Episode 127 THE MOUTH-BODY CONNECTION: How Your Oral Health Affects Everything | Dr. Toni Engram

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Adam Rinde, ND: Think about this for a second. You can spot a mouth breather from across the room, but what if that small habit is reshaping a child's face, disrupting their sleep, and potentially setting them up for autoimmune diseases? Later in life. My guest today is Dr. Toni Engram, a biological dentist and the founder of Flourish Dental Boutique in Dallas.

Adam Rinde, ND: She's at the forefront of connecting oral health with systemic health from the way mouth breathing can shape a child's development, to how your oral microbiome can influence autoimmune heart health and even stroke risk. Today we're gonna go into topics like nitric oxide, the oral microbiomes role in inflammation and disease.

Adam Rinde, ND: She shows us that the mouth isn't just about cavities and cleanings. It's actually a gateway to the whole system we're gonna speak about. [00:01:00] This might be the missing link in chronic illness and how simply simple daily practices can change everything from your breath to your brain health. At the end of this episode, please listen closely to a contest and give away, uh, related to your own dental hygiene where we'll be giving away a microbiome testing kit for your oral DNA.

Adam Rinde, ND: So please listen at for the end of the episode so that you can participate in this contest. . So without further ado, I welcome you to this week's episode with Dr. Toni. I know you'll enjoy it as much as I did. Please share it widely with your friends, family, and loved ones, and anybody you think might be interested in it.

Adam Rinde, ND: Thanks again and welcome to this week's episode of The One Thing Podcast.

Adam Rinde, ND: Dr. Toni, welcome to the One Thing Podcast. I'm so delighted to be here with you today.

Toni Engram, DDS: Thank you so much for having me, Dr. Adam. I'm glad to be here.

Adam Rinde, ND: You're welcome. Yeah, [00:02:00] it was great getting to know you a little bit offline here, and there's, as we were mentioning this topic that we're gonna get into is often overlooked, um, a lot by clinicians and, you know, patients don't know how to connect some of these dots or connect some of these concepts with their provider.

Adam Rinde, ND: So really looking forward to hearing and learning from you. Um, I think some of the fascinating things I've researched or heard from your work is how you look at. All aspects of the mouth from breathing to the microbiome. Um, and, you know, looking at also just the environmental impacts and the impact of oral health on autoimmunity.

Adam Rinde, ND: So I'd like to get started really with a concept that is fascinating from a dentistry standpoint, and that's the impact of breathing. So can you share [00:03:00] why the way we breathe is so important for oral health?

Toni Engram, DDS: Man, and it's it. Once you think about it, it just makes sense, right? That

Toni Engram, DDS: how we breathe, we breathe through our nose and our mouth, that of course it's going to affect the health of our mouth. To, so what's interesting is that, you know, we're, we're designed to primarily breathe through our nose, that that's how the system was set up. Now, I think it was brilliant that we have a backup system so that if we. We get sick and we can't breathe through our nose, or if we need a lot of oxygen really fast 'cause we're running from a tiger or a bear, um, then thank goodness we have our mouth as a backup system to breathe. But it's just meant to be a backup. So when we breathe through our nose, we have the benefit of, um, of filtering the air and. There are [00:04:00] cells in our nose that will actually produce nitric oxide as we breathe. That helps protect our heart. So if we're breathing through our mouth more often than we should be, then we don't have those things.

Toni Engram, DDS: We're breathing in unfiltered air. So we're exposed to more junk in our environment, which is, you know, more and more prevalent and we're not getting. That heart protective nitric oxides that we really need either. Um, and not only that, if we're breathing through our mouth more often, then it's naturally going to dry out our saliva. And when you dry out the saliva, that causes a whole host of negative effects on the health of our mouth. It shifts the bacteria in our mouth in the wrong direction. It, we no longer have the saliva to wash away some of the plaque from from the night or, or even the day, you know, depending on when we're breathing through our mouth. [00:05:00] So we'll get more plaque built up. It makes us more prone to tooth decay, more prone to gum inflammation, so, you know, sets us up for gum disease. Uh, it really just can wreak havoc. But then, and that's, you know, that's primarily adults when we talk about kids, it's all of those things, plus a ton of growth and development effects. So we can get all into the nitty gritty of that if you want, but essentially if your, if your child is breathing through their mouth. During those crucial years when their mouth and their jaw and their airway is growing, then it will have a huge impact on how those things grow. Um, and so I can, I, I've even trained my own kids that we can see. A child who has trouble breathing, we can spot it from a mile away because you start to see these dark circles under the [00:06:00] eyes, what we call venous pooling. Um, you see a longer lower face, they they start to, everything just kind of grows down. You'll get this recessive chin. Um, so more overbites and. You know, typically when we have mouths that grow the way that they're supposed to. Part of that is because their tongue is resting naturally along the roof of the mouth lips, closed tongue to the roof of the mouth. That helps guide this wide growth of the palate, so if the mouth is open, and that's not happening, if the tongue is kind of falling to the floor of the mouth. Then the tongue is no longer the strongest

Toni Engram, DDS: muscle in that area. Then the cheeks become the strongest muscle and the gr the direction of the growth and development goes from wide beautiful smiles. To narrow restricted smiles [00:07:00] where there's not enough room for the teeth. You know, part of the reason we're all having to get wisdom teeth removed so frequently. There's just not enough room in there and things aren't growing in the right directions. Um, but most importantly, if that's happening, then there. Airway is actually growing smaller too. It's not just their jaw,

Toni Engram, DDS: it's their airway. Um, and so we'll see extended bedwetting uh, symptoms of ADHD, this tonsillar hypertrophy, you know, these kissing tonsils that are just always constantly inflamed in the back of the throat. Uh, and it really just sets our kids up for this nightmare of health effects that take. Me and the pediatrician, you know, usually a functional medicine, nutrition, a pediatrician or a naturopathic pediatrician to kind of unwind these things and get them set up for success and growth and development again.

