Dental Health, the Oral Microbiome & Rheumatoid Arthritis: Episode 57 of the Arthritis Life Podcast

What’s the deal with rheumatoid arthritis and dental health?

On Episode 57 of the Arthritis Life Podcast, Dr. Victoria Sampson explains how oral health, the oral microbiome and rheumatoid arthritis inflammation are all interrelated.

She provides ample details about why people with rheumatoid arthritis should take extra care with their oral health, and explains how altering the oral microbiome can potentially lead to improvements in RA disease activity.

Episode at a glance:

• How rheumatoid arthritis can lead to gum damage and why flossing is so important
• Cheryl and Dr. Sampson’s tips and life hacks for flossing, brushing and other oral health care when you have hand pain
• Specific action steps people with RA can take to improve their dental health and oral microbiome
• What it means to be a holistic dentist or integrative dentist
• What is the oral microbiome and why should people with rheumatoid arthritis care?
• How oral health may affect one’s experience with Covid19
• A case study of a patient with severe RA who had dramatically positive response to changing her gut and oral microbiome, as well as overall RA disease activity, through diet and oral hygiene habits. 

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheumatoid Arthritis Roadmap, a self-paced online course Cheryl created that teaches you how to confidently manage your physical, social and emotional life with rheumatoid arthritis.

 Rheum to THRIVE, a community support & education program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. The next group starts in April 2022!

Speaker Bios:

Dr Victoria Sampson

Dr Victoria Sampson obtained her Bachelor in Dental Surgery from Barts and the London. She is now known for her work in developing salivary diagnostics, microbiome testing and incorporating artificial intelligence into every day care. Her work has been acknowledged worldwide resulting in her becoming a scientific advisor, board member and clinical lead of multiple dental companies globally.

Victoria has been at the forefront of change in dentistry, by undertaking research projects and taking a special interest in the relationship between the mouth and the body. She has published numerous papers both in the UK and internationally, with her most recent publication in the British Dental Journal being the most cited and viewed article ever published. Most recently, Victoria was shortlisted as one of the most promising young scientists in Europe for the Forbes 30 under 30 in Science and Healthcare 2021 for her efforts and devotion to healthcare. She is the first dentist to ever shortlist for Forbes.

Victoria currently splits her time between two private dental practices based in Harley Street and St James’ Park as well as heading two clinical trials.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for nineteen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

• Links to things mentioned in episode or additional listening
  • Why should you care about your oral microbiome article
  • Periodontal disease and RA article
  • What is the microbiome – from Harvard.edu
  • Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? Article from Nature that Dr. Sampson contributed to
• Dr. Sampson’s social media: @drvictoriasampson on Instagram
• Cheryl’s Arthritis Life Pages:

• Youtube channel

• Instagram
• TikTok
• Arthritis Life Facebook Page
• Cheryl on Twitter:
• Arthritis Life Podcast Facebook Group

Full Episode Transcript:

Interview between Speaker 1 (Cheryl Crow) and Speaker 2 (Dr. Victoria Sampson)

[Introductory music]

Hi! My name is Cheryl Crow, and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen life hacks, and how to respond when people say, “You don’t look sick”, stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness — no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started.  

Cheryl:

I’m so excited today to have our first dentist to come on to The Arthritis Life podcast. And this is Dr. Victoria Sampson! Welcome.

Dr. Victoria:

Hi, thank you so much for having me. It’s really exciting to be the first dentist.

Cheryl:

Yeah, yeah. And can you just give the audience a quick introduction to yourself, like where you live? And what kind of, I guess, what kind of dentistry you practice?

Dr. Victoria: 

Yeah, so I’m a dentist. I live in Central London, I work private — so, I’m a private dentist, I work in two clinics in London. And basically, my journey into maybe the more holistic side of dentistry started during COVID. In the first few months of COVID, dentists weren’t allowed to work, everything was shut down. And I found for like, the first time in my life, I had a lot of time to do nothing, and I didn’t know what to do with myself. So, I started to do a lot of research. And I just locked myself up in a room. And I started writing a very big paper on the potential connection between COVID-19 and oral health. And what we found was that actually, poor oral health increases your risk of gum disease — sorry, poor oral health increases your risk of COVID complications by nine times. And really, you’re much more likely to go into ICU. And we found that it was the same kind of inflammatory markers that were increased in gum disease that are also increased in COVID. And so, if you get COVID, it’s just like multiplied by 10, because you already have inflammation in your mouth. And so, that really opened the doors for me into a whole world where I was like, wow, I mean, yes, we’re, we’re cleaning mouths, we’re trying to stabilize the oral health. But actually, the implications on the rest of the body are huge. 

And that’s where it just completely — I started doing microbiome testing, I started to look into the saliva a little bit more to understand what bacteria does in your mouth, and how it can be found in other parts of your body. And then other people heard about me, because I was the only dentist who was doing these types of things. And particularly with rheumatoid arthritis, I had two health care clinicians. They’re both functional medical practitioners. And they started referring all of their patients to me, because they were doing everything else. But they had absolutely no idea what was going on in the mouth. So, they would send these patients to me with these incredible, you know, they were doing all the blood tests, everything; serum levels, all of it. And they were like, “Look, can you just take a look in their mouths and just make sure that they’re okay?” And lo and behold, all of the rheumatoid arthritis patients had some element of gum disease, and they had inflammation. And what we found was that when we were improving their oral health and reversing their gum disease, it was having really great consequences on the rheumatoid arthritis as well.

Cheryl: 

That’s incredible. And I’m always curious, like, what direction the causality goes, you know. Like, does RA cause you to have poor, you know, gum disease? Versus does gum disease maybe cause you to be more likely to have RA? So, what I mean, I guess — you know what, we should probably just start with the very basics. Sorry, I’m just thinking out loud. So, and then we can go into the nitty gritty details, especially with COVID. Because I think that’s such a hot topic right now. Of course, we’re recording this in January 2022. But what are some of the basic things people with rheumatoid arthritis should just know about how their oral health or their dental health is, maybe in their gums, are affected by having rheumatoid arthritis?

