the mouth from getting to the inside of the body and causing superinfection or just infections, and bacteremias, and damage via endotoxins, and allowing some bacteria that can cause for example, that can further your chance of getting colon cancer or Alzheimer's? There's a pathway now that was just discovered through cytotoxin release in a gingipain, a substance called gingipain that crosses the blood-brain barrier that essentially makes the brain lay down the amyloid protein, the plaque protein to protect itself. Well, that comes from the mouth. That comes from gum disease and that happens right around the area, we call it the violation of the biological width, it's where the tooth is sticking out through the bone, through the tissue, there's that little pocket, that little sulcus or moat, whatever you want to call it, and that's where all the activity happens. If the microbiome isn't doing its job, you'll get an infection in the folds of these gum pockets and then you get gum disease. Gum disease of course, can raise your overall inflammatory levels, can raise your CRP levels, it can cause all sorts of problems. It can complicate diabetes. It's a tough area of the mouth. It's to control and that's why we need to respect this oral microbiome.

Alexandra Arriaga: Absolutely. So knowing all this information, how delicate the balance of this microbiome can be; what would you say is the best standard of care for our mouths? Should we still brush our teeth three times a day?

Dr. Burhenne: That's a good question. You can over brush. I've mentioned that before, but it's also when to brush is also important. Let me start with how many times. Twice a day is fine, but brushing after a very acidic meal or beverage can be very dangerous. For example, when you drink like a diet soda, a sports drink, what are they called? The Red Bulls and all that; those are also very acidic. Wine, coffee, teas; if you brush right after that or even a lemonade, you could literally be scrubbing off some enamel and some denton Because the pH is so low that the phosphates and the calcium structure of the tooth lifts a little bit. It pulls a little bit and it dissolves a little bit and they can recalcify if you can up the pH again and that would mean drinking some Pellegrino water. In fact, the Europeans do this all the time. When they drink wine or something very acidic, like a coffee, they're always sipping on a mineral water and then they don't rush afterwards to brush their teeth. Americans are always concerned about staining their teeth. So they had their coffee quickly and then they brush their teeth and they're literally brushing tooth structure away. So I would say twice a day is fine, two minutes done properly with the right technique with a soft nylon bristle, something that's not worn, the right technique and then not after acidic foods or drinks.

Alexandra Arriaga: Okay. Sounds good. Now speaking more about you as a dentist, how has the way that you've treated your patients changed as you learn more about the impact of the oral microbiome?

Dr. Burhenne: Boy, that's a big question.

Alexandra Arriaga: It is.