Adam Rinde, ND: Mm-hmm. So I think a lot of people, when they're seeing mouth [00:08:00] breathing, they go right to. The nose as being like the problem. And you mentioned, you know, that you're, you're seeing all these developmental, uh, changes, especially in, in kids' bone structure changes and face changes. Why isn't it not the nose that's the issue, or is it also a contributor?

Toni Engram, DDS: Well, it can be, it can be partly the nose. Um, you know, if you've got a deviated septum or you've got, um, some inflammation in the soft tissue in the nose, then absolutely that can play a role too. But then it becomes like this chicken or egg discussion.

Adam Rinde, ND: Mm-hmm.

Toni Engram, DDS: Like, was it the, was it the anatomical features of the nose or the back of the throat?

Toni Engram, DDS: Is that what caused some of the congestion that forced that person to need to breathe through their mouth more often? Or was it were, was it other [00:09:00] things? Was it maybe a tongue tie that cause them to breathe through their mouth and then they develop that habit? And breathing all of that unfiltered air caused the inflammation in the tonsils, the inflammation in the sinuses.

Toni Engram, DDS: So it's, it becomes this really interesting case of what was the root cause of the root cause,

Toni Engram, DDS: um, and how do we get the most bang for our, but how do we fix it the fastest to get things to unwind?

Adam Rinde, ND: I love that. What is the root cause of the root cause? That's such a great way of saying how these puzzles are, you know, the cause and effect are not always so straightforward. Um, so going back to some of the things you just said, the. First, the filtration through the nose and using nitric oxide.

Adam Rinde, ND: What is nitric oxide and what is it actually doing for, for the, you know, the particles or the pollutants or the [00:10:00] pH um, of the, to the air was as it as it enters the nasal passage.

Toni Engram, DDS: Yeah, so nitric oxide is, is the way that we get. All of this oxygen and anti-inflammatory cells into the tissues of the heart, into our circulatory system. Um, if anybody in your audience has a chance, I highly recommend you look up a scientist by the name of Nathan Bryan. He is

Toni Engram, DDS: like the, the world renowned expert on nitric oxide. Um, I've heard him lecture in person a few times. He's such a huge proponent of biological dentistry. So. He's on my good side, obviously.

Toni Engram, DDS: Um, but man, just a wealth of knowledge. Um, and so he talks all about the nitty gritty of nitric oxide and how it works and how we can increase it and improve it. Um, it's funny, not only is it, it's primarily we get it when we breathe in through our nose the way that we're supposed to. [00:11:00] But what's interesting is that there are also strains of bacteria in our mouth. That also help reduce nitrates to nitric oxide, um, and help us produce more nitric oxide in the mouth also. And so we can check for that when we're doing saliva testing and see if you've got those nitrate reducing species that can actually help you along the way.

Toni Engram, DDS: Help increase your nitric ox oxide levels.

Adam Rinde, ND: Hmm. Yeah, so, you know, it's, it's interesting 'cause it connects so much with cardiology as well, and we think about nitric oxide from a standpoint of vascular health throughout the body, brain, heart, um, any really peripheral tissue as well. So, and. Such a vital part of that, if bypassing it through being a mouth breather, um, [00:12:00] what's the ultimate cost in your mind of that?

Adam Rinde, ND: Like when, when you, with, with not accessing so much nitric oxide or the proper amounts, what, what microbes tend to expand or what. What's the microbiome generally look like in the mouth when that takes place?

Toni Engram, DDS: When there's not enough of it. Well, anytime there's not enough balance in those, in the, the healthy cells that we need or in the healthy bacteria that we

Toni Engram, DDS: need, and it sets us up to create imbalance, it makes a way for those pathogens to really take hold. And so we do see, as part of this inflammatory process, we will see more of those pathogens like Porphyromonas, gingivalis. Uh, Fusobacterium nucleatum, , uh, Treponema denticola. These pathogens that are some of the, [00:13:00] the scary bugs that are associated with other negative health outcomes, uh, we can see those take hold a lot easier.

Adam Rinde, ND: I gotcha. Okay. So for the saliva, so many, um, conditions and especially like autoimmune conditions can set up where there's low saliva production. Um, how, how long, when their saliva issues do you start to see problems with cavities and. Other oral dental health issues? Like is it, is it a slow process or can it happen pretty abruptly?

Toni Engram, DDS: I mean, I've seen it. I've seen it both ways. Um, especially when we're looking at kids microbiomes. It's really transient. Tends to shift really quickly.

Toni Engram, DDS: And so it doesn't take very long of a disturbance for there to be some, some clinical symptoms like some, some cavities will start popping [00:14:00] up. Um. And unfortunately, a lot of times we're seeing the cavities first, and that's what gives us the trigger to say, okay, we need to test the saliva and actually see what's there. Um, in adults it, again, a lot of times patients aren't coming to me until there's a problem, and then we're testing the saliva to see. What's going on and how specifically we need to tweak things. But, but that can take longer. Sometimes we'll see the imbalance in the microbiome first. Um, and if we catch it and we make those shifts in time, then we can restore things back to some, some balance before there's anything that's clinically apparent.

Adam Rinde, ND: So, uh, you mentioned some obvious flags or features in children that their mouth breathers. Is that similar in, uh, adults? Is it, or does it present differently? Um, is it not as [00:15:00] obvious?