Dr. Victoria: 

So, I mean, there’s kind of a short-term or a long-term. So, in terms of the short-term, it’s having inflammation in your mouth. I mean, we know that rheumatoid arthritis is essentially inflammation elsewhere in the body. It’s an attack on your own body essentially. And so, what we found is that actually that same inflammation and the same kind of idea of your body attacking itself is found in gum disease. So, it is — you were saying, you know, “Is it one direction? Which one causes which?” It’s more bidirectional. So, if you have gum disease, you’re more likely to have rheumatoid arthritis. But also, if you already have rheumatoid arthritis, it’s going to get worse. And if you have rheumatoid arthritis, you’re much more likely to have gum disease. That’s kind of the more, I would say, the very simple short-term thing where if you are diagnosed with rheumatoid arthritis, and you’re early on, the — in my opinion — one of the first things to do is make sure that your oral health and your hygiene is absolutely optimal, because you are at a much higher risk of getting gum disease, decay. Because a lot of the time the medications that you’re taking can dry your mouth out. And so, if you have a dry mouth, you don’t have saliva, and saliva is extremely important for lubricating the mouth but also, its antibacterial and it will reduce your risk of decay. So, no saliva means no kind of attack — or sorry, no defence system against any sugar or anything like that. 

And then if we go into the more long-term, there will be patients unfortunately who may be diagnosed quite late on with rheumatoid arthritis, patients who are not able to brush their teeth as well as they may have wanted to purely from a kind of physical such issue. And again, for those types of patients, it’s kind of a self-perpetuating cycle because you’re more likely to have gum disease but you can’t brush your teeth and it just gets worse and worse and worse. So, if you get into very good habits from the very beginning, I would recommend that you see your dentist much more regularly than you would have usually pre-diagnosis then when, God forbid, your rheumatoid arthritis maybe gets worse. You’re in a much better position to take care of yourself and you won’t be as kind of, you don’t have as much inflammation in the body.

Cheryl: 

That’s so helpful and I honestly think it’s not something that most patients are told. I mean, I certainly have a family history not have rheumatoid arthritis but of, you know, gum disease and just kind of even with good oral hygiene still having some complications. And so, I didn’t even know that my, some of my personal dental issues were related whatsoever to rheumatoid arthritis. It didn’t make any sense to me. Like, you just explained it perfectly, but just no one necessarily took the time earlier, so I’m so glad that we’re doing this to educate patients. And so, you mentioned that the inflammation that’s like the overall disease process for rheumatoid arthritis where the body is mistakenly attacking healthy tissue, like includes the body in rheumatoid arthritis attacking the previously healthy tissue in your gums. Is it — and then what happens with the actual teeth? Is that more the issues with teeth in rheumatoid arthritis come from the dry mouth and lack of saliva? Okay, okay. I’m just trying to break it down in my head. So, really is, I think if you’re like, again, I think of my dental routine is like, okay, I’m brushing my teeth and I’m flossing my gums. Like, those are like the two kind of goals. And so, they are both separate processes, though, and really, really important. Like, you can’t make up for — or is this right to say you can’t make up for poor gum care by just brushing more? Like, you have to actually floss? Is that right? 

Dr. Victoria:

Yes. 

Cheryl:

Okay, yeah. I’m paraphrasing what my own dentist has told me.

Dr. Victoria:

No, no. 100%. I mean, a lot of people think — I mean, brushing twice a day is the absolute basics. And if you can brush twice a day well, then you’re actually doing a pretty good job. You’ll be shocked at how few people brush their teeth well, or for two minutes, or twice a day. Like, everyone says they do it but they don’t. And more importantly, the flossing is extremely important because 30% of bacteria is actually stuck in between your teeth. So, every time you brush your teeth and you think, “Wow, I did a great job today,” you’ve actually only removed 70% of the food and bacteria and there’s still 30% left.

Cheryl:

Oh, my gosh. You know what really convinced to me? I mean, I am actually very, in general, like, I’m by nature like a compliant person. Like, you know, as a child I did what the teacher said and like so, I mean, I try. But I was good about brushing and I would floss but I would do it halfway. Like, I would just be like nyeh, nyeh, nyeh, nyeh, nyeh. Like, not really paying attention to what I was doing and like flossing, not flossing the gums, just flossing kind of the bare minimum. And then yeah, the dentist explained what you just said, like you’re literally — like, you’re getting a C. You’re getting 70%. You know, you want to get an A. So, think, an A student, people like me, are hopefully convinced by that. But and I think that the barrier sometimes is the physical act, right. When you have hand pain, stiffness, soreness — I remember when I said, “Oh, I’m using these picks, like these little floss picks, because they’re easier for me to hold than wrapping a piece of floss around,” and I remember my dentist saying, “Oh, it’s really better to wrap it around.” But I’m like, then you have to say cost benefit analysis. Like, if I’m actually just not going to wrap the floss around my fingers because it’s uncomfortable, it’s better to at least get that floss pick up there as much as I can, you know. But what I know as an occupational therapist, there’s a lot of like gadgets and life hacks for flossing in particular and brushing, but from your — since you’ve been working with RA patients as well, what are some of the things your patients have told you that’s helped them, or what are some things you’ve discovered that help them with the physical act?

Dr. Victoria: 

So, because generally, they’re, you know, patients with RA are maybe not as, as you were saying, they cannot brush or floss as well as they would like to. I always increase the recalls for any patient who has been diagnosed with RA. So, that means that I’ll see these patients far more regularly for hygiene visits. I’ll actually usually book them longer as well, because I just feel like if they can’t brush well enough at home, at least someone should be getting into those crevices and cleaning every three to four months. And one of the biggest problems with gum disease, and this is why I think there’s like this kind of very nonchalant like, “Oh, it’s fine, I’ve never flossed and I’m fine. It’s okay,” is that gum disease is caused by a combination of a few factors. One is having bad bacteria in your mouth. And that’s usually caused by, you know, poor oral hygiene or maybe a diet filled with carbs and sugar and etcetera. But also, a very important one is actually your host response. So, how your body reacts to bacteria and etcetera. And so, not only an RA, but in a lot of different kind of medical issues as we maybe diagnosed with things like diabetes, with Alzheimer’s, with arthritis, etcetera, our body’s ability to fight anything is reduced, you know. So, for example, if you have even diabetes, you are much more likely to fall ill. If you grow older, you’re more likely to get pneumonia. And so, gum disease is exactly the same thing. So, you might have been chilling until you’re 45. You’re like, “Psh, I don’t know what they’re talking about. I don’t need to floss; I don’t need to brush my teeth. I’ve never had a cavity and I’m great.” But if your body’s immunity starts to get impaired, and that host response is reduced, then it will kind of spread like wildfire and it can get really bad really quickly.

