How To Be WellnStrong

57: Your Oral Microbiome and Your Health | Kori Estrada & Dr. Derek Gatta, DMD

• Jacqueline Genova • Episode 57

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My guests today are Kori Estrada & Dr. Derek Gatta, co-founders of the innovative dental care brand, Risewell. In this episode, we discuss the signs of poor oral microbiome health and the role that bacteria plays in protecting your mouth, why you should be avoiding mouthwash that contains alcohol, the connection between oral health and systemic conditions like diabetes, the dangers of fluoride and a healthy substitute for it, and practical tips for optimizing your dental health by changing your everyday habits. Whether you’re new to the concept of holistic dental care or seeking more ways to improve your dental health, this is an episode you won't want to miss.

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*Unedited Transcript
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Jacqueline: [00:00:00] Just to kick things off I'm super excited to have you both here.

I've been a long time fan and customer of Risewell. So this is a conversation I've been looking forward to having for, for quite some time now, but. I'd love to just kick it off in, in asking, you know, if you could both share a bit about your backgrounds and the inspiration behind starting Risewell.

Kori: sure. So I can, um, start it off and then Derek, you should feel free to go ahead after, um, I, by sort of my, most of my professional background has actually been as an investor. I'm, I'm still currently running a hedge fund in New York called Axon Capital. Um, so I, the idea that. I would be a part of starting a toothpaste company.

It was not something that I would have guessed early on. Um, but, uh, you know, life sort of takes you in on unexpected turns. Um, so I'll give a little bit of my kind of health background too, because I think it's relevant for the story. Um, so in my twenties, I was having a lot of, um, stomach issues. I was at the time working a very intense job in [00:01:00] investment banking, um, working too many hours.

This is also during the global financial crisis. So it was, A very eventful time in the world, um, when I graduated from Columbia and, um, you know, I think I wasn't, certainly wasn't choosing the most healthy lifestyle choices and, and also was dealing with some health challenges and doctors couldn't figure out what it was.

It was diagnosed as IBS and they wanted to put me on a lot of medications. And, um, I finally found a doctor who figured out that I had, um, a pretty bad gluten allergy. Uh, and so I, as a half Italian, the idea of cutting out, uh, pasta and bread was sort of unimaginable to me at the time, but, um, you know, I tried it for two days and felt immediately better and realized, um, that there really was this connection between what you put inside of your body and how you feel.

And that really kicked off, I'd say sort of my interest and passion for health and wellness. Um, and then fast forward probably 10 plus years later. [00:02:00] Um, I, me and my former partner, John, who's also the other co founder of the business were starting to think about having children. Um, I had PCOS at the time and, um, knew that I'd have to go down the IVF route and wanted to make sure made that a success.

And, um, we sat down with my doctor at the time who was helping us through that process. And besides sort of the obvious things, eat the right things, Follow the, you know, orders on the medications. Um, he also pointed out that we should just be aware of the consumer products, the, you know, face lotions, deodorants, and all of those things that we were using.

And so we went home that night and turned our bathroom upside down and realized that a lot of our everyday products actually had not so great ingredients in them. And we were actually quite successful in replacing most of what was in our bathroom with healthier alternatives. Um, but toothpaste was.

Sort of one area where I immediately went to my brother, who's an amazing dentist and said, what should we do? We want to use a natural toothpaste. And he said to [00:03:00] us, just save your money because most natural toothpaste are taking out the fluoride and they're not replacing it with anything that's actually effective.

So that was really the moment for the three of us where we said, yeah, let's do it. How do we solve this problem? We need a toothpaste that works, that actually, you know, helps to protect our enamel, but also doesn't contain harmful ingredients. Um, and so I'll kick it over to you, Derek, and you can give your perspective.

Derek: so, so, uh, thank you for sharing that again, Corey. And yeah, so I'm a practicing prosthodontist here in Boca Raton, Florida. And before moving down here, grew up in. Newport, Rhode Island went to school. National Tennessee came down to south Florida. I was on a military scholarship. Uh, so after dental school, I left south Florida, uh, to, uh, work with the Navy for eight years and got to travel all over work, work with some interesting people and help a lot of folks out.

So they're rewarding experience and did my advanced training to the Navy and at Walter Reed in Washington, D. C. And I was tired of the cold weather So [00:04:00] continued to migrate back to South Florida and was able to partner up with a great dentist down here who retired last year And kind of a long quarry the journey of health.

I was also encountering many old people here in Florida surprise surprise and they have a different set of challenges than young people and They're very health conscious very high dental IQ Uh, and we kept coming up with resistance with fluoride. And again, we know Florida works, been around for decades.

We're not against it. Uh, but a lot of, and I was kind of just tired of arguing with people because some of the folks down here, they're, they're very, uh, independent, free spirits, and they do a ton of research and I applaud their efforts. Uh, because they kind of helped encourage me to look at different solutions as well because in dental school, you know, when you say anything besides fluoride, you're kind of looked at like you have two heads growing out of your neck, um, and it really forced me to examine, uh, you know, my own background and, uh, you know, the, the folks we were working with to help us develop a toothpaste, I had recommended hydroxyapatite, [00:05:00] that's our all star molecule.