Toni Engram, DDS: . It kind of depends on what's going on in the middle of the night. So if they are mouth breathing and that's really all that's going on, but they're still able, like there's no apnea, there's no sleep disordered breathing, it's just that they breathe through their mouth, then. we'll we'll see the oral effects of that because it's still gonna dry out the mouth.

Toni Engram, DDS: So you're at higher risk for gum disease because it's, there's an inflammatory process and you're at a higher risk for tooth decay. Um, so we'll definitely see those oral health effects. Um, but if they're mouth breathing because there's a, a deeper problem and there really is some sleep apnea or hypopnea or, you know. Respiratory distress of any kind during the night, then, then yes, then we see other things that go along with that. And there are usually clues that present. You know, we're always screening patients in the office when they come in. Um, but I [00:16:00] see signs also like we'll see. What are, what's called scalloped borders of the tongue.

Toni Engram, DDS: You

Toni Engram, DDS: know, the sides of the tongue start to look like a really pretty pie crest,

Toni Engram, DDS: um, that your grandmother would make.

Toni Engram, DDS: That's not normal. Um, a tongue that doesn't look like it fits within the teeth. Um, we'll see flattened off edges of the teeth. Because the, you know, if you can't breathe at night, then your mouth is gonna instinctively kind of move around, shift to try to open up the airway and and sometimes there's more acid wear on the teeth.

Toni Engram, DDS: And so we can see that too. You know, there a lot of times will be some silent reflux that comes with some of these sleep disorders. So the other more, more serious sleep issues will absolutely have signs that we can pick up on.

Adam Rinde, ND: That's really great. Um, you know, good information and I think those are. Clues that people, you know, can see in themselves or, you know, [00:17:00] and obviously if they're concerned that they're having an issue with their airway or breathing, they can, you know, bring that up to their practitioner. And obviously I.

Adam Rinde, ND: You know, we all see people sleeping with their mouth open on the airplane, but I don't know if that's just an airplane thing or, um, just co you know, or it's an actual mouth breathing sign. Um, but a partner is always a, a great person to point out whether you're having, uh, you're mouth breather. I know as a clinician, as.

Adam Rinde, ND: If I ask someone, they're a mouth breather, you know, I think there's some pride. It's like, oh no, I'm, I'm not Just kind of like, do we have bad posture? We, we sit up

Toni Engram, DDS: Yeah.

Adam Rinde, ND: all of the sudden.. But, you know, other people can call it out better than ourselves sometimes. So if someone is listening to this and say they're just curious and they think they might be a mouth breather, what's one simple step they can [00:18:00] try?

Adam Rinde, ND: To encourage nasal breathing. Is there any just basic, um, steps or techniques?

Toni Engram, DDS: are actually, um, so I would say one that can be really helpful is mouth taping. Um, but I want you to test it out first. Like, just don't go willy-nilly and tape in your kid's mouth shut,

Toni Engram, DDS: um, or your spouse's mouth shut even if they're too chatty. Um. What you wanna do is you wanna test it during the daytime first, like try to, to, and you can do, they make mouth tape that you can get on Amazon or you can just do medical tape.

Toni Engram, DDS: Like, it doesn't have to be fancy, but put a little bit, you know, right in the middle of your mouth, just one tiny little strip and make sure you can keep it on. Five or 10 minutes without feeling panicky, like you can't breathe. Um, and then, and then test it. You know, if you feel comfortable that you can do it during the daytime, then try it at night. Um, see if you can [00:19:00] keep it on for an hour and then kind of work your way up. Um, because anytime there's something new on your face or around your mouth or anything like that, then sometimes it just doesn't stay on. For the whole night. In the beginning, you kind of gotta work yourself up to it, so don't feel like you failed if the, if the tape comes off in the middle of the night, the first time you try it. Um, so that's how I would recommend doing mouth tape, and that's super, super easy, simple to do. Um, the other thing that has. No restrictions really at all, is some xylitol and saline nasal spray that can be so, so helpful and so easy. Like, I can't think of a single person who can't do it. There's the, the rare person who might have a xylitol allergy. Um, but even if you are, even if you're. Digestive system is really, really sensitive. You can usually still do the nasal

Toni Engram, DDS: spray. Um, so the xylitol and the saline, not only will that help just kind of [00:20:00] clean out and thin out the mucus over time, um, but the xylitol will shift the bacteria in your sinuses over time as well.

Toni Engram, DDS: And so you'll have less of that sinus drainage over time, less of the inflammation. And so. I would say, especially if you are prone to seasonal allergies, if you start doing the nasal spray, you know, a, a few weeks before your allergy season normally starts, then you can head that off by quite a bit. Um, and so I think that's, those are my two favorite tools, just to kind of give yourself a jumpstart for breathing better at night.

Adam Rinde, ND: That's great to to hear and I really like how you, uh, describe expectations. 'cause I think it is so normal that the tape ends up on the, the floor or somewhere in the bed at some point.

Adam Rinde, ND: Yeah. It stuck to your hair. Um, and yeah, it's, uh, it's good to, to hear from a. [00:21:00] Dentist to know that, you know, this is sort of a gradual process and you can build up and, you know, not everybody sleeps through the night with the, the tape on.

Adam Rinde, ND: You know,

Toni Engram, DDS: Right.

Adam Rinde, ND: so, and you know, it's, it's really interesting. It's like one extra hour of good nitric oxide flow, you know,

Toni Engram, DDS: Seriously.

Adam Rinde, ND: build on. Um,

Adam Rinde, ND: as you were talking, I couldn't help but think about the tongue positioning while having the tape on. And if people are used to being a mouth breather, you know, where they might feel sort of awkward about where they place their tongue.