Cheryl: 

That’s so good to know. And it really is one of those ounce of prevention is worth a pound of cure things, right. The more you can get.

Dr. Victoria:

100%.

Cheryl: 

And I will say that, you know, my gums used to bleed every time I would, you know, go to the dentist and once I improved my technique of flossing. I still use — I’m calling them picks, they’re like little pieces of plastic that hold the floss?

Dr. Victoria:

It’s like a harp.

Cheryl: 

Yeah! Yeah.

Dr. Victoria:

I don’t know what to call them.

Cheryl:

Yeah, and I also use —  there’s also a thing that’s like a little stick. I think it’s the brand is just Gum, like G-U-M. It’s a stick that has like a little swirly thing around it so that you just put it between after flossing. So, like my dental my routine is like five steps. It’s like, I brush with a Sonicare, then I floss, then I use the floss pick, then I rinse with the fluoride rinse, and then I put the thing, Clinpro 5000, I don’t know if it’s an American thing or if they have it over there. But it’s like a fluoride — just you put it on at the end and leave on, you don’t rinse it out. And once I started being, instead of just doing a two-step just brush and floss, when I started doing not just flossing, but improving the flossing technique to actually floss the gums like get all the way around, hug each tooth on each side, I don’t bleed at all when I go to the dentist now. So, I’m just saying that to the people who are like, it can feel the sense of like defeat sometimes. I’m just, maybe I’m projecting but, you know, I remember at one point at the dentist I was like, “Oh, my gosh,” I feel like I’m being so defensive right now but I was like, “I know people lie when they go to the dentist and they say — but I’m telling you the truth. Like, I brush with a Sonicare twice a day and I floss every day. Like, let me — like, what else can I be doing?” And that’s when they’re like, it’s not enough just to floss to check it off your list to be like du-du-du-du-du. You know, you have to actually really floss. It’s like my dad used to say, coaching me in sports, “Practice doesn’t make perfect, only perfect practice makes perfect,” like in the sense like you could do something over and over and if you do it poorly, it’s not helping you. So, sorry. Sorry. But a little side note there, but, um, but —

Dr. Victoria:

No, 100%.

Cheryl:

Yeah, I just want people to know that you can improve it, even if you have these risk factors. I know you’re saying that too, that you can — Yeah.

Dr. Victoria: 

Another thing that I do with my RA patients is, I mean, you were saying that you use a Sonicare toothbrush. So, I think electric toothbrushes is an absolute must for any patient really, but particularly those who may have impaired mobility, or are not able to get to the very back teeth very easily. An electric toothbrush just it helps you so much. So, there’s a few that on the market which I really like. I like the ones which have small toothbrush heads, we’re not going to advertise any brands. But we know the big dogs, the big dental companies, and they’ve all got pretty good electric toothbrushes. Just make sure that your electric toothbrush is rechargeable. So, not the battery charged ones, you need to have an actual charging port. Ideally —

Cheryl:

Why is that better? Oh, sorry.

Dr. Victoria:

So actually, it’s just not as effective. So, the battery charged ones do not have the same movement and the same intensity of vibrations. So, you want a chargeable one with a small toothbrush head, so nothing too big. The idea being that with a smaller round head, you can kind of reach each tooth and give each tooth it’s kind of TLC that it needs, as opposed to a really fat toothbrush where you’re like, “Yay, I just brushed the whole side of my mouth,” and you actually didn’t. So, small head, obviously change that head maybe about every three to four months. And then also if has a pressure sensor, I find that really great as well. So, you can see when you’re brushing, definitely watch yourself in the mirror. Time yourself for two minutes. Most toothbrushes have timers now, but the pressure sensor will blink red when you’re brushing too hard. And some patients have the inclination to brush a little bit hard thinking, “Oh, if I brush hard, I’m brushing well,” and actually it gets to a point where you start brushing away your enamel, and you brush — and it’s actually quite dangerous and not very good. So, you want a pressure sensor, which will kind of train you to brush at exactly the right pressure. So, you’re completely 100% right with that one. 

Floss, if you can use a string of floss or floss harp, or both. Some people use floss at the front and then they use a harp for their back teeth. Whatever works for you. That’s how — that’s what I do. Because I find it difficult to get to my wisdom tooth, so I use one of the harps. And then in terms of toothpaste, because you may have a dry mouth because of your medication, I would go for quite a high kind of highly remineralizing toothpaste. So, one that has a lot of calcium phosphate fluoride. I know that I’m sure I’m getting it all the time these days, a lot of patients are fluoride-free. And that is a whole debate that I’m not going to go into. But what I do give I always give an option of a fluoride-free toothpaste too. All I am concerned about is that it’s remineralizing. So, it needs to have calcium and phosphate and hydroxyapatite. If it’s not going to have fluoride, then you need to at least have those minerals inside your toothpaste.

Cheryl:

That’s super helpful. And the thing I would add for the toothbrush, in addition to obviously, using a vibration one or electrically vibrating one. That’s good to know that I happened to have a rechargeable one, I was just curious why the battery one was not the optimal one. But there are gripping aids. So, if you still have a hard time grasping the electric toothbrush, there are aids. I have one called Easy Grip or Easy Hold, and it goes around either corner of your device. Well, it goes around anything. It’s like a universal thing so you can put it around a hairbrush or a toothbrush and you’ve slipped it, it ends up so you can just slip your hand through and then it looks like a little like a — it’s effectively like a Velcro strip. But it’s actually made out of plastic. I can show you this. This is terrible to try to have describe this on a podcast but I know the life hacks are like so essential, but it’s like very hard to put them into words. But maybe I’ll put a little visual aid along with the show notes for this episode. 