And so really looking at people, giving them a choice, uh, for something different besides fluoride. Uh, and Corey had let me know what they were. Thinking and kind of dreaming up here. And I definitely wanted, wanted in to help out because I had faced a lot of patients down here in South Florida that were looking for alternatives.

And frankly, I was tired of arguing with them. So, uh, so I was kind of dragged kicking and screaming to look, look for alternatives because it's not something that's intuitive in dental school. Back when I was, uh, uh, going through the curriculum, it

Jacqueline: Wow. So fascinating. Oh my gosh. So much I want to say in response to, to both of those wonderful backgrounds, but Corey, interestingly, I also have a bit of an unconventional background. I went to a school called Babson College for my undergraduate, I'm sure you're familiar. Right outside Boston. Yeah, that's what's done for entrepreneurship.

So not, not too astray from what I'm doing now, but I graduated with a degree in economics and finance and started in strategy consulting. And yet here I am in the wellness space. And [00:06:00] it really was my mom's journey that was a catalyst for that. But I think it's funny how, you know, the obstacles in our lives essentially lead us to fulfilling what our purpose is and what we're called to do.

So I absolutely love your story. Um, I think that's incredible and, you know, kudos to you for building such an incredible team. how Long has Riseval been around?

Kori: It's been five years, I

believe. Um, yeah, 

I mean, it's the idea sort of phase of it and, and finding the right ingredients and formulation did take a few years. Um, so it, you know, it took us a few years to actually get to launch. Um, but yeah, it's been a very exciting five years to say the least.

Derek: So yeah, I vividly remember that Corey. So I was around, so I was still in the Navy at the time. I was, I was stationed in Newport, Rhode Island. We have a small Navy base in our hometown, coincidentally enough as the Naval War College. Uh, and it's very slow in the winter because it's a summer tourist town.

So I would routinely go to New York city, hang with Corey at the time. And, uh, you know, I remember vividly sitting on the couch, like dreaming up ideas and thinking about, you know, Uh, [00:07:00] alternatives and options and, you know, there's a lot of legwork, uh, to get to that point. But, uh, I believe after that, uh, uh, dreaming up and brainstorming phases, uh, you know, finally had a prototype around 2019.

Dr. Justin

Jacqueline: I love that. Yeah, what's the phrase necessity is the mother of invention? My mom's always like, what do people need, right? And that's where it starts. But I love that. And I was saying that you, you both couldn't have chosen a better time because now we're hearing about the importance of our oral health when it comes to our overall health.

Again, something that's very important. overlooked, um, but really has some, some critical consequences if not properly taken care of. And I know that the mouth, is considered to be a major gateway to the rest of the body. And it's often indicative of what's happening elsewhere. And I actually first learned that when I started acupuncture years ago, and I'm sure many listeners are familiar with this, if they receive acupuncture, but you'll go and the acupuncturist will always first ask, open your mouth and stick out your tongue.

People like, I don't understand the connection, but You know, [00:08:00] in Chinese medicine, it's believed to reveal the state of a patient's organ health, blood circulation, among other things. And through that insight, I started to learn more about the importance of optimizing our oral microbiome and the role of the oral gut microbiome, which again, is this other axis that not many people.

have heard about. So with that, can you elaborate on what exactly that oral gut connection means? And then perhaps maybe some of the roles of the microorganisms that actually live in our mouths.

Derek: Yeah, so it's a, it's a great point you bring up here. And it's funny when I hear the, yeah, it's fun. It's funny when you hear the term, uh, oral gut connection because, you know, the mouth is the same too, but it's the, it's the digestion track. Digestion begins in the mouth. Uh, begin digestion with a salivary embolase in the mouth here.

And so digestion begins at the beginning of the tube, which is the mouth. Uh, and yeah, the interplay between the, uh, oral microbiome and the gut microbiome is pretty profound. I think some of the, uh, systemic, you've got the, obviously the oral health, [00:09:00] looking at periodontal disease, caries, looking at how if you're dysregulated with your, uh, bacteria.

You can get overgrowth and these ecological niches get overrun by the deleterious strain that leads to the periodontal disease, uh, the caries and decay of the teeth. When you look at systemic health, there are really interesting factors regarding diabetes. Uh, it's one of the unique models where it's bidirectional, where bacteria in the mouth can affect blood, uh, dysregblood sugar dysregulation, uh, and vice versa.

So, uh, when you have diabetes, it can exacerbate the breakdown of the periodontal tissues. Well, another example of systemic health will be looking at the role of nitric oxide. It's really fascinating. The bacteria on your tongue, like actinomyces and vianellus, they contribute to nitric oxide formation when you're digesting leafy greens and vegetables.

The nitrates are converted to nitric oxide. Nitric oxide has a huge role to play in [00:10:00] Regulation of blood pressure and cardiovascular health. It's a vasodilator It's just a whole host of Roles it does in modulating activities in the health. So it's a really interesting look at how a major oxide You know just from bacteria on your tongue It can play a big role.

Jacqueline: Yeah. It's so interesting. Could you say with like some level of confidence that a patient with gingivitis or some other type of gum disease may probably be experiencing some type of systemic or chronic inflammation throughout the rest of their body? 