Dr. Burhenne: It's the respect for what's going on in the mouth and truly understanding or attempting to understand how complex it is and how important it is to nourish and maintain it. So definitely respect for the oral microbiome is key. Keeping your mouth shut, I mean I say that just to get attention, but mouth breathing is a big issue. A dry mouth is a big issue, which lowers the pH. Saliva's a great buffer. Saliva is one of the microbiomes in the mouth. It has substances and components in it that help remineralize teeth and help fight off infections. Anything that dries out your mouth, that would be medications. If you're exercising lots, stay well hydrated. You could be dehydrated. That causes a dry mouth. Sleeping with your mouth open at night can cause lots of disruption or dysbiosis of the oral microbiome. Also, I think it's important. I tell patients on the website that they need to seek out a functional dentist. Because of the oral microbiome because we can't see a lot of the symptoms early on of a dysbiosis like gum disease or cavities, we wait to take an x-ray and then we see the cavity and we treat it. In dental school, we were told that dentists were the most preventative minded health practitioners out there. Now I would disagree with that. We need to go one step back, further back. We need to treat diseases in their pro domo periods. That is essentially respecting the oral microbiome. I would tell patients to find a functional dentist, someone who is looking for root cause treatments, not just treating your symptoms. Dentists, they see a hole in the mouth, in the tooth and they fix it. They see deep pockets; they go in there and they scrape them clean and they hope for the best. That is not the kind of practitioner I want to be today because of what I know about the oral microbiome. Yes, brush and floss. I'm not going to say not to do that, but all these things that affect the oral microbiome; dry mouth, diet, biofilm management, genetics and epigenetics, for example, something epigenetic would be facial development. As we are evolving, the younger people that we're seeing now don't look like our ancestors. They have narrower faces, tapering jaws. The width of our jaw is not developing correctly because we have a lot of allergies, because we're being born via cesarean instead of being pushed through the birth canal. We're not picking up mom's microbiome, vaginal microbiome, and we're not being shaped and pushed through the canal. We're not breastfeeding as much. All of these things have an effect on how our faces develop and hence, how we breathe and we are not good nose breathers anymore; then of course causes a dry mouth. It lowers the pH. That's why I tell people to keep their mouth shut, unless they're talking to me and then I won't say that. Anyway, when I came out of dental school, I was learning how to create just beautiful restorations and reversing symptoms and signs of diseases in the mouth. Now it's more about aggressively counseling the patient and looking for and measuring, we have tests now, we have DNA tests that we can use. Prevention occurs even earlier. It can occur with prenatal advice, making sure they take the right form of a B vitamin that prevents midline defects, which would cause a tongue tie. If you have a tongue tie, then you can't breastfeed properly, then you won't be able to breathe later as an adult properly. There's a lot that dentistry can do to further the role of any healthcare practitioner, physician, dentists in terms of providing functional advice, functional care, and preventing diseases like diabetes, even Alzheimer's. I see myself as on the front line of the fight against Alzheimer's as a dentist and I think dentists now need to, and I counsel them to be practitioners of the oral microbiome. I think that's what a general dentist, any dentist, how they should be thinking.

Alexandra Arriaga: It seems like beyond just the aspect of, "Oh, keeping a healthy mouth and not developing cavities," there seems like there's more and more science backing up the fact that our mouths can actually either prevent a lot of disease or produce it if we're not careful. Right?

Dr. Burhenne: Both. Exactly. There's that connection now between a bug in the mouth and Alzheimer's. There's been for the last two, three decades connection between heart disease and bugs in the mouth. The one I mentioned earlier about colon cancer and there's more to be found. We're just beginning to discover what the actual mechanisms are. A lot of researchers are looking at histological slides and they're looking, "Oh my God, there's an oral bug in there. How did it get there?" Well, it's that leaky mouth, it's that oral microbiome, it's that dysbiosis that allowed that to happen. What better practitioner than a dentist to start identifying when that occurs and preventing it from occurring?

Alexandra Arriaga: A lot of students and alumni who are getting their MPH here at NYU are looking for the way to make an impact on the world and improve health and wellness for people. For those that are interested in pursuing a career in this area, what do those jobs look like? Or how or where can someone get started?

Dr. Burhenne: Oh, that's a great question. I like it when that's asked because there is just so much new stuff coming out, exciting stuff. If you're going into the health sciences, I would definitely recommend dentistry. Medicine of course as well, but I would always look towards the functional approach, kind of this integrative idea of preventing diseases and diving deep into everything about the patient. In other words, why are we here? Why do you have bleeding gums? Don't just look at the conventional models of Western medicine of just treating the symptoms and signs. So in dentistry, there's a revolution coming and I think the most exciting thing... In the short answer for dentistry, I would say go into orthodontics and become an orthodontist that is concerned about facial development and you can even reverse now through computer modeling and CAT scans and 3-D cone beam type of x-rays. You can now control and verify the reversal of improper facial development, which is essentially why I think why sleep apnea is on the rise and poor breathing issues and depression. For example, a lot of young women now because of the spatial development issue, are being prescribed psychotropics, the depression medication and it's really probably a function at least in half of the cases of not being able to breathe properly. That's a condition called UARS, upper airway resistance syndrome. Push back a little bit, look at the bigger picture. This can happen in any healthcare area. I would also advise not to necessarily just think that medicine is the big one. In other words, you can do this now. You can do functional healthcare as an acupuncturist, as a chiropractor. These are things and thoughts and methods that you can use and even pharmacologists now are doing some treating and especially in the area of diabetes. But always look towards the functional approach. I don't know if that answers your question, but-

Alexandra Arriaga: Yeah.