Adam Rinde, ND: Like usually it's probably just hanging out wherever it falls, but there's, you know, there's something to that too, isn't there?

Toni Engram, DDS: There really is. Um, and there's a, a, new field. I mean, it's not that new, but it's really new in its popularity and I'm so excited about it. Called. Oral Myofunctional therapy, um, or OMT. And [00:22:00] we love our OMT specialists. A lot of them are also trained as speech and language pathologists. A lot of them are trained as dental hygienists. Uh, and that's how they get started into OMT. But what they teach is that. The tongue should for proper breathing and proper development, uh, for completely proper function that the tip of your tongue should rest on the top of your mouth, on the roof of your mouth, just behind your front, your top front teeth.

Toni Engram, DDS: That's where it should be resting all of the time. And if it's resting there, then you're required to breathe through your nose.

Adam Rinde, ND: Hmm.

Toni Engram, DDS: Try,

Toni Engram, DDS: try. Just try to breathe through your mouth, with your tongue in the right

Toni Engram, DDS: place. You can't do it. Um, so it forces that. And that's what they'll, those are some of the exercises that they'll do with our kids is they'll have [00:23:00] our, every, every exercise, they'll remind the kiddo, okay, put your tongue on the spot. Tongue on the spot, and that means right behind those upper front teeth. Um, and so that's where, that's where we want it to rest, and that's why it's so important for, um, for parents of, of littles to have their kiddo evaluated for a tongue tie if they think that there are any kind of airway issues going on. Because sometimes the tongue tie can be the root cause of the mouth breathing. If their tongue, and when I say a tongue tie, I mean the frenulum, the little string of tissue that connects the tongue to the floor of the mouth. If it's too tight, then you can't properly lift your tongue all the way up. And sometimes it's even, you can't lift the back of the tongue all the way up the way that it should. And it not only does it prevent you from sometimes from breathing appropriately, it sometimes it [00:24:00] also prevents proper swallowing. Um, can inhibit proper nursing when you're breastfeeding infants. Um, and so that's important to look at because you wanna remove any kind of inhibitor to, to breathing properly.

Adam Rinde, ND: Hmm. Such a good point. And again, one of those things that, uh, I think people. Just overlook, you know, seem like the tongue is not something to to consider in the mix. But, um, since you're describing it under the terms of myofascial therapists or, um, people who work on the myofascia, it sounds like, you know, a little bit of it is trainable.

Adam Rinde, ND: Um, and then there might be points where it's, you know, uh, interventions are needed, but you know. Um, so would you agree that it's trainable?

Toni Engram, DDS: Uh, you are, you hit the nail on the head. So much of it [00:25:00] is trainable. Um, and then sometimes we need to, we need to do a procedure. Sometimes we have to intervene with a teeny tiny little surgical procedure to give the tongue the freedom that it needs to be able to function. But I actually, um, I, I do a lot of tongue tie procedures in the office. We use a we numb it use a laser, like we do it on infants, we do it on big kids, we do it on adults. Um, and it obviously not in our infants, but on our big kids and our adults, I require that they are working with a myofunctional therapist before I'll even agree to do the procedure because they've gotta get, they've gotta get the, the tongue muscles and the, the whole muscles of the mouth complex. They've got to get those strengthened and trained. Um, and then they need support to know how to then get those newly freed [00:26:00] muscles to function correctly once the procedure is

Toni Engram, DDS: done. Because usually in that case we're, we're doing sutures and we need to prevent scar tissue from

Toni Engram, DDS: forming. So it's really important.

Toni Engram, DDS: It's like doing, it's very much like having, uh, a knee replacement and then doing physical

Toni Engram, DDS: therapy. You have to do the physical therapy or your surgery results will not be optimal.

Adam Rinde, ND: Right. Well, you know, it's interesting, you know, that you're doing the laser procedure. I think even 10, 15 years ago, people would have to travel, you know, outside their city, try to find, uh, a provider that would do that. Does the laser technique versus other techniques,

Adam Rinde, ND: is it becoming more prevalent? Um. Or is it still seen as a very select specialty?

Toni Engram, DDS: It, thankfully it's becoming much more prevalent. Um, it's still [00:27:00] controversial, which is funny to me. I get, um, you know, healthcare is so funny. Um, new in healthcare is like 30 years. So,

Adam Rinde, ND: Yeah.

Toni Engram, DDS: so we're still in the new phase of this because laser frenectomies have been done for less than 30 years. Um, so I hope that we can dispel some of the controversy soon.

Toni Engram, DDS: But yes, there are more and more dentists who are getting the training to do this. Um, there are some, you know, pediatric. I think ENTs will do it. Um, most of them are, are not using a laser, though most of them are using, you know, scalpel or scissors or something like that.

Adam Rinde, ND: Okay. Well that was really helpful, and I think one of the threads to all this is, you know, the changes that you spoke about related to mouth breathing and its impact on the oral microbiome. So on this podcast we've [00:28:00] talked a lot about various microbiomes, you know, including the gut and the vaginal microbiome and, um, going into the skin microbiome.

Adam Rinde, ND: And the oral microbiome is often overlooked. Um, and I'd, I'd love to hear how you define it and what. What all lives in the oral microbiome? Like how expansive is it? Is it viruses? Is it, um, fungi? Is it bacteria? What, what is it?

