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Guest Bio:

Doug Thompson, DDS, FAAMM, ABAAHP, is a board-certified dentist who is currently pursuing a fellowship in anti-aging and regenerative medicine. Dr. Thompson believes in using an interdisciplinary treatment model that coordinates dental care with other medical practitioners for total body health care for his patients. In 2015, Dr. Thompson founded the Wellness Dentistry Network, which is an internet-based community of dentists with a keen awareness of how oral conditions affect whole-body health. He also assists dentists and their teams with implementation strategies designed to put knowledge to work in their daily practices. Dr. Thompson’s work bridges the gap between traditional dental care and health care, recognizing the vital importance of oral health on systemic health and championing a whole-person approach to health and well-being.? 

Transcript: 

Kalea Wattles, ND:
After the gut, the second largest and most diverse microbiome in the body is located in the mouth. The oral microbiome is becoming an increasing area of interest in the medical community as research highlights several connections between chronic oral dysbiosis and systemic disease, with inflammation being a common link. Pathogenic oral bacteria may influence inflammatory pathways, particularly via the gut and by translocation through perivascular spaces. Maintaining balance in the oral microbiome is a critical strategy for reducing the inflammatory burden and the risk of certain diseases.  

On this episode of Pathways to Well-Being, we welcome Dr. Doug Thompson to discuss new prevention and treatment opportunities that bridge the gap between dental care and health care. Dr. Thompson will present additional research on this topic at our upcoming Annual International Conference, and we’ll get a little preview into his presentation today. I am so looking forward to talking about this topic. Welcome, Dr. Thompson. 

Doug Thompson, DDS, FAAMM, ABAAHP:
Thank you so much, Kalea. It’s an honor to be here, and it’s a privilege to be invited to speak at the conference in June, so I’m really looking forward to it. 

Kalea Wattles:
I think we’re all very excited for that conference and hearing about the oral-systemic connection. I’ve been just so excited to see more and more research emerging about this topic. And for a primary care doc like me, I think we have this tendency to really treat the mouth and the rest of the body as separate entities, but we know that’s not true. And research really shows us that there’s this intricate connection between the oral microbiome and systemic health. I know we have so much to talk about in this arena. So to kick things off, will you just tell us a little bit about this oral-systemic connection for those who may not have explored this topic before? 

Doug Thompson:
Yeah. You know, Kalea, it’s pretty interesting, I mean, way back in 2004, I think Time magazine had that critical issue about inflammation and how inflammation was like a secret killer. And inflammation was responsible for Alzheimer’s and cancer and just a whole host—obviously, heart disease—it’s a whole host of diseases. And then, as heart disease started to get a little bit more redefined as an inflammatory disease of the blood vessels, what we realized in the dental world was that there’s certain bugs that live in the mouth. And I would say it’s really biofilm. So certain bugs, bacteria, yeast, and viruses that live in the mouth. And you know, it really is the traveling oral microbiome. I mean, they move around. And these bugs have certain components of their cell wall or certain components of their existence create oxidative stress, leads to inflammation. And we know that we were trained as dentists to control the oral microbiota so we could prevent tooth loss. Actually, periodontal disease is a chronic inflammatory condition in the mouth. And what will happen is the microbial challenge stimulates a unique host immuno-inflammatory response, which you know about. And then we get a dysregulation of bone metabolism, and the bone wilts away on the teeth. Happens very slowly over lots of years. And so our job was to control the microbiota to prevent that from happening.  

But what we now know is that the microbiota’s doing a lot of things to the biology of the blood vessel wall and to a lot of other things. And we’re up to 57 cross-referenced systemic diseases now with periodontal disease. So it’s a really great opportunity for dentists not only to become aware of what to do with the mouth but how to collaborate with physicians, because I can’t manage cardiovascular disease by myself, and I can’t manage cognitive decline, and I can’t manage insulin resistance and all the other things that happen. So that’s, in a nutshell, what it’s about. And you can imagine, it’s a diverse and widely variable topic. So there’s so much to do. 

Kalea Wattles:
There’s so much to do. And I really consider dental care primary care. I mean, this is really our foundations of health. So it’s fun to talk about all of these connections. I think we can all see how our oral microbiome influences other body systems with these inflammatory components you just talked about. Is this a bidirectional communication? I mean, can imbalances in other areas of our body actually contribute to oral health or oral disorders? 