Derek: I'd say it's, I'd say it's very likely. Uh, you know, when you look at having open sores around your gums, you know, there, there are two routes for bacteria to kind of get into your system. It's through the bloodstream or if you're swallowing bacteria in your mouth. So if you have open portal or bleeding gums, it's an absolute entry point for bacteria to get into the system, causing that low grade inflammation.

The body's got to fight and regulate, and that has cardiovascular effects. And a whole myriad of [00:11:00] downstream consequences when you're bleeding in the mouth. I mean, it is funny when you, when you're bleeding anywhere else in the body, if you were like, Oh, that's, that's not normal. Like we should get that address, but bleeding gums, like, ah, you know what?

That's I've been like that for years doc. It's no problem. So it's just kind of funny how. How we, um, get set in our habits here.

Jacqueline: It's so funny because it's like what you can see you don't necessarily pay attention to but it's so interesting. I mean, yeah, bacteria in our mouths.

It really does affect a lot in our body. And just example of this. I have mitral valve prolapse. And I'm sure Dr. Derek, you're familiar that years ago, back when I was, you know, middle school, high school, the protocol was that before every dental cleaning, I had to take like four or five of these horse pills of antibiotics, um, during a cleaning to ensure that, you know, if there were any type of infection or bacteria, that it wouldn't reach the heart.

Um, so at that point, they kind of knew of the connection, right? But more and more research is coming out, and I know that's not protocol anymore, thankfully. Not a fan of antibiotics. That's a whole other route. But, um, you know, even back then, they, they knew the [00:12:00] importance of that connection. And also, too, I'd, I'd love to touch on what are some of the signs of poor oral microbiome health 

Derek: yeah. So I think a lot of it just goes back to listening to your body, listening to the symptoms. And you know, it's, I almost wish periodontal disease and gingivitis caused pain because if there was pain associated with it, people were like, Oh wow, something's wrong. Let's get this checked out.

Unfortunately, in those people, you don't really feel anything different. Yeah. Your, your, your gums bleed, they're red, they're puffy, but unfortunately there's really no pronounced, uh, Oh my God moment where I got to get this checked out. So. Uh, if you're bleeding in your mouth, that's, that's not, not appropriate and not normal.

Uh, if you have, uh, excessively bad breath that you can't figure out or get a, get control of, those, that's another symptom. And also looking at karyology, uh, and the decay forming process. And again, the demineralization process or weakening of the enamel does not cause pain until the decay hits the dentin.

The dentin is the next layer of tooth structure that's connected to the nerve and pulp, and that's [00:13:00] when you feel discomfort. But by that point, the filling is a little bit bigger. So, those are, those would be the three signs looking at, uh, any dysregulation in the mouth. Bleeding gums, uh, excessively, uh, bad breath, and any teeth that may, uh, hurt. 

Jacqueline: And speaking of cavities, too, my understanding, and I'd like for you to verify this, is that the actual cause of tooth decay, um, and cavities are actually related to imbalances in our oral microbiome rather than the presence of bacteria itself. So like certain pathogenic bacteria won't cause problems for someone who has an overall healthy microbiome.

However, they can trigger disease in some people who lack enough healthy bacteria. Yeah. to, I guess, counteract the pathogen's effects. Is that, is that true?

Derek: Yeah, you make a great point. I mean, a lot of the bacteria, I mean, the oral microbiome is composed of over 700 species of bacteria, viruses, fungi, protozoa. And so, looking at the interplay, that's really the, the main ingredient here. When you have a normally [00:14:00] functioning mouth and system. It is not a problem.

There's, there's no decay. There's not periodontal disease. It's usually if we inadvertently are using an alcoholic mouth rinse or something where we get dysregulation, dysbiosis. And once some of certain species, their populations go down, you create open ecological niches where other deleterious bacteria can, uh, overpopulate, take the resources and kind of grow uncontrolled and unchecked.

And that's when you might get a species of uncontrolled strep mutans, which is related in dental decay and a demineralization process or actinomyces or P. gingivalis associated in the breakdown of your periodontal tissues. So it's a very good point. It's really not the specific presence of the bacteria, but the interplay, uh, in the relationship between the, um, the normally functioning microbiome.

Jacqueline: So interesting. And I think it's important to note, too, and this is the premise of all of holistic medicine, right, is that if we restore balance to the body, the [00:15:00] body can heal itself, right, when put back in that state of homeostasis. So with that, I mean, I've read that it is possible to, quote unquote reverse a cavity and remineralize a tooth.

I guess my question to you is at what point does that become no longer possible once it's actually reached the dentin? Like, how do you make that call?

Derek: So it's a great point. Uh, we use, uh, radiographs or x rays to, to image the tooth and take a look and see how shallow or deep the demineralization process is and routinely in my practice, I try and be as conservative as possible. I don't want to do anything. To my patient's teeth, I wouldn't want done to my own teeth.

So when we have incipient lesions, they're still in enamel. I give them every opportunity to recharge and remineralize those lesions. Once the lesion has progressed to dentin. So the outermost layer is the enamel. That's the armor around the tooth, the hardest part of the tooth. The next layer is the dentin.

The dentin, the touch softer is not as calcified. And once the decay has reached [00:16:00] that point, they call it the dental enamel junction. You can get great remineralization from products like hydroxyapatite. Uh, both surface and subsurface remineralization is actually a nice advantage advantage it has over fluoride.