Toni Engram, DDS: So the oral microbiome is just the beautiful ecosystem of bacteria and other bugs that live in our mouth. And like you said, just like there's a unique skin microbiome and vaginal microbiome, eye microbiome, gut microbiome, uh, and even in different parts of the gut, the microbiome is a little bit different. There will be overlaps, you know, some [00:29:00] species are able to. Travel back and forth. Um, but it, it, it has its own unique set. It's, it really is an ecosystem in the mouth. Um, and so far we've observed over 700 different species of bacteria, viruses, fungi. Um, all kinds of really cool stuff in the mouth that can either help us stay well or promote illness and disease.

Adam Rinde, ND: Yeah. And so

Adam Rinde, ND: it makes sense to me that the exposure to oxygen, um, and just where these bugs are living and their exposure to the environment makes them special and unique, um, and. One of the things I've heard, and I'd love to hear you talk about this, is the way they survive and how, how they're able to [00:30:00] tolerate the environment.

Adam Rinde, ND: And, you know, plaque is something that we know of. Um, I've heard that connected to biofilm. And can you, can you talk about the strategies, these bugs, good and bad microbes use to, to survive this environment that's seemingly like, has a lot going on, a lot of activity.

Toni Engram, DDS: Right. Yeah. It's not like other parts of the body. It's not like your intestinal microbiome where it kind of has a, a pretty steady, um. Environment like

Toni Engram, DDS: things are, are relatively the same throughout the day in your mouth, who knows what's going on in there. The temperature vary widely, the pH

Toni Engram, DDS: varies widely. Um, so yeah, it's really fascinating. And dental plaque, plaque that is on your teeth actually is a biofilm. Um, and it sounds like you've talked about it a lot, so I'm sure your audience knows. A biofilm is really just this [00:31:00] beautiful, super city. Of bacterial colonies. It's like the bacterial universe. Here's the best example. Um, do you remember the movie Men in Black?

Adam Rinde, ND: Oh yeah.

Toni Engram, DDS: And in one of 'em, I'm not sure if it was the first one or if it was one of the sequels, um, but there was a cat called Orion. And Orion had, you know, this little collar and

Toni Engram, DDS: this little medallion on its collar and inside the little medallion. Was an entire galaxy. Again, that with planets and living beings and all these things that is similar to. The microbiome in your mouth. It is like this entire galaxy. Um, and what we know is that when the bacteria get together to form this biofilm, then they have modes of communication. They have ways to [00:32:00] transport to different areas.

Toni Engram, DDS: They have like highways and roads and super highways. Um, they can talk to each other. They've got like their own police force. Um, and so it's really fascinating and when it's. Healthy when it's I balance. So you can have some dental plaque with a healthy microbiome. And what's amazing is that when your microbiome is healthy, then your dental plaque will actually be self-limiting. It will be self-limiting. It doesn't want to get. Big and bulky and out of control. It wants to stay nice and thin. It exists peacefully with its toast, so it's not gonna bug you. Um huh. Bug. See what I

Toni Engram, DDS: did there, dad joke. Um, so it, it all just kind of is this kumbaya kind of situation. [00:33:00] Um, most of them are aerobes, so they like oxygen or they're facultative. Anaerobes. Like, they can kind of go either way. They can survive with a little bit of oxygen, but they don't necessarily have to have it. Um, and so that's when things are in balance.

Toni Engram, DDS: The pH is, is fairly neutral most of the time. Now when things get out of balance and there are. 5700 different ways that it can get outta balance. We'll talk about some of 'em here in a minute. Um, but when things are out of balance, then it can shift the entire pH of the mouth. So the saliva can shift to be very acidic. It no longer cares if it's thin or not. It would rather make the city a whole lot bigger. Uh, and so the, the thickness of the plaque and the tartar buildup will increase. Um, so when plaque has, the has time to just sit on the teeth when it's not disrupted. By brushing and flossing, it [00:34:00] sits on the teeth for a long time. Then the minerals in your saliva will adhere to it. And when the plaque becomes mineralized, it becomes hard tartar built up that you can't get off with toothbrush or floss, then you have to come in to the dental office, um, and have the hygienist take it off for you with, uh, with all of her fun tools and gadgets. Um, so that imbalanced microbiome is, is really. Really inflammatory. So some of those bacteria will, they'll ingest the carbohydrates that you eat and they will poop out acid. And so that acid is what causes cavities and some of them will feed on dead and dying blood cells in your own inflamed gums.

Adam Rinde, ND: Hmm.

Toni Engram, DDS: So it, they crave more inflammation and then it becomes like this icky cycle where the more that bacteria is, [00:35:00] the more it's eating on your inflamed gum tissue.

Toni Engram, DDS: And the more that happens, the more inflamed your gum tissue becomes.

Adam Rinde, ND: These are, these are like sinister strategies that they have.

Toni Engram, DDS: It's like a sci-fi

Toni Engram, DDS: movie, right?

Adam Rinde, ND: it's

Toni Engram, DDS: Yeah.

Adam Rinde, ND: really fascinating. Um, and with the biofilm. It's always been such a difficult concept to test. Meaning if you're, if you're walled off from in your, in your own galaxy, like you say, nobody knows what's going on in that galaxy, really.

Adam Rinde, ND: Um, you can't get into the galaxy. So how, how do we even know with. Clinically, um, what to do about these bio, the biofilm and like what's actually in it? Is it healthy biofilm, is it not? I mean, is there a way through your testing that you found that you can interpret that?