Doug Thompson:
Yeah, it’s totally bidirectional. For instance, the European Federation of Periodontology and the American Academy of Periodontology got together back in 2017 and created a universal global language about how we diagnose this disease. And we staged the disease now much like you stage cancer. And so we stage the disease, and part of the staging of the disease is added to by a concept called grading. And a grade A, B, or C is also the likelihood of the disease, how fast the disease will progress and how likely the patient will respond to therapy. And interestingly, some of the things that will cause it to either progress rapidly or not respond well would be things like an elevated A1C. If you have a patient who’s insulin resistant or pre-diabetic or diabetic or an uncontrolled diabetic. I mean, periodontal disease, I think, is the fifth major consequence of diabetes. And additionally, if you’re a diabetic, 75% of the time, you have Candida dubliniensis in your mouth, or you have Candida glabrata, or you have some of the other Candida species. When we look at the oral microbiome, we’re up to nine species of yeast now that we identify and try to treat those as well as the viruses and as well as the microbiota. So it’s very bidirectional. And periodontal disease affects lipids. It affects vascular elasticity. It affects endothelial function. It affects a number of things in a bidirectional relationship. And when diabetes is worse, periodontal disease is harder to control, and it’s worse. Bacteria love sugar. And so it’s one of the things that we have to think about. So we need help from physicians, and I believe physicians need help from us to make sure that there’s no oral infection contributing in a negative way as well. 

Kalea Wattles:
The collaborative care team. The magic that happens when we work together, right? 

Doug Thompson:
No question. 

Kalea Wattles:
I think about this all the time in my patient population (it’s fertility patients) because of the way that our oral health can affect our reproductive organs. And you just mentioned how this can also be such a player in cardiometabolic issues. I also think of cognitive decline. I mean, in our patients who seem maybe even resistant to treatment, it seems like this might be the missing link. We really need to consider their oral health, right? 

Doug Thompson:
Well, there’s no question. And one of my biggest referral sources right now are physicians. And what they ask me for, Kalea, is they ask me for an oral inflammatory illness evaluation. And what we’re looking for is any condition in the mouth, uncontrolled sleep apnea, periodontal disease, or periapical. Periapical would be around the root of a tooth. That would be what you would commonly think of as an abscess. Someone would come in with a swelling, and they have a big bump on the gum, and it’s pussy. That abscess is called a periapical infection. And that’s usually loaded with strep viridans. The periodontal infection is loaded with spirochetes. It’s loaded with Porphyromonas gingivalis. It’s loaded with Treponema denticola. And these different bacteria all have a synergistic relationship with yeast in a different way. They connect in a different way. They assemble in the saliva. They stick to the tooth. They form a biofilm layer that’s very hard to treat. And they translocate to other places in the body. And you mentioned fertility. You know, we have a test that specifically looks at, for expecting mothers and for people who are thinking about getting pregnant. Both partners should really be tested, because if you have the wrong kind of bacteria, it could affect fetal development, it could affect preterm delivery, it can affect quite a few different things in the gestational period that we need to be concerned about. 

Kalea Wattles:
Yeah. Well, for anyone who’s listening, this is why I always recommend seeing a dentist as part of the preconception planning for both partners, for all of these reasons that you’ve mentioned. And you just touched on the fact that a hallmark of periodontal disease is potentially a high pathogenic load of P. gingivalis bacteria. And these little microbial infections seem to be a common link in conditions, including heart disease and neurodegeneration like we’ve talked about, because maybe it’s igniting this inflammatory cascade, which goes systemic. So aside from our standard oral hygiene practices, hopefully, we’re all brushing regularly, what else should we be doing to prevent this bacteria from really taking over? 

Doug Thompson:
Well, I think, interestingly, 5% of your oral microbiome is pathogenic. So we have core species, we have variable species, we have health-associated species making up the balance, the other 95%. But what happens in a periodontally diseased patient, you get this dysbiosis, and what happens is the pathogenic load outpaces the commensal load, and you get up to 48 to 50% of the biomass is now pathogenic. So Porphyromonas gingivalis is a component of that, but it’s not always a component of that. So sometimes it’s other bacteria. In the testing companies that I can work with, I can either test for as few as five pathogens or I can test for as many as 29 pathogens. And the pathogens all carry a different level of pathogenicity, if you will. So I look at the high-risk pathogens very specifically on all patients.  