But once it breaches the dentin, uh, that'd be really challenging to, to completely remineralize that. You, you may need a dental filling, uh, at that point.

Jacqueline: Interesting. Yeah. I had a Dr. Kelly Blodgett on the show back when I first started back in September, October. But he's, he's done some incredible work in the, I guess he's called like integrative Dentist dentistry space, but I shared with him a story and I'll share it again with you both.

I want to say 10 or so years ago, I was visiting my, my childhood dentist and out of the blue, he took an x ray and he was like, you have six cavities that need to be filled. And immediately I was like, something does not sound right because I, nothing really changed in my, in my dental care. I wasn't necessarily ill.

So rather than having them [00:17:00] filled, I went to see another dentist. Long story short, I didn't end up needing to get any fillings, but through that process, I read a lot of books on tooth remineralization and things to actually reverse cavities from chewing on eggshells to supplementing with certain things.

So what are some of, I guess, your top natural remedies that you share with patients to try to remineralize a tooth?

Derek: So, uh, remineralization, uh, is absolutely possible, uh, and hydroxyapatite is naturally occurring. It's the substance that's made of the enamel, uh, crystals. It's a calcium phosphate molecule. hexagonal in shape, really interesting crystal lattice structure here. And it's been shown to fill in the little chips in the armor of your navel here.

So. Using a hydroxyapatite toothpaste is a great way to naturally re mineralize, uh, without introducing any artificial chemotherapeutic agents, uh, into your, into your mouth. Keeping debris off the teeth, [00:18:00] uh, flossing is critically important to really try and practice preventative medicine. Prevent the de mineralization process from occurring in the first place.

A lot of that happens too when the pH or the acid level in your mouth increases. So, after a meal, the pH slightly goes down, which is actually an increase in acid level. Uh, and that's the cavity causing zone. The material can, the tooth structure can demineralize in that environment here. And so, you want to make sure you're keeping your teeth clean.

using products that get your pH back to an, uh, an elevated neutral or slightly basic level. Um, and that's when you, you are getting out of the D mineralization zone and back into the remineralization zones. Also keeping your saliva flow, healthy saliva is critically important for remineralization because that's the source of the calcium and phosphate.

You want a super saturated solution. of the calcium and phosphate in your saliva to help drive the reaction of calcium [00:19:00] phosphate back into the enamel here. So hydroxyapatite is a great way to, uh, to remineralize naturally. 

Jacqueline: What about any supplements? Like, does calcium, D3, magnesium, collagen, like, do any of those play, play any key roles in remineralization

Derek: yeah, they absolutely, absolutely do, uh, play a key role. Uh, so when you take those supplements, you know, when they work and they get in your, your body systemically, again, you're, you're giving your body and saliva the bioavailability of the calcium and phosphate it needs here. Right. You're just checking with your physician, having your blood work checked, looking at your panels, looking at your levels.

Um, you know, I, I, I think it's cheap insurance too. I mean, I take supplements. I, I try and keep my levels optimal and it's a great way to just make sure you, you give the body its ability to heal itself essentially by having the minerals that it needs to do its functions.

Jacqueline: Yeah. Yeah, that makes sense. Going back to pH balance, what are some things that can disrupt that balance and, and I guess [00:20:00] what are some ways to, to kind of mitigate the effects of some of those things? I occasionally will take some apple cider vinegar. Um, I'll mix it with water. It's really great for your gut health amongst other things, but I also recognize that that is very acidic and can damage your teeth.

So, like, drinking it with a straw, like, I guess little hacks like that that you could recommend for, again, things that disrupt that pH balance.

Derek: Yeah. So if you're, if you're uh, with the apple cider vinegar crowd, I don't wanna interfere with that. By all means, uh, do it for gut health, but please, please use a straw. That stuff is so caustic to the enamel and maybe swish out with water afterwards. Really just getting the acids out of the mouth. The saliva is very protective and buffering against acids, but uh, when you're introducing substances that caustic to the mouth.

just use a straw, try not to let it touch the teeth and just clear out with a swish of water afterwards. And that's a nice way to try and prevent your, your mouth pH from dipping down into that dangerous D mineralization zone.

Jacqueline: What about coffee?

Derek: Not worried about [00:21:00] coffee. I'm not going to take that

away. Yeah, it's more soft drinks, more soft drinks and energy drinks. That stuff is a, it's just so caustic. I've seen so many young people just blow through their enamel with, um, specific colas that are just loaded with the amount of sugar and acid in those products is unbelievable.

Jacqueline: And also, too, Dr. Derek, so you touched on mouthwash with alcohol earlier. Can you elaborate on why this is probably one of the worst practices for our dental health,

Derek: yeah, so I think, you know, ingrained in our culture, decades ago, there was this push to have complete sterility, scorched earth, kill everything at all costs, and yes, bacterial overgrowth is bad, and infections are bad, and you need antibiotics sometimes when you have an acute infection, but just blindly killing everything in your mouth, is not great.