Toni Engram, DDS: [00:36:00] So in, in the old days, we would just have to go off of clinical signs and symptoms. So we would have to look and see is the, is the plaque thin and easy to remove, or is it sticky and tacky and not healthy feeling? Or is there a ton of buildup of tartar, um, that has to be removed? You know, with our, our, our bigger tools. Um. It, you know, are, are the gums bleeding? Are we seeing signs of gum disease? Like, you know, when the hygienist takes the little pokey thing and measures around the gums and calls out all those numbers. Um, do you have small numbers like ones and twos and threes, or do you have bigger numbers like fours and fives and they're, the hygienist says, oh, those are bleeding pockets. Um, so used to, we. Could only just look at those clinical signs. But now we can, and especially if we're seeing some of those clinical signs already, then all we have to do is have our patients spit in a tube. [00:37:00] That's it. Um, because there are good labs and I'm, I've got. You know, a couple of favorites. Um, but there is some good lab testing where they can analyze that.

Toni Engram, DDS: And within a couple of weeks, then we know exactly which bacteria they're seeing or if there's an overgrowth of candida, um, or, or anything like that so that we'll know like, okay, here's what we're dealing with. Here are the, the bad actors in the the microbiome city in the mouth. So what do we specifically need to do to tweak these strains of bacteria?

Toni Engram, DDS: Because some of them respond better to oxygen, so then we're using ozone and peroxide treatments. Some of them respond better to very specific probiotics because the probiotic species will create their own bacteriocins and that can kill some of the bad bugs. Um, and then sometimes we're, sometimes if, if things [00:38:00] are scary and we're worried about. Where the microbiome is and we're seeing clinical signs, um, then we take more of a, a, a blowtorch approach. Like we may have them do an antimicrobial

Toni Engram, DDS: rinse no, for a couple of weeks. We're not doing it for a long period of time, but doing it for a couple of weeks so that we can knock down all of the bacteria it knowing that we're gonna kill some of the good with the bad, and then we're re-seeding after that with the probiotics that we want to be in there.

Adam Rinde, ND: Gotcha. Wow, that, that is really fascinating. And you know, I, I think one of the articles or posts that you wrote, um, was referring a little bit to the impact of this scenario, um, on, and you said it was like the paper that changed your career. I think it was the name of your post. And not to scare people, but.

Adam Rinde, ND: I don't think people realize [00:39:00] the research and what's, what's out there as far as what this scenario means systemically. And you know, it's something that, you know, I think about a lot. Um, and can you share but about the paper? I think it was a paper related to, um, stroke or cardiovascular disease. Yeah. And I'd love to hear.

Adam Rinde, ND: Your thoughts about like why this is so important, not just in our mouth but elsewhere.

Toni Engram, DDS: Yeah, absolutely. Well, and what's, what's sad is that that's what it took for, for the light bulb to go off in my own head. Um, because we were, we were trained in dental school to know that the health of the mouth is really important. Um. But I don't think I, I understood, or I really grasped the, just the the proof that was undeniable proof that there [00:40:00] is a direct connection to the health of the mouth and the health of everything else. So in this particular study that you're talking about, I believe the main author was a, um, last name was Pessi and so it's the Pessi study. It was published in the Journal of the American Heart Association. Um, circulation is the name of the journal, and this was a study in, I wanna say maybe 2015 ish. Um, maybe it was a little earlier than that, but in this study they took a hundred patients that were having a heart attack. Um. They were in the middle of a cardiac event, and so, and the, the solution was a procedure. And so as part of, you know, how they were helping these patients get through their heart attack, they were obviously removing the clots and the coronary arteries that were causing the heart attack. Well, then they took those claws and they [00:41:00] looked at them under a microscope and what they found. Is that under the microscope, these clots that were causing heart attacks in these patients that I think it was like 40% of the clots had bacteria that were directly implicated in gum disease.

Adam Rinde, ND: Hm.

Toni Engram, DDS: That's huge. Huge percentage of these clots had gum disease causing bacteria. And then the real kicker was that then over 70% of those clots had endodonic specific bacteria.

Toni Engram, DDS: That means bacteria that are around tooth infections, so root canal type of bacteria. Over 70% of those clots.

Adam Rinde, ND: Wow.

Toni Engram, DDS: Um, so it was just, just in your face, undeniable proof that man, what's [00:42:00] going on in your mouth actually is going on in the rest of your

Toni Engram, DDS: body too. And it makes just so much sense when you think about it.

Toni Engram, DDS: I was just too busy thinking about, you know, tooth carpentry to pay attention.

Toni Engram, DDS: Um, is that, you know, when you take medication, so much of the medication that sometimes we take is. They'll tell you to put it under your tongue because that tissue is so absorbent and gets into your bloodstream faster.

Toni Engram, DDS: When you've got all of this really, um, highly circulated tissue that's in this, in your oral mucosa, all the pink stuff is just highly, highly absorbent.

Toni Engram, DDS: It. And so not only will you absorb the medications that you put in your mouth, you'll absorb the weird chemicals you put in your mouth. The, the dumb, weird gross crap that you brush your teeth or rinse your mouth with, you're gonna absorb, um, and the bacteria [00:43:00] that's out of balance. You're gonna absorb that too into your circulatory system, and that has just a profound impact on the rest of your health.

Adam Rinde, ND: Amazing. It's, um, you know. I think the scary part is when people learn that, when they've already are kind of far down the road. So it, you know, it'd be interesting, you know, at some point, maybe to circle back with you, even if we have time today, just to hear people who are like really bad off and they were able to improve their oral health and maybe reduce some of those risks.

Toni Engram, DDS: Yeah.

Adam Rinde, ND: But, um, you know, it's, uh. I think at this point, like I think, you know, people sitting there listening to this and they're like, wow, I better get on top of this oral microbiome, uh, issue. You know, especially if they're in the prevention mode or if they've already started to see some, some issues. [00:44:00] Um, what's like a three step checklist to start supporting?