And what I think people can do, in addition to just brushing their teeth, is obviously look for any kind of clinical signs that periodontal disease might be going on. That would be bleeding when you brush or floss. It could be spaces that develop between the teeth. It could be root structure of the teeth that starts to show; we call that gum recession. It could be bad breath. It could be flaring or drifting teeth. It could be dark spots on the teeth. And these are all things, Kalea, that you can just see even on a visual exam in your office. And then asking patients, what is their care frequency? How often do they get some kind of professional intervention that would benefit the management of the oral microbiome? 

And interestingly, 10% of our population probably will never get periodontal disease. They’re resistant to it. Their host immuno-inflammatory response is not sensitive to it. However, about 80% are going to need some kind of further care at some point in their life. They’re either going to have gingivitis, inflammation of the gingiva, or they’re going to have periodontitis, where it involves bone dysregulation. And that’s going to be a big problem. So knowing what to look for and what you can see at home is very important. And cleaning the tops of the teeth is very important, because it’s the biofilm on the tops of the teeth and in between the teeth that support the network of the growth underneath the gum where all the damage is done. 

Kalea Wattles:
Mm-hmm. Oh, I have so many follow-up questions. Okay, so before we move on from this point, you talked about kind of disrupting those biofilms…  

Doug Thompson:
By the way, my lecture at the center is four days, so we can go however long you want.  

Kalea Wattles:
So much time. I mean, is flossing enough? Is there something more that we should be doing to disrupt those biofilms? Can we use a water flosser? I mean, let’s really dive into the details on this. 

Doug Thompson:
Yeah, I think the flossing is great if you have healthy teeth. I mean, if you have healthy teeth, you want to get the food particles out from between the teeth, and you want to just keep your teeth reasonably clean, I think flossing is fine. But, Kalea, what happens is when the gum starts to shrink away from the tooth, we get torturous contours of the teeth. They’re not just round. And so a floss or a piece of string will harbor between two high spots, and it won’t get in the middle. So it’s just really not enough to control periodontal disease. And I say it to my dental colleagues; I don’t have anybody in my practices controlling periodontal disease with a piece of string. I mean, that’s not happening, right? So oral irrigation is great, and then we can enhance the oral irrigator by putting some additives into the water. Maybe we could add something like Biocidin. Maybe we could add something like an essential oil drop, or we could add other things to it. We could add grapefruit seed extract. We can add an ammonium quaternary compound or different things to the Waterpik to enhance the effectiveness to make it more beneficial if you’re trying to manage or correct a dysbiosis. That’s what we would do. In the management state, if you’re a healthy individual and you have no known periodontal disease and you have clinically healthy dentition and clinically healthy gums, you need very little. Brushing and flossing would be perfectly fine. But for the patient that has even disease propensity, we want to do other things. And we need to figure out who’s at risk. We can do that. Figure out who’s at risk and make sure they get everything they need and nothing they don’t. That’s the idea.  

Kalea Wattles:
Hmm, yeah, personalized medicine. I really resonate with that. So you talked about some physical signs and symptoms of periodontal disease, or even just gingival inflammation, which maybe is an early sign. We can all look at our gums and our teeth when we’re brushing, right? So this is my call to action. 

Doug Thompson:
No question. 

Kalea Wattles:
I guess to all of us as we’re brushing, just to look at our gums. And then, in the clinic when we’re doing our annual wellness exams, we should be looking in the mouth.  

Doug Thompson:
There’s no question about it. And we’re getting to a point now in the understanding of the oral microbial load that even if your body’s not responding poorly gum and bone-health wise to an insult, to a microbial insult, it’s even nice for my new patients that come in, especially if they’re referred in by a physician. I measure the oral microbiome because even if the patient has some resistance and they’re not showing detrimental signs to the gum tissue, they still could have a higher load that could cause other systemic implications and have other systemic implications.  

So we’re just at a transition point. I’m at a transition point in my practice where I’m starting to measure the oral microbiome on almost everybody. And I think that that’s a big stretch for the average dentist. But for the last 15 years, I’ve been at least doing microbial analysis on all my diseased patients. I would do microbial analysis on all my diseased patients, and why I do it, Kalea, is it helps me figure out how to treat them. What can I do to modulate the host? What can I do to try to manage the oral microbiome? And it helps me figure out how to treat them. And that’s why I use microbial metrics. And in my presentation in June, we’re going to talk a little bit about how we measure that, what we do with that. And I even have some physicians that are measuring the oral microbiome in their office, and they’re sending me patients with a report in hand and then they’re asking me, “What can we do with this?” 