You're really disrupting a lot of the natural processes that are occurring with what I was mentioning earlier with the formation of metric oxide with the bacteria on your tongue. Uh, and really, you can [00:22:00] potentially be causing an overgrowth of the harmful bacteria when you wipe everything out, you open up these ecological niches to be super populated by some deleterious strains, unfortunately.

So, uh, your body, you don't want to be killing everything. I'd really recommend. Uh, not using an alcoholic, uh, mouth rinse, and, uh, you don't want a sterile, uh, environment. It's more, you know, the, the balance, making sure your, your diet is optimal and, uh, trying to minimize your exposure to acidic, sugary drinks, uh, and also for just fermentable snack type foods.

I mean, many things that you eat, it immediately drops the pH in your mouth. So just crackers, routine crackers, uh, the shared cheese crackers, They're super cariogenic. The, the, the, the genicity profile of some of those, those products are, are pretty, pretty mind blowing. And it's not even a dessert type food.

You don't think about it, but basically everything you eat reduces to a sugar, a fat, or a protein. So if it's not fat or protein, everything is reducing to some kind of basic glucose molecule, which is, uh, the, the food source for [00:23:00] strep mutans to produce the acids for demineralization.

Jacqueline: On the topic of food, what is the optimal diet for someone looking to preserve, good teeth health? And perhaps if you can't label an actual diet, maybe touch on some of the best foods.

Derek: Yeah, I think a lot of it is just the common sense foods that we know is good for us. Leek, greens, fruits and vegetables, uh, uh, calcium, any foods with calcium. Cheese is great for your teeth because it's a calcium super source for creating that saturated saliva for remineralization. And also, I think a lot of it goes back to just avoiding bad foods, avoiding acidic energy drinks, sugary colas.

Things that you know are going to introduce sugar and acid, uh, to the mouth. Um, so, those are, those are really some of the big things to try and avoid, uh, getting a optimal exposure of the protein and, uh, fruits and vegetables. I mean, you really can't go wrong. I mean, high fiber foods, it's the prebiotic fuel to feed, uh, the bacteria in [00:24:00] your gut.

Jacqueline: Yeah, no, that all makes sense. And for someone who I guess is more inclined to develop cavities, would you recommend restricting feeding windows? So not necessarily eating as frequently, or if not, perhaps maybe like brushing your teeth after every meal? Is that necessary? 

Derek: If you're at a higher risk for decay, a lot of it does go back to nutrition and I'm not so concerned about that. Uh, restricted feeding window. Look, uh, food is very enjoyable. It's, it's, it's important in social situations and through their daily life. So I don't want to restrict people's ability to enjoy their lives and have fun.

But I would say is, you know, just take simple steps to keep debris off your teeth when you're at home. Usually you have breakfast and dinner at home, so just brush brush afterwards and your other meal lunch. Keep, keep a toothbrush at work. Uh, just get the debris off the teeth. And really it's the exposure of the sugars and acids.

So if you're, you know, sipping a soft drink or energy drink every five minutes for three hours throughout the day, you're constantly dipping down [00:25:00] into the acidic pH zone. You're never giving your body and saliva a chance to re buffer and re mineralize up into that higher, less acidic Uh, dangerous ph zone.

And so you're always in an environment where decay can occur. So uh, just keeping acids and sugars off the teeth, brushing after work, keeping a toothbrush at work. Um, those are all tips to minimize your risk for developing decay.

Jacqueline: Yeah, and speaking of sugar, can we home in on that a little bit? So when you say sugar, specifically what type of sugar are you referring to? Because

there's obviously so many different types. And we also hear a lot about like sugar substitutes like monkfruit and stevia. Has there been any literature on the impact of those sugar substitutes when it comes to tooth health?

Interesting.

Derek: Yeah, so I don't, I don't know specifically about some of those other, um, formulations that you mentioned here, but if they're, if you're able to get a xylitol, so xylitol is a sugar alcohol. It cannot be [00:26:00] digested by the strep mutans to produce the acid that leads to demineralization. So it's a great substitute.

I know in some folks that may. Uh, lead to, um, you know, GGI upset in some individuals and you can't give it to dogs. But, um, Xylitol is a wonderful safety profile for reducing your risk for decay. But when I say sugars, I do mean sucrose, table sugar. I'm not so much worried about. So yes, there are many different types of sugars.

But for instance, when you have a peach, yes, there's naturally occurring sugars in a peach, but you're also getting the fiber. You're getting the fiber, which is prebiotic fuel to help feed your, your, your biome. Okay. And the good bacteria in your gut, uh, yes, there's sugar. So it's, at some point, uh, you want to just clean the debris off your teeth.

I wouldn't fruit and then let it sit on your teeth overnight for eight hours because yes, you're going to probably drop down into the acidic pH zone, which could potentially lead to demineralization, but more, more the kind of sugars and sucrose. [00:27:00] that you find in processed foods. I do think there's a difference between, uh, the processed foods, uh, those sugars versus naturally occurring sugars that are associated with fruits and vegetables and have fiber along with it.

Jacqueline: Right. No, that makes complete sense for those who are just shopping in their nearby grocery store, what are some tips in terms of, like, things to look out for when shopping for, for toothpaste?

Kori: So I'd say that, I mean, there's always that sort of to fluoride or not question. And I think that's a personal one. And I think Derek would agree that fluoride does have proven benefits to the teeth when applied topically. Um, for me and my family, um, we choose not to use it.