Adam Rinde, ND: Oral microbiome at home. What? What would be a good way to start?

Toni Engram, DDS: I think some great, easy ways, I mean. The basics when you brush. I do think we want to keep the, the biofilm thin, so I really like a Sonicare as a toothbrush. I think the electric toothbrushes do work better. You do get your money's worth. Um, I really like tongue scraping, so if you've never been a tongue scraper, I promise guys it will change your life. It'll end your breath. there's a ton of bacteria that likes to live in all the little nooks and crannies of your tongue, and you just can't get them out. You can't get them off nearly as well with just a toothbrush. So the tongue scrapers do an amazing job. [00:45:00] Um, so that, you know, just basic, like normal oral hygiene stuff. Um, some other really easy, simple things that you can do is just getting. Xylitol products that you like.

Toni Engram, DDS: So gums or mints, or candies or sprays. Anything with xylitol and xylitol starts with an X. Um, so xylitol, it's a plant-based sweetener. It is a sugar alcohol that's similar enough in structure to sugar, that the bad bacteria will ingest it. They'll take it in, but they can't metabolize

Toni Engram, DDS: it, so they wind up kind of dying off over time. So over time, it's just a great shift in the microbiome that selects for more of those. Helpful bacteria. Um, and in the short term it also raises the pH of your saliva. So, you know, anytime you have something acidic or if you have a treat or something like that, then xylitol can help reverse those negative effects too. [00:46:00] Um. Then a third. So oral hygiene xylitol, and then there's some good oral probiotics out there now, and that's just so easy. They're usually in tablet form. It's not the same. When I say probiotic, I don't mean a capsule like you take for your gut health. The capsule is designed to absorb. The, the acidity of your stomach and make it down into your intestines. Um, an oral probiotic is gonna be in tablet form and it's meant to dissolve in your saliva. So they're usually in mint form. Um, it's gonna be a tablet. They're, you know, mint flavor fruit flavored for kids and stuff like that. Um, but those are just really easy ways to make these positive shifts over time.

Adam Rinde, ND: That's great. The, I I really like that, those practices. Um, and it's great to hear about that tongue scraping actually, you know, is actually does something therapeutic, you know, I mean I obviously, I've heard about it for improving breath, but it's [00:47:00] great to hear that it's actually restorative, you know, for the microbiome.

Adam Rinde, ND: Um, the, I have to, my, the skeptic in me always gets a little bit puzzled about oral probiotics because I take them. And I'm always just so confused as to how this, this probiotic is, is actually sticking around where I want it to stick around. Like

Adam Rinde, ND: do I, do I take it at bedtime? Do I take it, you know, after I brush my teeth, do I, is the last thing I do is, is there a sequence for it?

Toni Engram, DDS: I think it's, you know, you're right. You don't wanna kill, just like any probiotic, you don't wanna kill it off as soon as you take it. Um, so I think right before bed, after you've done all your other oral hygiene stuff, I think that's a good time to take it. Or, you know, in the morning on your way to work. After you've already done all your your morning routine

Toni Engram, DDS: stuff, I think that's a good time too.

Adam Rinde, ND: Excellent. [00:48:00] Well, great. Um, so we've talked a lot today about, you know, the. Different aspects and alluded to, you know, the, the major aspect of having, um, uh, sort of oral microbiome imbalances and, and chronic disease, and you, you have a special interest in autoimmunity. Um, uh, before we leave today, I just, I'd like to hear a little bit about, you know.

Adam Rinde, ND: Where you're at with working with autoimmune patients and sort of how that fits into your practice.

Toni Engram, DDS: Mm. Well, you're right. That's personal to me because that's how I got started in biological dentistry was after I had my own autoimmune illness. And man, just western medicine didn't gimme the answers that I needed. Um, and so what shifted for me is when I realized. How [00:49:00] similar because I did, by the way, I did find ways I had to go down all the rabbit holes myself.

Toni Engram, DDS: I didn't know about functional medicine. I didn't have a, a naturopath that, that I knew I could go to. I was just new to the whole holistic world. Didn't even know what it was. Um, but I did find ways that nutrition and lifestyle and managing my own stress, um, I did actually heal and get better and weaned myself off of all of my medications. Over a decade ago. Um, so, so grateful for that because I know that's not everybody's story. Um, and what really made the shift in my career was when I saw, when I started just making these correlations and seeing how similar it was, um, the. Yeah. Crohn's disease is, is what I was diagnosed with. It's an autoimmune condition. Um, but it's an inflammation in the gut caused in part by a, a dysbiosis in the gut. Um, [00:50:00] you know, when I, when I finally got bad enough that I, you know, had terrible symptoms and got my diagnosis, it was. After I had taken some antibiotics for a sinus infection because I thought, oh no big deal. Let me just take some antibiotics and knock this out 'cause I'm tired of my sinus infection. Um, not knowing that that could potentially have negative consequences on the

Toni Engram, DDS: backend. Um, so man, if you think about inflammation and dysbiosis, and I just kept seeing it over and over again. I was like, well. Good grief. What I treat every day in my office is tooth decay and gum disease. It's all about inflammation and dysbiosis in the very first part of your gut, which is your mouth. Um, and so I knew, I was like, okay, if I can figure out. If I can figure out how to make myself well, when I know nothing, I don't, don't know anything about what I'm doing [00:51:00] here, um, then I have to be able to figure this out for my patients too. Um, and so again, not knowing where to go, not knowing if there were any dentists who believed this stuff too. Um, I started getting into oral systemic health and then, you know, my patients really started nudging me the rest of the way. Uh, we started talking about nutrition in the office and preventive strategies, and my patients would say things like, that's great, Dr. Toni, but what are you still doing with fluoride?