Kalea Wattles:
The testing aspect is really fascinating to me because this seems like it offers a degree of specificity to our treatment plan that we may not have otherwise had. So I know that you’ll talk about this at our annual conference, but will you just give us a little bit of a sneak preview of…I’m just not familiar with how that testing is done. Is it a swab? Is it a salivary sample? How do you make that assessment?  

Doug Thompson:
Yeah, in days of past, we used to try to grab a sample of bacteria from around the teeth, and we would swipe it on an agar plate, and we would grow it. And then we would try to analyze what was in there. The problem is most of the facultative and obligate anaerobes would die on the way to the testing media. So it wouldn’t really grow out what was in the sample, or we couldn’t really figure out what we were looking for. And it seemed that anybody that had a real serious dysbiosis, there was just a standard antibiotic regimen that we would use in addition to our mechanical debridement and our pharmacotherapy or any kind of therapeutic rinses or anything else that we would use; we would use systemic antibiotics.   

Well, since the understanding of gene sequencing and PCR analysis, now we have the DNA address of the bacteria. And so what we do is we take a saliva sample, it can either be a small amount of pure saliva or it could be a saline rinse that we swished for 30 seconds, we put it into a collection funnel. We send that to a testing laboratory, they run PCR analysis on the samples, and they run PCR analysis just looking for the sample of bacteria that are significant for periodontal disease. In other words, if I contaminated the sample with E. coli, E. coli wouldn’t show up, because that’s not what they’re looking for. They’re looking for just the periodontal pathogens, and they give us a report to basically the presence and the concentration of the periodontal pathogens in the saliva sample. And then we take that information, and then we develop a customized treatment plan.  

Kalea Wattles:
Wow. It’s truly amazing that the technology exists to give us this type of information. So for someone who might be otherwise healthy, I’m thinking I just am a data collector. I love to do this type of testing on myself just as an experiment. Is there some benefit in doing testing like this just to make sure you’re on the right track and maybe prevent issues down the road? 

Doug Thompson:
I totally think so. While we’re getting to a point where the testing companies have seen so many samples now, thousands and thousands of samples, and they usually ask about co-related risk factors or co-related diseases. And we’re starting to learn that if you have certain pathogens above certain threshold values or certain concentrations, if you will, we know there’s some downstream biomarkers somewhere that’s changed or affected by that, and we just have to find it. So we’re getting more and more precision, and we’re getting to be able to be more and more predictive. And we can do that based on what we learn when we take that sample. So there’s no question that, yes, I think looking at everyone’s saliva and looking at what’s there is really important. And if we see a pathogenic species or a group of pathogenic species above a certain concentration, it would be really smart to think of a way to suppress, eradicate, or alter that combination of pathogens, for sure. 

Kalea Wattles:
Wow. Those of us who work in preventive medicine I think are very eager to learn more about how we can do some predicting. And in the functional medicine world, we utilize a timeline where we try to look at our patient’s health trajectory to figure out where they’ve been, where they’re going. Can you talk to us a little bit about maybe factors that precede periodontal disease that we might be able to identify on our patient’s timeline and do some early intervention?  

Doug Thompson:
Yeah, one of the things that could precede the disease that you might be aware of is first maybe start to understand a little bit about your significant other or anybody that you might share saliva with. We’ll see with the cavity infection, for instance. We’ll see kids that have no history of cavities, they go off to college and maybe they share saliva with somebody and then they come back and all of a sudden, they have cavities, which is a sign of the disease. That’s a disease of the tooth. Caries is the name for the disease. That’s a disease of the person. And that’s because of the dysbiotic oral biofilm that they acquired. So one thing would be, where do we get this from? Where do we get this from? And there is some transmissibility to some of the bacteria. So that’s number one.  

Number two would be if you notice any redness around your gum tissue. This disease usually starts as what we call gingivitis. It’s this mild inflammation of the gingiva. So if you see any pink on your toothbrush, pink on your floss, then that’s a good indication that something’s not right. And once that gingivitis happens, Kalea, what happens is the capillaries, and as you know, gingivitis or inflammation brings increased capillary activity, increased leukocytic infiltration, a decrease in fibroblast quality around the gum tissue, and what happens is it becomes a food source for the bacteria, and the bacteria thrive in that environment. They love the inflammation. So making the inflammation go away and controlling the inflammation is one of the first things we need to do. And sometimes, that inflammation is visible; sometimes it’s not. That’s why you need a periodontal exam by your dentist, because we have a special instrument that we use to test the gum tissue to figure out who has bleeding or who has inflammation. Sometimes you can’t see it. So that would be one of the earliest things that would happen. And also the genetic susceptibility. If you have a family history, if your mom or dad has dentures and they lost their teeth because of gum disease, then that would be a big risk factor going forward. And we would want to look carefully at that population. 