Um, there have been shown to be some negative side effects from fluoride, which I don't need to get into. To too much of those. Um, but, um, if one can avoid it, um, and then there's a, a decent alternative. I'm, my view is I'd rather use something that's, that's totally safe. Um, in the [00:28:00] case of hydroxy appetite, um, you could consume a huge pile of it.

I mean, as Derek said, it's 97 percent of your teeth enamel and 70 percent of your bones. So it's abundant throughout your body. Um, and so that was a really easy choice, especially with young kids where. Sometimes they're eating the whole tube of toothpaste to not have to worry about what happens after they do that.

Um, in terms of other, other ingredients that you find, um, things like foaming agents can be overly harsh for the inside of your mouth, which is actually quite delicate. Um, and there, you know, the acronym SLS, um, but there's also alternatives that companies use, but the, the easy way to know if you have a foaming agent is if.

You're using your toothpaste and it's foaming. It likely has a foaming agent. Um, and then besides that, I mean, there's other things like natural flavors, which is something that we avoid because unfortunately you don't actually know what's in the natural flavor. And I think for a company that. Really prides itself on transparency.

It's really important for us to [00:29:00] know exactly what's in our toothpaste. Um, and beyond that, things like, um, propylene glycol, it's the main ingredient in founded antifreeze is something we want to avoid. Um, also things like triclosan, which is, um, an ingredient that was actually banned in hand soap. But it's still found in toothpaste.

So there's a kind of a list of ingredients that we try to avoid. And then I think in terms of the effective ingredients, as I noted, hydroxyapatite is something that's extremely important for helping to remineralize your enamel. Also, the xylitol that's in our products is extremely beneficial as well. Um, it's essentially, as you know, it's a sugar alcohol and, and while there's some controversy, I think on the food side, which, um, you know, I try to avoid eating lots of it in, in food products, but there are, clear oral health benefits to using it.

Uh, it essentially sort of tricks the bad bacteria into thinking it's sugar. It's actually not digestible by the bad bacteria. And so it's a [00:30:00] more targeted way of getting rid of the bad bacteria as opposed to taking the, uh, alcohol scorched earth approach, which I think is an important one for overall health.

Jacqueline: Yeah, that was an awesome. That was an awesome breakdown. Um on the fluoride front, so I would love for you to touch on Why fluoride might not be the best option because sadly I think a lot of people out there don't necessarily know Um, some of the negative impacts of of fluoride. I mean, I've, I've read so much research lately on even how I can pass the blood brain barrier and also even pass through the placenta into the body of an unborn baby, which is a little scary.

So can you touch on maybe some of the reasons why, like, even you personally, opted to not. Use fluoride, especially for your family.

Kori: Yeah, so I think, I mean, Derek, you should certainly speak as the dentist, but sort of as a mom and, um, co founder of the business, I think we've all done lots of research, um, on this topic and I think, you know, the one thing sort of that our research has [00:31:00] told us is that the benefits of fluoride in water are very limited.

So personally, we try to avoid it in my family. Um, it has been shown in studies that populations that use fluoride in their water actually have lower IQs than populations that don't. It's a known neurotoxin. Um, it's also an endocrine disruptor and as somebody that has PCOS, that's something that I also wanted to avoid.

Um, and so without enough sort of science, I think on the water side, I mean, it was, it was pretty easy to say that that was something we wanted to avoid in our drinking water. Um, and then on the toothpaste side and with oral health care products, I think the good news was that we didn't have to dispute the fact that when applied topically, fluoride can be beneficial for your teeth.

Um, but as we've discussed, there are, there are side effects, um, especially with too much fluoride contained. Consumption and I'll let Dr. Derek get into the details of that. Um, but now that there is an alternative that, [00:32:00] and this has been around, I mean, the, the cool story about hydroxyapatite, it was, it was invented in the seventies, um, by NASA, who, when the astronauts were coming back from space, they noticed their enamel was actually weakening and they wanted to figure out how to more of what Your enamel is made of, which is the hydroxyapatite.

So NASA figured out how to chemically manufacture it in the 70s and the Japanese quickly picked on to this and said we want to use this in our toothpaste. And so a majority of the market in Japan is actually using hydroxyapatite instead of fluoride, um, and they've been doing that for the last 50 plus years.

So there's lots of data about the safety and efficacy of hydroxyapatite, uh, compared to fluoride. Uh, and so we've got lots of good data and the Japanese don't use fluoride in their water. So it's a really good sort of control population to look at. Um, and so for us, it's, it's, we can agree that there are some benefits topically of fluoride.[00:33:00] 

Um, With also some side effects when consumed too much, um, but you don't have to sacrifice on efficacy when you go to use hydroxyapatite instead of fluoride, which I think is really important. Because when you think about the natural category of products, it's not always true that when you switch to natural products that they work as well.

Sometimes you have to make sacrifices for something that's cleaner. And the best example I use is with deodorant.

Jacqueline: I was just going to say Yeah, I have natural deodorant and I love it. I feel better 

Kori: using it. what brand do you use?

I use Primarily Pure, which I love,

Jacqueline: a good one.