But there’s also things called like a universal cuff that are used for like spinal cord injury, when people really don’t have — they can maybe move their shoulder, but they can’t move their hand very precisely. These gripping aids are great because then you can use those like gross motor movements and kind of get it into your mouth if you don’t have that grip strength or you just have too much pain. So yeah, that’s just another thing to think about. And there’s actually a lot of people find that wider grips are helpful. Like think, you know, that’s why we have like a wider grip toothbrush. But for floss, usually it’s tiny little pick, right, or the harp but there are — I actually have one that I mean, I’ve been meaning to do a video on. It looks like the bottom of a toothbrush, like a wide toothbrush, and at the top is the floss harp. So, it’s like a wide grip flosser for people who again, have either from like a deformity or just from, you know, pain and stiffness can’t really get that full pincher grip with their thumb and their pointer finger. So, those are some other things. Another thing I was going to ask because my husband bought one of these and then like, just one of those things that we just, he didn’t use it. But the Waterpiks, what do you think about water flossing? Is that as good as real flossing?

Dr. Victoria:

No, it’s not. I mean, a Waterpik is a great adjunct or in addition to your, you know, classic brushing and flossing. And particularly again, if you’re having limited kind of mobility and issues gripping things, maybe a Waterpik would work quite well. However, it’s not — it doesn’t get in between the teeth as well as a good old-fashioned piece of string does. So, floss will always win in my heart. But you know, if a patient wants to have a Waterpik as well, and they feel — some people are like, “Oh, I feel so great after using a Waterpik.” I’m like, yeah, go for it. Do your thing. Like, if you enjoy it, it’s not causing you any trauma or anything. But it’s just not replacing your need for flossing. And it’s definitely not replacing your need for seeing the hygienist. I think some people who have got a Waterpik are like, “I don’t need to see the hygienist,” and I’m like, no, no, no, it’s not the same thing.

Cheryl:

Oh, yeah. Yeah, I would definitely agree like the, especially the scraping they do. That’s very specific. I’m like, I don’t think I could do that. And so, I’m making a little list as we’re talking, you know, the most important things for people to do with RA for their dental health, like we have brushing well twice a day, flossing well, using the right toothpaste, and obviously controlling their overall inflammation or their overall disease activity. And what about, like, diet in terms — I know diet is a giant rabbit hole, we could go down to some types of disease and control, but what about like, what things do you recommend in terms of — I mean, obviously know that I’m told, you know, don’t eat too much sugar or don’t put leave a lot of sugar on your teeth. You know, like if you’re gonna have something sugary lithium, one of things my dentist told me is just rinse your mouth out really well after. Like, even just swish with water after you eat something, even something that’s not quote-unquote, like an ‘unhealthy’ food like raisins. They’re healthy because they’re like a natural food, but then they just grind into the spaces between your teeth and leave sugar on them. So anyway, what would you say about dietary contributors?

Dr. Victoria:

So, what I do with a lot of my patients is I’ll look at the bacteria in their mouth, and I’ll specifically prescribe or recommend certain foods based on the bacteria that they have in their mouth. So, for example, if they have high levels of a certain — the bacteria’s called Fusobacterium nucleatum, I will recommend that they actually have green tea once a day. So, generally, I can’t give like specific, you know, a general diet, it’s all kind of more specific, but green tea is really high in catechins, so it’s quite good for, um, it’s very good anti-inflammatory. Turmeric is also great. They stain your teeth, but if you’re coming to see the hygienist every three to four months then you should be okay. I also, with supplements, what I recommend, particularly an RA, is the classics. So, you’ve got your calcium, your vitamin D, I mix K2 in there too so that you’ve got better absorption, but also CoQ10. So, I’ve actually, I’m actually publishing a paper right now. Right before this podcast, I was just like editing and rejigging things, but basically what we’re finding is that CoQ10, or Coenzyme-Q10, or it’s also called ubiquinone, is a really great antioxidant and a great supplement for gum disease and for inflammation generally. So, it helps to combat oxidative stress and inflammation in the body. And what we’re finding is that actually as a result, because gum disease is inflammation, it’s improving results massively in gum disease patients too. So, I’m all up for CoQ10 as well.

Cheryl:

Wow, I just had to google that. I don’t think I’ve ever heard of it. So, that’s really — that’s like hot off the press. 

Dr. Victoria:

Yeah! [Laughs]

Cheryl: 

Really exciting. No, there’s so —

Dr. Victoria:

It’s like an insider secret for you guys. 

Cheryl:

Oh, yeah. Wow, we’re the first to know.

Dr. Victoria:

You heard it here first. 

Cheryl:

Wow. Oh, that’s so —  I think so many patients, including myself are like, you know, just tell me, I want to do everything I can. I mean, I even asked my dentist once ’cause I had gotten a couple of cavities and I was getting really frustrated because I was just like, I’m literally, you know, it’s a hard feeling to feel like you’re doing everything right and you’re still having issues. And I might talk a lot about acceptance on the podcast, and like at a certain point it’s important to come to a place of like this is just what it is. But you know, I said, “Look. Like, if I need to come and like private pay to come like more frequently, I’ll come every like month or every two weeks.” Like, what — tell me, you know, like, it’s hard to feel like, you know, you don’t have that many things you can control. But things like you just mentioned, you know, different supplements and knowing that what you’re like, what’s prescribed for you is actually based on your unique microbiome, that’s really exciting. Is that something that’s available in the US, do you know? Like, I don’t, I haven’t heard of anyone doing that here. Okay. Let me know or I’ll bring you over. [Laughs]

Dr. Victoria:

Well, that’s, I mean, as far as I’m aware, no. There are dentists who definitely treat patients in a much more holistic way. And I work with some of them, and they are based in America. So, there’s one called Ask The Dentist, Dr. Mark Burhenne. He’s pretty cool. There’s a few. Steven Lee; there’s quite a few but they, they don’t do microbiome testing and like trying to alter your bacteria, but they see you — it’s kind of a new trend in dentistry. It’s called like functional dentistry, holistic dentistry, or biological dentistry. And it’s this idea that, just like functional medicine, where it’s a little bit maybe off the beaten track, where we’re kind of like, actually, sometimes Western medicine is not 100% the answer. And if you can combine that you need to know the knowledge and you need to understand Western medicine, but sometimes, like diet and nutrition, you know, habits, those types of things are far better than just throwing medications at patients and hoping that, you know, they’re not going to react to them. So, it’s a kind of a, it’s a growing kind of group of dentists. And there are a few in America. But as far as I’m aware, no one does microbiome testing or modulating the bacteria like I do. But definitely, if you’re in America, you should check out Ask The Dentist. He has a website, and he’s got like a directory of lots, of a lot of different dentists around the world who kind of think in the same way and will treat you in maybe a more holistic manner.

Cheryl:

That’s really helpful. And, you know, I know that in a lot of our previous episodes, we’ve kind of had a theme of like, it’s not either-or, you know, it’s both-and. I think, why wouldn’t you want to know every tool at your disposal, you know. I’ve certainly had a really good reaction overall to Western medicine. And, you know, I feel fortunate to have been diagnosed during the era of modern medications that have totally changed the, you know, change the prognosis for rheumatoid arthritis. But that doesn’t mean that there’s — that, you know, that it 100% solves all my problems all the time, right, so.

Dr. Victoria:

Yeah, that’s the thing. Like, I agree, I mean, at the end of the day, like, there’s like a huge spectrum, right. You’ve got those, you’ve got the very — I don’t know, the class, I don’t know what type of doctor to call them. But the ones who just, if you come in with a headache, they throw painkillers at you. And if you come in with a — you’re tired, they give you iron, and they’re constantly just throwing things at you. And part of that is because of the you know, insurance and because of the way that healthcare is and Big Pharma and all of that. And then you’ve got on the complete opposite side of the spectrum. Some people who quite frankly, I don’t agree with the way they practice either, where they’re all about kind of oils, and, you know, seeds, and extracts, and stuff like that. And you’re like, actually, no, this patient’s got like heart disease, like they need more than like, grapefruit. Like, you know what I mean? And so, there’s a very good, like, there’s a middle where the clinician will assess the patient, will give them the medication that they need, but also try and get down to the source of it. And you know, if you’re tired, yes, give that patient iron if they need it. But why are they tired? What is going on in their life? Like, is there something that needs to be kind of looked into in a deeper way? And I think that’s the way that medicine and dentistry is going down, where it’s kind of more of a personalized medical or dental treatment plan and you’re actually looking at the patient as a person, not just as a insurance claim or something.

Cheryl:

Oh, that’s a mic drop moment there for sure.

Dr. Victoria:

Sorry, that got really deep. 

Cheryl:

No, I totally agree. Like, I’m just like, yes, preach. And yeah, I think that it is interesting. It’s just fascinating that dentistry is its own separate area. Like, I remember seeing someone make a funny meme that was like, you know, like, here’s the human body and that’s like, the mouth — like, that’s what the medical doctors look at, but it’s like, “Oh, not the mouth. Definitely not the mouth. No, no, that’s a different — that’s a totally different thing.” But anyway, but yeah, there’s this huge, huge surge of like functional medicine people in the Western medicine world and who have gone — people in the Western medicine world who have gone to like functional medicine or integrative medicine and I guess I hadn’t, until I saw and met you met you on Instagram, I hadn’t seen any other dentists go that route, but it totally makes sense. Especially if in autoimmune diseases, I know it’s not just RA but other inflammatory diseases, I know a lot of my listeners — now that I’m on this tangent — a lot of listeners have either like ankylosing spondylitis or axial spondyloarthritis or psoriatic arthritis. Do those have a similar relationship with gum disease? Or is it more specific to rheumatoid? Or do you know —?

Dr. Victoria:

As far as I — I don’t know. As far as I’m aware, no, not the same. There are specific things like with ankylosing spondylitis where like, there are certain ways that we might treat the patient differently in the chair just because they might not be able to go back the same way. But in terms of the pathogenesis, and how the disease is caused, and whether or not gum disease would contribute to that, I don’t think any research has been done. But rheumatoid, there’s a lot coming out right now.

Cheryl:

Yeah, yeah. And I know every year when I go to the American College of Rheumatology Conference, I always try to catch some of the presentations on the microbiome and rheumatoid arthritis in general, which are usually trying to kind of come to an understanding of what dietary, you know, contributions. So, what can I eat, right? I’m just like, tell me what to eat so I know what to do here. But what is the microbiome? Not everyone knows what it is.

Dr. Victoria:

Okay, so, similar to your gut, I think the gut microbiome has had the spotlight for many years, everyone knows their gut microbiome. They all take probiotics and they’re all drinking their kefir and all of that, but you’ve actually got multiple microbiomes all around your body. So, your skin is one of your microbiomes. You’ve got your vaginal microbiome, and the one I’m most interested in is your oral microbiome. So, that is your mouth. It’s everything inside your mouth; it’s the heart, it’s your teeth, it’s your tongue, your gums, your cheeks, the roof of your mouth. And interestingly, the oral microbiome has the second largest number of bacteria. The first is the gut. So, it’s got about 700 different species of bacteria, which make up 2 billion bacteria in your mouth alone. Now, what’s interesting about the oral microbiome is that it’s got lots and lots of different niches. It’s got — it’s like, imagine it’s a — it’s got multiple homes in the same, like, you know, area. So, you’ve got — because in the mouth, you’ve got teeth, which are hard. And it’s actually the hardest substance of the body. And then you’ve got the tongue, which is, you know, filled with all these tastebuds. And then you’ve got your tonsils, which you know, and if you can imagine bacteria and where they’d like to live, you can imagine that bacteria would want, you know, different bacteria is going to live on your teeth, then under your tongue, and on the side of your cheeks. So, you have a very, very varied microbiome in the mouth and you’ve got lots of different types of bacteria. And —

Cheryl:

Can I just stop just for one quick second, ’cause I don’t think everyone knows what the word microbiome means. It’s just the organisms that live in a place. Is that right? The microorganisms? 