Kalea Wattles:
Yeah. And I think that’s an important point. And you mentioned this association with other conditions. Diabetes, for example, or even the connection to our lipids. Are you seeing in practice where, let’s say, someone has diabetes that’s not very well controlled, if we’re able to get their glucose in a little bit more healthy range, do you see benefit in their oral health? I mean, is there a bidirectional communication in that way too? 

Doug Thompson:
We do. We do. Because, again, the bacteria, they love sugar, and they love unregulated sugar in the blood. They love oxygen-poor blood. So for our sleep apneics, there’s no question they harbor more bacteria, and they can harbor more bacteria. But the pathogenic load where we have probably the most research is on, and where I spend most of my time, is looking at biomarkers of vascular disease. So things like Lp-PLA2, myeloperoxidase, hs-CRP, which is just a risk factor. I look at not only risk factors for cardiovascular disease, cognitive decline, and vascular issues, but we also look at disease activity indicators. And so those are things that we want to know. And so when I see a patient, if I feel like they have periodontal disease and they have a couple other risk factors for cardiovascular disease, rheumatic arthritis, psoriasis, gout, you name it, obesity, a number of different things. If they have those, then I start to fish, and I start to really look carefully, because I know that for all of those diseases, as they get more under control, it’s going to be easier for me to control the oral microbiome. Again, they all have this feed system. Some drive yeast development, some drive viral development, and some drive bacterial development. I have to sort that out.  

Kalea Wattles:
Right. Well, this is very compelling for us all to care for our oral microbiome in a variety of ways. I think I always like to start with our modifiable lifestyle factors. Let’s spend a little bit of time there, and I would love to hear your perspective on a dietary approach. I mean, are there foods that we’re eating that are setting us up for periodontal disease? 

Doug Thompson:
Yeah, there’s no question. Some of these really high-protein diets can create an inflammatory condition for sure. But we know that probably the Mediterranean-style diet, high in antioxidants, vegetables, and fruit. You know, I think we say it wrong in our society. We say fruits and vegetables. I think it should be vegetables, vegetables, vegetables, and a little bit of fruit. And so we know that people that have these diets rich in antioxidants and diets low in simple refined sugars and simple carbohydrates, they do much better. And the gum tissue does much better. So whether you incorporate that style of eating as a dietary regimen or if you incorporate time-restricted feeding or intermittent fasting, they’ll all have an effect on the oral microbiome in a positive way. The cleaner our diet, the better the gum health is going to be. And it’s the same thing with stress management. It’s the same thing with sleep. These are all things that strengthen our immune system. And as our immune system’s stronger and we can ward off more, then we don’t become so susceptible, and then we can manage things quite a bit better.  

Kalea Wattles:
I love how you highlighted all of these foods that are healthy for so many other reasons too. I’ve seen more and more oral probiotic supplements on the market. Is that something that you’re using, or food is enough? I’d love to hear your thoughts. 

Doug Thompson:
Yeah, I’m having a little bit of a hard time with the probiotic world. And what I mean by that is I use probiotics for two reasons. Really, for one reason. I always give a probiotic with Sac boulardii in a blend. Saccharomyces boulardii, which is a friendly yeast. I use that, and it competes against Candida. I use a blended product for all yeast management. I use a blended product for anybody that has an infection that I need to use antibiotics to treat or to assist with. I have to cover the gut. What we don’t have, Kalea, and what we have weak research on, is I don’t have an ideal probiotic that you put in your mouth, you chew it up, or you let it dissolve, you put it in the mouth in some way. I don’t have anything that changes a dysbiotic biofilm back to health. I just don’t have that. And I also know when you take the probiotic away, your body typically won’t sustain it, because it’s not indigenous to you. You’re not used to it. So it’s something that you’ve got to be on for a long time. And all my clinical tests with probiotics have provided some change in the biofilm, but there’s always been a lot of bleeding. It’s not a magic bullet. It’s just not a magic bullet. We’re not there yet. And the research would support that more needs to be done in this area. We’re just not there yet. To have a probiotic to say… maybe it could enhance some treatment, but it’s just something that’s too variable and it’s all over the place. And I’m just not ready to use that yet routinely. 