Toni Engram, DDS: Like, why are, why are you still using this stuff? I'm like, oh, well the ADA says blah, blah, blah, blah, blah, blah, blah. Um, and the more they would challenge me, the more I would have to look stuff up and dang it, learn new things. And so

Toni Engram, DDS: that's what shifted the practice really.

Adam Rinde, ND: Amazing. Yeah. So it's, it reminds me, you know, that the, everybody always talks about, well, all disease begins in the gut. Right. [00:52:00] And that's like a, a, a common saying. But I think, you know, just connecting like this, uh, concept that, you know, and the mouth, you know, it's, we,

Toni Engram, DDS: Which is the mouth. Yeah, the gut. Which is the

Adam Rinde, ND: Exactly. It's the first, and you know, it's the first part of the digestive process, you know, the cephalic phase.

Adam Rinde, ND: And so we have to, it's one of the beautiful things about the work that you do and integrative providers do, is it's like not these separate parts of the body that have their own domain. You know, it's like the connections, the holistic approach. So this has been wonderful. Um, I could talk to you about so many things, uh, related to this topic.

Adam Rinde, ND: And I know we only have so much time. Um, so before we. We wrap up. I, I want to hear a little bit about Flourish Dental and your work and some of the things that [00:53:00] you, you want our listeners to know about. That would be great. And then if you could leave us with, um, just revisit a couple, two small daily practices that can improve oral health or overall health.

Toni Engram, DDS: Um, so Flourish Dental. Flourish Dental Boutique is the, the name of my practice. Um, right now we have one location in Richardson, Texas, which is just outside of Dallas, and we're opening a second location, hopefully early next year. Um, so hope. I'm trying to get that open and going quickly. Um, so maybe in the next few years there will be a Flourish Dental Boutique near you.

Toni Engram, DDS: But, but happy in the meantime for any of you to come visit us in Dallas. Uh, we do have patients who travel in all the time, so we would love to see you once we get everybody healthy. You know, it doesn't, it doesn't take just a ton of time in the dental office. You know, you come, come see us a couple of times a year and we're happy to help you, [00:54:00] um, get well and then send you back to your regular dentist if, if you're super far away. Um, so happy to see anybody. Our website's www.flourish.dental um, and I spend a, a good bit of time on YouTube and Instagram. Instagram's probably our most active platform right now. And that's just my name. It's @drtoniengram Um, so happy to see you there as well. We have an online course. If anybody wants to go through like a DIY, do it yourself. Reverse that cavity process or if you've got kiddos that are struggling with cavities. I've got an online course called The Cavity Cure, um, and you can find links to that on our website and on our Instagram as well. Um, really, if I could just. Leave your audience with the most important takeaways. Um, so yes, I love nasal sprays.

Toni Engram, DDS: I love mouth taping. I love, um, [00:55:00] brushing and flossing, even though that's not sexy anymore. I get it. Um, I love tongue scraping. I love all things xylitol. Xylitol is my friend. Um. I, we didn't even talk about toothpaste ingredients. Um, so fun fact and maybe controversial with your audience, maybe not. Um, but you don't need fluoride to prevent or treat cavities.

Toni Engram, DDS: Believe it or not. It is not an essential nutrient. And so, um, I try to get all of my patients on a good remineralizing toothpaste. My favorite ones, the most effective ones have calcium hydroxyapatite in them. Um. So look for, for those ingredients. And if not, then just look for good clean ingredients that you can, can pronounce, you know, nothing crazy.

Toni Engram, DDS: You don't need a bunch of weird chemicals in your toothpaste. Um, but most importantly, most importantly, I want everybody to know that your teeth, your mouth, the rest of your body. [00:56:00] You were designed to heal. So if you take nothing else away, um, just know that, that you're designed to heal. You can get well from cavities, you can get well from gum disease, you can heal from so many things.

Toni Engram, DDS: Um, if you just give the body what it needs, give it the support it needs, um, it, you don't need to knock out symptoms with a bunch of chemicals and pharmaceuticals and surgeries. So that would be my, my lasting takeaway.

Adam Rinde, ND: Amazing. That was such a great way to conclude For today, I thank you for being here.

Toni Engram, DDS: You bet. Thank you. I'm so glad to be here.

Adam Rinde, ND: Thank you so much for listening to the episode with Dr. Toni Engram, where we went into all aspects of the oral microbiome, saliva breathing, and talking about the connection of oral health with systemic disease. I think at one of the takeaways for this is just how important it is to have these practices [00:57:00] in place, uh, as our daily routine and all the different.

Adam Rinde, ND: Concepts of, um, how to nourish the oral microbiome and nourish our gum health and, uh, practice breathing in a way that supports our oral microbiome and supports our overall oral health. And these are really useful tips and what I'd like to do is see if the audience can, um. Apply some of these, uh, techniques or strategies that we talked about today and put together, uh, say a routine and in order of how you do the routine, and if you could place that routine, say on the counter of your bath bathroom sink, and take a picture of the oral products that you do and describe your, your dental hygiene [00:58:00] routine.

Adam Rinde, ND: Take a picture and tag the, uh, IG @onethingpodcast. And if you could do that. And what I'll do is I'll select one winner from those pictures and I will send out one free testing kit for testing your oral microbiome. So please do that. This, uh, contest will. Last for two weeks after the launch date of this episode.

Adam Rinde, ND: And so just listen for this and if you've heard this, the where you want to tag is one thing podcast on Instagram at One Thing podcast. So looking forward to that and uh, looking forward to sharing future episodes with you. Thank you for listening to the One Thing podcast.