Kori: but unfortunately, it does not stop perspiration. I love the brand, I know they're trying their hardest, and all of the deodorant brands truly are, um, but perspiration will never be stopped by a natural deodorant, sadly.

So you

just, is that, next on your list of business ideas?

Um, maybe, but, uh, you know, we, we've got enough in the world.

Derek: [00:34:00] Justin 

Kori: to keep us busy for a while, but I think I've just resigned my fat and myself to the fact that I will have, um, better smelling perspiration, but it won't disappear. Um, with oral healthcare products, uh, and ours in particular, the nice thing is is that you can use healthier products.

Without actually having to sacrifice on the efficacy. And I think we wouldn't have started the company if we couldn't do that. Because I think the truth is for someone like Dr. Derek to recommend products to his patients, they have to work. And that's really important. He can't recommend a product that's causing his patient's teeth to fall out.

I mean, ultimately, he would just stick with a conventional product. So that was really the key for us kind of in moving forward with, with starting the company.

Jacqueline: I love that. That's one thing I love about Rizal toothpaste is that your mouth still feels fresh. And I know that a lot of people like my dad, for example, and he no longer uses Crest, but he would use Crest toothpaste, which is so horrible for you. 

But he loved the sensation of that, like, minty, fresh taste. You know, feel. [00:35:00] So while, like, you feel fresh, you don't actually, like, have, like, freshness in your mouth, going back to what we spoke about earlier with the importance of maintaining that healthy pH and proper bacteria balance. Um, but you do, your mouth does feel fresh after using Risewell.

So that's one thing I love. So kudos to you guys for nailing that. Um, I did have some just random questions on practices that I do in my daily dental routine. And again, I'm just curious of both of your takes on that. efficacy, if it's something that everyone should be doing, if it's something that maybe doesn't really make much of a difference.

Derek: Before I answer that, can I jump in and piggyback off of my sister's comment previously?

Jacqueline: Yeah, absolutely.

Derek: So, so when she was talking about ingredients, it's important for your audience to know also some of the reasons, even if you're not using ours, whatever brand you choose, you really want to get sodium lauryl sulfate out of your oral care products.

Like my sister said, it's a foaming agent. It creates the illusion of, oh, effervescent bubbles. It must be working better somehow. Uh, but it's not. Uh, you don't need it. Your mouth is highly absorbent. You don't need [00:36:00] it. There's been studies indicating that SLS interferes with fibroblasts. Fibroblasts are critical in wound healing and repair.

So if you just had mouth surgery or an extraction, if you're using an SLS based toothpaste, you're inhibiting your body's ability to heal itself, which is not great. So you really don't want it in your mouth in a highly absorbent tissue, looking at a fluoride. We know the benefits of topical fluoride, but looking at the mechanism of action of how it works compared to hydroxyapatite, fluoride remineralizes only the outer surface of a lesion, that outer shell, leaving the subsurface, uh, demineralization unchecked.

Hydroxyapatite has been shown to create a more harmonious remineralization zone, both surface and subsurface remineralization, which is a great benefit to really fill in the chips in the armor of your enamel shell. Also, in order for fluoride to work, you need a store of the calcium and [00:37:00] phosphate. If you've got poor saliva, which many Americans do because most side effects of prescription drugs is dry mouth or xerostomia, when you don't have saliva, you don't have the reservoir of calcium and phosphate to drive into the enamel shell for remineralization anyway.

And that's another advantage for the hydroxyapatite. So those are mechanistically some nice advantages that HA has over uh, fluoride. I just wanted to make sure your audience knows that as well.

Jacqueline: Yeah. Thank you. No, that was super interesting. And I, I didn't realize that about only fluoride coming like the outer, outer part of the tooth. See, another reason to use hydroxyapatite. Um, but yeah, going back to, to my question on dental practices that, that I've shown to, to work or not. One of which is tongue scraping.

So, is that a, is that a good practice? Does it really do much at the end of the day? 

Derek: I, I also enjoy that practice and I've seen a lot of tongues in my day and there are definitely a lot of folks out there that need to brush their tongue. I think people don't realize that plaque and debris stick to not only [00:38:00] your teeth but also your soft tissues including your tongue. If someone's breath isn't so pleasant, could be the tongue, could be tonsil stones, could So, uh, brushing or scraping the tongue, uh, is a nice practice to keep debris off of it.

Uh, but again, you don't want to sterilize the tongue with an alcoholic mouth rinse because there, there is good bacteria that resides there like the actinomyces or the neanderthals that is, is, uh, contributing in the formation of the healthy nitric oxide in your system here. So you don't want to sterilize your tongue, but you know, gently brushing or scraping the anterior part of it without gagging yourself can be helpful to remove plaque and, and help freshen your breath. 

Jacqueline: Key, without gagging yourself for listeners out

Derek: Yeah. 

Jacqueline: first try it. Um, speaking of brushing, so electric versus a regular toothbrush, is there a benefit to one over the other? Take care.

Derek: Uh, I, I think anecdotally there, there is sure. I don't know if there's a specific research study comparing the advanced efficacy of electric, but I just think for older peoples or just any Americans, but your dexterity of your [00:39:00] hands, it doesn't rely on you being nimble with a mechanical, regular toothbrush.