Kalea Wattles:
That’s fair. Doug, I thought you were going to tell me, yeah, there’s just a tablet. You just chew it. Your oral microbiome is changed forever.  

Doug Thompson:
It’s not that easy.  

Kalea Wattles:
It’s all good. 

Doug Thompson:
When you tell me there’s something like that for weight loss, I’ll take it. 

Kalea Wattles:
All right. Not that easy. It never is. But, I mean, we really have to cultivate this healthy terrain in our oral cavity. And it sounds like there’s a variety of lifestyle factors that are contributing. I don’t want to move on without looping back to sleep, because I constantly see ads and things in the news about mouth breathing, and maybe we should consider mouth taping or just a way to protect our mouth at night. Do you have any advice in that realm? 

Doug Thompson:
Yeah, I do. I think that if we can encourage nasal breathing, you know, we get air filtration, we get nitric oxide production, we get parasympathetic stimulation from nasal breathing. And so if your situation is just lip incompetency or you can’t keep the lips together at night, or they flop open, lip sealing, I call it lip sealing. But really, it’s lip taping. There’s no question there’s a benefit to that. There’s no question there’s a benefit to that. However, what we try to train our dental colleagues to do is look for structural abnormalities in the mouth that’s making it hard for the patient to have a successful night’s sleep without snoring. So things like a scalloped tongue, things like a tongue restriction, a tongue-tie, a very narrow dental arch. These are all anatomical signals that maybe there could be an airway issue. So we’re a big proponent of either using a high-resolution pulse oximeter for a couple nights and take a look at the oxygen desaturation and heart rate and some other things. Or maybe we would even wear a home PSG device. We can wear a home PSG device where we can do some sleep screening. And, Kalea, we screen for the disease, and then we get collaborative help to treat the disease. I want for the patient whatever’s going to work best for them. And there is a small space, a small space in dentistry for the use of some kind of oral appliance that pulls the mandible forward and relieves the airway for obstructive sleep apnea. But it’s just a small percent of the population. Other people need much more than that. Whether it be CPAP or some other type of device. But we need to be on the frontline for screening.  

And where we really need to make sure we pay attention is, Kalea, there should be no kiddos snoring. There should be no kiddos struggling to breathe at night. So if we have little kids that are having snoring, we used to think it was cute to watch our kids snore. That’s the first sign there’s an airway constriction. And so we want to make sure we get those kids help. And it often involves orthodontics, moving the teeth. It also involves myofunctional therapy, which is training the mouth on what to do. And we make sure we take care of any functional concerns as well. Teaching the child how to swallow properly. Where the tongue position should be when we’re speaking. These kinds of things. It’s an interdisciplinary approach that we need to take, and we need a team of people for the airway management.  

Kalea Wattles:
You read my mind where I was going next. I’m a mom of two young kids, and so this is something I’m thinking about all the time, especially with the structural issues. It seems like it’s so much easier to adjust those things when our children are young. So I think that is a point very well made.  

Doug Thompson:
No question.  

Kalea Wattles:
Now, Doug, you’ve talked, and I know you’ve written extensively about this concept of personalized periodontal medicine. We’ve talked about that a lot today, how you customize your treatment plans based on testing. There’s so much synergy with functional medicine; we’re always striving for these personalized care protocols. I’m wondering, without giving too much away, if you’d be able to just tell us when you’re ready to develop those treatment plans, is it a combination of lifestyle factors, antibiotics, if someone needs them, supplements? I don’t know if you’re using botanicals, but just to get a sense of what our options are. 

Doug Thompson:
Yeah, you know, we’re just like you, we’re really looking for root causes of diseases, and as we get into more root causation, it allows us to manipulate or offer suggestions to the patient how they can be healthier. And, you know, it doesn’t matter if it’s exposure to pollutants, and, of course, heavy metal exposure from—I want to figure out, is your mercury coming from fish or is it coming from a dietary source or is it coming from your amalgam fillings? I want to figure out if you have a mold exposure. We have patients with Lyme disease that seem to be very sensitive to EMF pollution. So all these things, nutrition, hydration, sleep quality, do you exercise? You know, there’s nothing more you could do to get your metabolics going than move your body for 30 minutes a day. 