Dr. Burhenne: ... it's an exciting area. We have these silent epidemics like sleep and inflammatory diseases, metabolic syndrome, increase in BMI, obesity in children, all these things that... We've got chemicals in the environment, we've got the glyphosate, fluoride, that's another big issue, controversial issue. But there's a lot of space there for... It's almost like global warming. We've ruined our environment, but in doing so, we've also ruined our biomes. Our microbiomes are our ability to fight off all the things that we did so well as ancestors. We're seeing a lot of an increase in death rates and we're dying earlier. We're not doing so well in our older years. So why is this? Well, there's a lot of room for improvement and again, it's going to be more of a functional approach.

Alexandra Arriaga: If you could invite public health practitioners to join you in this quest for increasing the awareness for the oral microbiome and using oral health as a means to improve overall population health, what would you tell them?

Dr. Burhenne: Well, there's a study out of a Columbia College, I think it was late 1998, maybe the year 2000 and it essentially looked at what a reduction of inflammatory oral health diseases, a 30% or 40% reduction would mean in terms of total healthcare dollars spent in the US. It was a $247 billion reduction. Oral health and systemic health are intimately connected. You cannot treat the mouth or look at the mouth in a vacuum and that's what we've been doing. Medicine's been doing its thing. It looks at the mouth as a black box. That's what they're referred to as. Dentists have been just looking at the mouth, we haven't been looking at the systemic implications and the big picture of how oral health affects systemic health. So there has to be a lot of collaboration. I've actually created a letter, a two page form called the CRP physician letter and that allows a physician who is looking at the patient's CRP, for example, a cardiologist who's trying to lower the patient's CRP, that's a measure of the overall inflammation in that person's systems and body. That's a letter that should be sent to the dentist. The dentist should fill it out because gum disease or even gingivitis contributes to the CRP. Why would a physician... Or it could work both ways. Why treat a patient for CRP if you're not addressing all the issues that contribute to CRP. So this kind of collaboration, this letter is used by the IFM; that's the functional group of medical doctors. It's being used in other big medical systems here on the West Coast. I think the Cleveland Clinic is using it now. This is a letter that can be very helpful and it can help physicians or any other healthcare practitioner to realize that you need to address what goes on in the mouth when you're addressing the whole body. Of course, it works both ways; dentists need to look at the bigger picture, of course. If we don't take care of the mouth, that's going to lead to a patient who's going to contract Alzheimer's 10, 15 years earlier than they would have if they hadn't dealt with that gum disease.

Alexandra Arriaga: Wow. So there is a lot of room for collaboration. That's great to know. Last, but not least in a few words, what would you say is your best advice for everyone listening to keep excellent oral health?

Dr. Burhenne: Boy, best advice in a few sentences. I would say just to make it simple, mouth tape. I'll give you a short explanation of that. I'm big on dry mouth. Dry mouth is an issue. Dry mouth leads to so many different things. Then if you can tape your mouth shut at night and keep your mouth closed while you sleep, you're going to do so much. I would Google it. Google mouth taping and you'll see a host information on there. A lot of it from our website, but a lot of it from other sources as well, like production of nitric oxide; being happier; breathing better; sleeping better; feeling better in the morning; fewer cavities; less bad breath. I can go on and on and on, but that would just be probably one of the biggest things we talk about at askthedentist.com is mouth taping. Keep your mouth shut at night and you'll feel great the next morning in so many ways.

Alexandra Arriaga: Okay. Well, Dr. Mark, thank you so much for joining us. It's been a pleasure talking to you and we will hopefully stay in touch.

Dr. Burhenne: Thanks, Alex. Great talking with you.