Dr. Victoria:

Mm-hmm. Right, exactly.

Cheryl:

So, like, that microbiome on your skin is like all the little, you know, are they just bacteria or other, you know, other little things living on there? And so, you mentioned that there’s a vaginal microbiome, there’s the gut microbiome, and there’s the oral. So, I just — I just want to make sure because it is kind of word that gets thrown around but some people might be like, “What actually is it?”

Dr. Victoria:

Yeah, 100%.

Cheryl:

This is super cool. 

Dr. Victoria:

And so, what’s weird about the oral microbiome in particular is that it’s constantly subject to attack. Every time you drink, you eat, you smoke, you breathe; everything you do. You kiss, you name it, it usually is entering through your mouth before it goes anywhere else. And so, that means that the bacteria in your microbiome in your mouth are constantly changing, they’re evolving, they’re trying to fight off all of these attacks. So, you know, if you’re smoking 20 cigarettes a day, you’re gonna have very different bacteria to someone who, you know, is a sugar-free vegan and has never touched tobacco in her life. So, it’s very different between people. And the reason why the microbiome is such a hot topic — any of the microbiomes, your gut, everything — is because the bacteria, they work together, sometimes in what we call ‘symbiosis’. So, symbiosis means that they’re working together, they’re a happy family. You know, you’ve got your 700 species, and they’re all just like great family and they love each other and they’re feeding off each other and breaking down food and sharing between each other, etcetera. 

But then what can happen sometimes — and you have bad bacteria, sorry, in that. So, you’ve got your bad bacteria, your good bacteria, the good kind of keep the bad in place; the bad bacteria give the good bacteria something to do. You know, it’s like a whole little ecosystem going on. But what happens is if you start to introduce bad habits — smoking, drinking, eating bad things — or you’re taking specific medications, or you genetically are more predisposed to having specific bacteria in your mouth, or you have a systemic disease of some sorts. So, for example, rheumatoid arthritis or diabetes is a really big one, cardiovascular disease, etcetera, it will actually change that balance. And so, all of a sudden, there’ll be more bad bacteria than good bacteria. And the good bacteria can’t control the bad bacteria. And that’s when you start getting destruction. 

And that bad bacteria can cause a lot of — it can release enzymes which can break down bone or tissue in your body, it can release inflammatory markers which can cause inflammation not only in the gums but also this chronic low-grade inflammation which can travel through the rest of your body, which is why rheumatoid arthritis is quite a big issue or situation there. And there’s so many different kinds of connections with all of the bacteria and how they interplay with each other. So, everyone’s kind of role or a dentist’s aim is to achieve symbiosis and to get that bacteria into a good place. And that’s why everyone takes probiotics for their gut, because pro- and -biotic means its good bacteria. So, they’re drinking or eating lots and lots of good bacteria hoping that they they slide that kind of equilibrium back into symbiosis. And they have a happy, healthy gut and life.

Cheryl:

Yeah. And they live happily —

Dr. Victoria:

That’s your 101. 

Cheryl:

Yeah, no, that’s super, super helpful. And I know that there’s so many studies, yeah, that the microbiome is, you know, in people with rheumatoid arthritis, is out of whack. You know, basically, to put it bluntly, in the microbiome and the oral microbiome. Or sorry, the gut microbiome, the oral one. And for speaking from my personal experience, the skin, you know, can also be affected. So, the more we can do to promote that symbiosis, obviously, we want to do everything we can. Or at least most patients, what most patients do, and then we get to the point where we’re overwhelmed. And we’re like, “Ah! I can’t do anything more,” and can we just take a moment and then and then get back into it. So, I’m just curious, I know that you have a lot of special training — you’ve done additional research and training into this, but in general, is a general dentist trained to treat people with rheumatoid arthritis, or can understand their needs? Or is it something that, like, when someone’s looking for a good fit between them and their dentist, do you recommend that they find someone that has like specific experience with conditions like rheumatoid arthritis?

Dr. Victoria:

Well, so, no. I mean, every dentist should be trained to be able to treat pretty much all kinds of disorders or diseases or anything. There are specific ones which we may not be able to, you know, for example, I have a patient coming in tomorrow who’s got Parkinson’s, and I’m not sure if I’ll be able to treat her because she — and it’s, you know, because she can’t stay in the chair. So, there are specific situations where dentists are not trained, I’m not trained to treat that type of patient. And so, they’re wanting to go to the hospital to be treated, and probably under sedation, you know, those types of things. But as we were saying, you know, I don’t know about 10 minutes ago, we were talking about how medicine and dentistry, it’s interesting how it’s kind of been like chopped off, and like the dentists were like, “Great, we’ll take the mouth, and you guys take the rest of the body,” but we actually have to learn about all of the, you know, all of the medications. I remember, so, the first two and a half years of dental school are exactly the same as medical school. 

So, we actually learn all about, you know, the pathogenesis of different diseases of different disorders, everything. So technically, every dentist should be able to treat any RA patient. I would say that when you’re choosing your dentist, you want to choose one that is maybe more preventatively based, so someone who is very hot on, you know, hygiene and trying to — and understands that, whilst you may be okay right now and everything seems dandy, that you are at a higher risk of things going the other way. And so, to be a little bit, you know, over the top with the prevention and just like, I’m a bit extra, I’ll be honest with you. I’m like, “Oh, my God, we need to change your toothpaste, we need to change your toothbrush,” and they’re like, “No, but I’m fine.” I’m like, “Yeah, you’re fine now. But I want you to be, you know, I want you to be good for the rest of your life and I don’t want you in 10 years’ time to then come with me. And you’ve got four teeth falling out your mouth,” like, I don’t want that. So that’s where I think it’s you need to choose someone that you’re happy with and that you trust and maybe is a little bit more preventative than aggressive like cosmetic dentists who just wants to veneer everything. You don’t want that.