So all of these things we coach and guide people to do, but we do it, and we dribble it in over a period of time. It could be overwhelming. If you look at like 23 different lifestyle factors you need to change right now, that’s a lot. So what we do is we try to educate the patient first off about the dysbiotic situation in the mouth. And then we let them know there’s many risk-modifying things that are in their lives that if they changed or if they altered, that could be better. Even hydration. Hydration’s critically important for the proper saliva flow, quality, and quantity so that the saliva’s a great buffering agent against some of these pathogens. I see people with xerostomia. I see older people that don’t drink water. So even just hydration is just one of those. So we do get into helping people make lifestyle modifications, and we give supplements when we think people are deplete. So I believe in testing, or I believe in having some metric or some way of determining what we give. I don’t just give a blanket amount of stuff to people just because I know there’s some research supporting that CoQ10 is great. I want to measure how our CoQ10 is, and if they’re deficient, I want to replace it. If they’re not, I want to leave it alone. 

Kalea Wattles:
Mm-hmm. Doug, a theme that has emerged to me as we’re talking is just how powerful and empowering it is to know that if you take charge of your oral health, there’s almost certainly going to be a systemic benefit. And looking beyond just our oral health, we’re really doing risk reduction. And that feels really actionable to me. So I’m just very motivated to see the dentist after this. 

Doug Thompson:
Well, good. And I hope everybody is. I mean, it’s really, you know, dentistry is very, very complex when it comes to figuring out what to do to fix the teeth. In other words, the mechanical piece of dentistry, working with a 300,000-revolution diamond burr on an eight-millimeter subject, it’s very complex, and that part is very hard. And what happened is as the technology increased, we’ve gotten into scanning and implantology and all these different things in dentistry, it’s been easy for dentists to disconnect the mouth from systemic health. And what I’m trying to do is bring awareness back to people that, look, you can put the most beautiful restorative dentistry in somebody’s mouth if you want, but I want to create healthy smiles, and we do all that mechanical stuff, but I want those people with healthy smiles to be as healthy as they can be. And that’s going to start by having a balanced microbiome. And then it’s going to come from lifestyle things that we can help encourage, and we can help support in conjunction in collaboration with our physician friends in getting the patient to another state of health. Most of these chronic diseases could be avoided if we just did a few lifestyle things that made sense and that we all know we should do. 

Kalea Wattles:
Yeah. Healthy smiles, healthy hearts and vasculature, healthy brains, all of it.  

Doug Thompson:
But let’s be real. We’re human beings, right? I mean, last night, I had a cookie for dessert, so I know better, right? So, I mean, we do some of that stuff. So that’s the idea. 

Kalea Wattles:
We do some of that stuff, but we’re managing our health determinants in general. So as we’ve been talking through all these various concepts, do you have any patient cases or examples that come to your mind to think of, wow, that was a real success story? 

Doug Thompson:
Yeah, well, I’m going to share in our conference in June, I’m going to share, I think one of my patients was referred to me for elevated myeloperoxidase. You know, these types of success stories where we get to be part of reducing risk, that’s real risk to the patient and life-threatening risk. When we get an opportunity to either discover that or when we get an opportunity to help a patient with that, I can’t tell you how gratifying it is. So I have two criteria when I treat somebody for periodontal disease. I have to have certain clinical determinants of disease that need to be met. So that would be like if you took somebody who was very unfit and overweight, and your goal was put them in an optimal weight range and get them to a level, certain level of fitness. And when you achieve that, you know what freedom you give that patient to be healthier. And so the success of our cases creates a culture in our practice of health and wellness. And that culture of health and wellness creates joy in practicing.   

So, for me, I can’t tell if I’m working or playing when I go to work. I’m having such a great time helping people get well and helping people be well. And then, let’s face it, we have those cases that don’t respond too, right? Those challenge cases. But the idea is the success in our practice comes from not only the financial reward of doing a different type of job, but it’s the feel of practicing that way and it’s a culture of health and wellness that you create. And when you walk in my office, you’ll feel the difference. And that’s the idea. And that’s what we want to promote, and that’s what breeds success for us. And that’s what creates loyal, trusting, recurring patients. And that’s a blessing.  

Kalea Wattles:
Beautiful. I hope we all have something that we love as much as you love your job. So that’s truly incredible. You gave us a little teaser that now we know a little bit about what you’ll be speaking on at our Annual International Conference without ruining the surprise. Will you just give us a brief, maybe even just the titles of the talks you’ll be presenting so we know what to look forward to?  