Cheryl:

Yeah, thank you. I realized that was kind of putting you in an awkward position. I just — I wanted to reassure people that it is part of the basic training of dentists. If you’re happy with your current dentist, you don’t need to like, run out and find some. But at the same time, it is important to know, like you said, what are some things to look for, you know. Someone might be moving or they might be, may not really be the most happy with the dentist. So, and I think, and I have a friend who’s a dentist and yeah, she’s always making sure people know. Yeah, basically the first couple years are medical school. You know, you are a doctor, it’s just doctor of dentistry, you know, so yeah. But I think another thing that I — that a good sign I usually look at is like, you know, whether the dentist like — I always want to remind them of the medications I’m on, I want them to really understand that I have rheumatoid arthritis. I’m not just — especially when I was a little bit younger… 

I mean, I’m 40 now but you know, like, you might just look at me and think, “Oh, there’s nothing going on,” you know,  and like, when I had a couple of like, for example, I once had a conversation — sorry, this might be helpful to someone listening — where I had two teeth that needed fillings side by side. And they were very, very back. And we had this kind of — at first the dentist was like, “Let’s just do them at once,” like at the same time. And because it’s like then you don’t have to come back a second time, you have to be numbed up a second time. But then they ended up taking so long that we ended up doing that, but my jaw was so sore that afterwards I was like you know what, next time I know from your standpoint of like, having to numb me up and make an appointment everything, it makes sense to do at the same time. But that for me, that was worse because then my jaw was like — and I had like actually a huge bruise. I never bruised before after like a dental procedure. So anyway, it’s things like a dentist that will work with you to problem solve like, “Okay, maybe next time we’ll do two separate appointments,” you know, that kind of thing? Yeah, just like with a regular, you know, your primary care, your rheumatologist, someone that you can actually have a relationship with, that doesn’t, like you said earlier, doesn’t just see you as like, Patient #42. Or, you know, dollar signs.

Dr. Victoria:

Yeah, exactly. And will remember these things. Exactly, definitely. Yeah.

Cheryl:

Yeah, this is all so, so helpful. Is there anything else that we didn’t touch on that you want to say to the audience? Mostly of people with like inflammatory forms of arthritis but some with juvenile idiopathic arthritis, or some just loved ones and family members of people with arthritis. Is there anything else that we didn’t touch on? It’s okay, if there isn’t.

Dr. Victoria:

I think, well, I can tell you quite an interesting case study if that would be interesting to anyone? 

Cheryl:

Yeah!

Dr. Victoria:

Yeah, this was what really opened my eyes to the connection between RA and gum disease. And I was just like, “Oh, my God,” like, it was just, I don’t know, like dentistry can be it’s very fulfilling, and I love my job. But sometimes, you know, it’s difficult to, like, people don’t love to see me. No one’s like, “Oh, I can’t wait to see my dentist, who’s gonna numb me up and like, you know, annoy my gums or give me a root canal,” or whatever it is. And this was one of the first times where I was like, “Oh, my God, I’ve actually really helped someone here,” and like, without sounding dramatic, like may have helped change their life. And so, I had a patient — this was about a year and a half ago — she was being seen by a functional practitioner. She had been diagnosed with RA about 10 years ago. And then, about two years ago, she was really sick and tired of just being, you know, medication after medication. She basically was — she had quite severe RA, she couldn’t really walk properly anymore. She was getting massive Baker cysts constantly. And she, like she had no energy she was and she was very depressed. And I think part of the problem is, from what I’ve heard from what you were saying, a lot of the problem is kind of acceptance and understanding that like, it’s not your fault. 

And unfortunately, this is, you know, you need someone who can hold your hand to help you because it’s, it’s not because you had a terrible lifestyle or habits. And I think that’s kind of maybe the most frustrating thing from what I can see for patients. But she was, yeah, very depressed and just like not happy. She decides to go down an alternative route, goes to this functional medic, who changes her whole diet, nutrition, adds lots of supplements to her. She’s on quite heavy steroids and very heavy painkillers as well, which is also altering her mood. And then she was getting a little bit better, but not that great. Then her functional practitioner was like, “Hey, you should meet my friend Victoria. She’s a dentist, but she does a lot on like bacteria in the microbiome and she’s very into this kind of thing. So, let’s try it out.” 

So, she comes and sees me. She’d lost 10 teeth within two years within those two years that I’ve not seen her, 10 teeth, and she was really upset. And she had quite bad gum disease on the rest of her teeth. There were a few which were like, “We don’t know how long these are going to last in your mouth.” And she had exact — she was like, I brush every day, I brush twice a day, I floss, I’m doing everything and like, I’m just so annoyed. And so, we did a microbiome test on her, we found that she had really high levels of certain really bad bacteria. So, I added a few supplements, changed a few things, made her use some specific mouthwashes to get rid of the bad bacteria. I recommended she actually brushed her tongue; she had a really, and that’s another thing — sorry, by the way, a lot of RA patients will have very furry tongues, and that can harbor a lot of bacteria. So yeah, get a tongue scraper. Don’t brush your tongue, scrape your tongue scrape. Brushing will actually increase make your tongue a little bit more furry. So, it’s weird. Yeah, it’s weird. So scrape, scrape your tongue. You can get this good metal like a stainless steel scraper, the antibacterial ones online and stuff. That’s what I recommend. 

Anyway, so she scraped her tongue, and where I was doing a lot of treatment on her and we were doing something which are called guided biofilm therapy. So, this is like spraying the gums and the teeth with an anti-microbial spray, getting rid of all the plaque and bacteria and etcetera. Long story short, we then did her microbiome test a couple of months later, and her microbiome had like, amazingly improved. And she was back to normal again. And I was also doing a lot of other saliva tests on her. So, we were looking at her collagen breakdown in her mouth. And collagen is what makes your gums and also a lot of your joints as well, and the cartilage, etcetera, is all connected through the collagen. So, if you have high collagen breakdown, that means that you have gum disease occurring in your mouth. And it can also be an indication of breakdown of cartilage or etcetera in the rest of the body. And so, when she started she was, her level was 80. And to put things into perspective, you need to be less than 10 to be healthy, above 60 is very bad. So, she was 80. It was the highest I’ve ever seen. And she was a very good patient and she was coming in constantly. And basically, six months later, she had everything retested. And she was off her steroids, off her painkillers. She was walking, she was actually cycling. I was like, all right, steady on tiger. But okay, go for it. [Laughs]

Cheryl:

She’s showing off now!

Dr. Victoria:

Yeah, I was like, whoa, okay, I don’t even like cycle to work now. But she was cycling. And she was super happy. And she now has an oral hygiene routine that she can maintain. She sees me every four months. She has not lost any teeth since she’s been with me. And we’ve basically gotten to like the base of the problem, which was all these high bacteria and etcetera. And what I was really impressed with was the fact that had I been doing this alone without the help of a functional practitioner, this wouldn’t have worked. It has to be in conjunction with someone else. And he was looking at her CRP levels, her inflammatory markers, even her ACPA, like everything had went down significantly to the point where she’s completely stable now. And it was just, it’s just an amazing thing that I’d never thought would have been, would have worked, but it really did.

Cheryl:

And my first question is, did she have to change her diet? Or was it all just the oral hygiene and the, you know —?

Dr. Victoria:

Diet too, so it was a two-pronged approach. So, the functional practitioner was doing all of her nutrition, etcetera. He put her on a lot of — he cut out her caffeine, he put her on some anti-inflammatory foods, you know, like really upped her, I don’t know, turmeric and those types of things. She had a lot of blueberries, I remember. And then I was, yeah. And then I was at on the other side, just focusing on her mouth and saying, “Look, let’s do this, and that.” And the reason why the oral health component was quite important was because she’d been seeing this functional practitioner for six months before me. And whilst she was improving, but not much. But the moment that her mouth was taken into consideration, and just something as simple as like brushing better, having a good hygiene, you know, those types of things. And as she tried to floss, she wasn’t flossing correctly. Like you were saying, not everyone’s taught that. And something as simple as that was able to completely change her whole kind of prognosis.

Cheryl:

That’s amazing. And the only reason I asked is just because I think that would be the question on most people’s minds, would be like, “Wait, can I keep eating all this crappy food and then just change my —?”

Dr. Victoria:

No. [Laughs] 

Cheryl:

No, darn it. We’re Americans. We’re always looking for the loophole.

Dr. Victoria:

Like, if I come to the hygienist every three months, I can just eat lots of chocolate and all the bad things.

Cheryl:

Oh, that’s so amazing. That’s so — I really do think, yeah, we tend to like separate different parts of our body, right? It’s like, okay, our joints are something totally different than our mouth, you know, and even like going to different specialists reinforces that. But really, we are part of one overall body system. And one of the little just offhand things, I did a training, I learned from a training on fatigue for occupational therapists, and one of the just offhand things that presenter said that always stuck with me is like, inflammation doesn’t like to stay in one place. Like, if it starts in your joints, it doesn’t like to stay there, it just travels, you know. But yeah, so they said, inflammation doesn’t like to stay in one place. And that was kind of like a clicking moment in my head, right. Because that explains why the inflammation might start in your joints, then it can travel everywhere else, like to your brain, to your mouth, you know, to your gut, and that’s the same. Like, it goes bidirectionally, like you said earlier, you know, from your mouth, it doesn’t like to stay in there. And actually, I knew that obviously that there’s collagen in your connective tissue and your joints, I didn’t know there was collagen was in your gums. I’d never heard that, so that’s super, super, super helpful. All of this is amazing. I know that the audience is gonna be wondering where they can find you. Of course, I’ll put your links in the show notes. But can you tell them your Instagram handle or whatever, where you would like them to go to learn more about you or follow you? 

Dr. Victoria:

Yeah, of course. So, I have an Instagram called at doctor like @DrVictoriaSampson. And I like to post quite — I mean, that’s how we met, was through my post on RA and gum disease. But I like to post quite a lot of fun facts and research on multiple inflammatory diseases and their connection with gum disease. I work in Central London, so if any listeners are in London or in England, you’re more than welcome to swing by and say hello. Yeah.

Cheryl:

That’s wonderful. And I really, really appreciate you taking the time, especially in the middle of doing an academic paper. I feel like — 

Dr. Victoria:

That was a great break. 

Cheryl:

Yeah. Oh, good. Yeah. You’re like blowing our minds. And you’re like, “Oh, this is the easy stuff,” yeah. No, I thank you so much. I know that everyone listening has learned so much. And I think that, you know, we can transform the experience of going to the dentist from kind of this depressing experience to okay, you know, there’s actually more stuff that I can do that I didn’t realize. And it can, I will say, just from my own experience, it can definitely be a little bit fun when you get to the point where you’re like, “Hey, I’ve really improved my flossing technique. And now we’re seeing the results,” you know, and yeah, be something you celebrate with your dentist. I’m not gonna say make everything fun every day.

Dr. Victoria:

It’s like a massage. It’s like — I mean, I hope it’s like a massage. But the first few times that you come if you’ve got bad gums, it is going to be painful. And I’m not gonna lie, like I’m not a very nice dentist when it comes down to like, I want to get rid of whatever is underneath your gums. So, I will get in there and I will do it. But once you maintain that, it should actually be a pretty fast and relatively pain-free appointment because I don’t need to go underneath your gums because you’ve been cleaning. So, nothing’s getting underneath there. You know, that’s the goal that everyone should try and aim for.

Cheryl:

Yeah, that’s wonderful. Thank you so, so much.

Dr. Victoria:

My pleasure. Thank you for having me. And I think it’s amazing what you’re doing and creating such a great community. So, it’s, yeah, keep on doing what you’re doing. 

Cheryl:

Oh, thank you! You too. 

[Ending music] 

Thank you so much for listening to today’s episode. This episode is brought to you by Rheum to THRIVE, a membership and support community where you’ll learn how to develop your own THRIVE toolbox so you can live a full life despite your rheumatic disease or chronic illness. Learn more in the show notes, or by going to www.myarthritislife.net. You can also connect with me on my social media accounts on Instagram, Facebook, Twitter, and even TikTok. Check out the links in the show notes.