Doug Thompson:
Yeah, the first, I’m going to address the group early in the day, and I’m going to talk just a little bit about the uniqueness of the oral microbiome and just what that is. And I hope that I can create some awareness for some people that maybe it’s not what they thought. So we’re going to talk about the oral microbiome. And then in the afternoon, I have the privilege of co-presenting with Dr. Ellie Campbell from the Atlanta area. And Ellie is very much into understanding the oral-systemic relationship. And she’s going to, from her perspective, talk a little bit about oral care and the oral-systemic relationship. And then I’m going to talk a little bit more on the back end of that on treatment, what do we do to actually treat patients, and I’m going to show some treatment cases. And what I hope comes out of it, it’s a very short amount of time. So there’s a Q&A at the end, but it’s a very short presentation. It’s only an hour. And we hope just to create awareness and maybe open some doors for some more collaborative relationships with like-minded dentists.   

And you see behind me, inside the Wellness Dentistry Network, that’s a network of dentists that maybe understand the language a little bit more than the average dentist that hasn’t had this exposure. And so that’s the idea. And we want to find the functional medicine docs and the doctors who want our collaborative effort, and we want to match these people up. And you know, there’s a lot we can do even through the internet. So we have a really unique opportunity, I think. And I’m super honored to be the dentist that gets to address the group.  

Kalea Wattles:
Yeah, it’s amazing. And it sounds to me from this conversation, you’re really on the cutting edge of the science, but also the model of how we deliver care. So my final question, it’s a big and exciting one, and you may have touched on it already, but where do you see the future of functional and integrative dentistry going from here? 

Doug Thompson:
Yeah, as we get more and more knowledge about what’s happening and how the mouth affects systemic health, it’s impossible, it’s impossible to separate the mouth from the body. In fact, in 2009, I rebranded my practice to a very bad dental name. It’s a very bad dental name, but it’s called Integrative Oral Medicine. And once you come in, and you feel it and you go through our examination process and you think about all the ways we’re integrating oral health with systemic health, I think that’s really where we’re going to be in the future. We’re going to be, Kalea, much more integrated, and we’re going to realize that we really do need each other. We really do need each other if we want to create healthy bodies. I can’t do it alone, and neither can you. And we’re going to have to figure out how to get together and how to bridge that gap. And we need to be respectful that we might not both know the same language. We need to be respectful that we have different time constraints, we have different patient opportunities, and we need to capitalize on who can provide the most when and make sure we do our part. And if we all do our part and we get together and talk at a nice table where we can work together, I think it would be amazing.  

I think we see about 72% of our patients come to us pretty regularly. They stay pretty on track. I think the stats in the physician world is about 52%. So we need good re-care systems. We need good recall systems to get people to be consistent. And then, dentists need to help motivate patients to maintain their medical regimens. And we hope that the medical professionals will encourage people to maintain their dental regimens. And we should know what they are. So when I work with physicians and I send reports to the physician, I send perio charts, I send bacteria reports, and I send brief letters saying, “Here’s what the concern is, and here’s what we’re doing.” And it’s really, really a nice way. And one of my most unique referrals was, I’m in Detroit, Michigan. One of my most unique referrals was from a physician in Massachusetts that referred me a patient from Belgium. So I had somebody come in for a half-a-day evaluation from Belgium. Now that patient passed a lot of dentists. What I’m trying to do with my network is create dentists all over the world that understand this language, are willing to collaborate with physicians, and where we have physicians willing to collaborate with them in a respectful, professional way. That’s what we’re looking to do. And that’s, I think, the future. 

Kalea Wattles:
Wow. Well, cheers to collaboration. I can’t wait to see that future emerge. Doug, I wanted to thank you so much for your time today. It’s been just such a pleasure to hear all of these insights, and we can’t wait to see you in Orlando in June at our Annual International Conference. Thank you so much. 

Doug Thompson:
I can’t wait to be there, and I’ll be staying for the whole meeting. So thank you, and thanks for your time today. I appreciate it. 

Kalea Wattles:
Did you know that IFM’s Annual International Conference is the largest gathering of functional medicine practitioners in the world? Expert clinicians and thought leaders in medicine convene to pave a new path forward for improving health outcomes worldwide. Come join the conversation this June 1-3 in Orlando, Florida, as we return to an in-person program. See you then. 

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