I also like the timing feature of electric toothbrush, the way they have timing 30 seconds for each quadrant for a full two minute brush. It's a great way to just put your mind on autopilot. You don't have to worry about if you brush long enough because I mean, let's be honest with a mechanical, regular, traditional toothbrush.

And so he's just say, Oh, you know, five seconds, each quadrant done, ready for bed. Uh, but with mechanical, it's hard to, or electric, it's hard to cheat because it's got the timer. A lot of new ones have a pressure sensor too. So you know you're not putting too much pressure. I know it's very common for a lot of geridion type A successful people.

I think, I think, wow, if I'm brushing harder, I must be brushing better. Yeah. Well, that's not necessarily the case and you can actually be inducing gum recession and creating those little gouges of, uh, on the enamel by down by the gum line. And so really, I tell my patients, pretend you're brushing a ripe tomato and you don't want to puncture that thin layer of skin.

That's all the force you need to remove plaque and not [00:40:00] potentially induce gum recession or those little gouging marks, uh, on your, on your teeth. So I do favor electric brushing. Make sure there's soft bristles. You really don't need medium or hard bristles. Soft is plenty of force to remove plaque without potentially causing injury.

Jacqueline: Yeah. Gum recession. Is there anything folks could do naturally to, I guess, I mean, we can't, I don't think we could really reverse gum recession or maybe we can, but just to prevent it from, from getting worse.

Derek: Yeah, so great, great question. It's a really annoying situation that occurs and it leads to sensitivity, uh, so you probably want to be using hydroxyapatite. Also has great sensitivity relief and including the dentinotubules that lead to sensitivity if you already have recession. To naturally fix recession, I don't, I don't know a lot of great, uh, ways Uh, options for that.

Unfortunately, you probably need to see a periodontist. They're the gum experts and they can talk about grafting procedures. Really. The name of the game is prevention. You want to prevent applying too much force, uh, to when [00:41:00] you're, when you're brushing, uh, and also some, sometimes despite your best efforts going through ortho or going through braces, like when, when you're moving teeth, sometimes that can, unintentionally induced recession because as teeth are tipped, it kind of can push the gums up a little bit as teeth are moved through the bone.

So the price of a beautiful straight smile sometimes unfortunately is a touch of recession and I experienced that myself after my ortho treatment as a kid.

Jacqueline: Interesting. So, I also had braces in the sixth grade. I was not, um, diligent in wearing my nightly retainer, so I had to get Invisalign a few years ago, and ever since then, I do use my nightly retainer, but do retainers have that same effect?

Derek: Uh, it's possible. Yeah, I mean, if you're if you're moving teeth through bone, sometimes the consequence of that is the gum tissue is going to change in shape, uh, ever, ever so gently. So whether it's traditional metal bands and brackets or a clear aligner, uh, you know, [00:42:00] there could be a risk of potentially, uh, having some slight recession in some areas.

Jacqueline: All right. Noted. Um, and also, speaking of force. water picks. What are your thoughts on, on water picks? Is that an effective means to help floss teeth or is regular floss, does that work just as well?

Derek: Well, I, I think traditional flossing with, uh, with two hands is, is great because you can really, it's not just about clicking through the contact of your teeth. It's wrapping it around like the letter C and really swishing away debris between the teeth like a letter C, uh, which you can't totally do with the water pick.

Look, if you, if you're an older person with manual dexterity or hand issues, sure, blast away with the water pick. It's better than nothing. It's a great tool too for people with complicated dental restorations. So a lot of my folks with big prosthetic rehabilitations, I recommend water picks because the clean up around and the nooks and crannies of implant restorations can be very cumbersome to try and thread [00:43:00] the floss between and through and underneath you've got connected bridges or spaces where you're not allowed to click through with floss.

Yes. A warm pick is a great alternative and great for people with complicated uh, rehabilitations. But the average person probably doesn't, uh, need one if you're already using an electric toothbrush and flossing traditionally.

Jacqueline: All right, good, good to know. I was, because I was considering getting one, but maybe, maybe not necessary. Um, and my last question in terms of things that I do for, for my dental health, oil pulling. So this is an ancient Ayurvedic practice, for listeners. It's basically just swishing around about a tablespoon of, of coconut oil in your mouth.

For 10 minutes, if you can't do 10 minutes, try to shoot for five or even two. Um, but I've read that that has some incredible, benefits in terms of also just serving as a detoxifying agent, um, in, in your body. So what are your thoughts on, on that?

Derek: Yeah, so I don't, I don't have a problem with oil peeling. I have patients that tell me they do it and I say that that's fantastic. I mean, here's [00:44:00] some of the, uh, you know, techniques behind it. So really what you're looking at doing is matching, uh, the similar, um, like lipo felicity of the membranes and the oil in the coconut oil you're swishing with and the bacterial cell wall membranes.

They have a similar solubility. So when you mush those two together, the oil kind of pulls and attracts the cell walls of the bacteria and meshing them in this oil concoction that you're swishing. And yeah, you can absolutely collect and swish and expect to rate and spit out some debris and bacteria that way.

Definitely don't want to swallow it. I have no problem with people doing it. Uh, I'm not sure if I've seen studies linking, uh, like direct causation, uh, health benefits, but I don't, I don't see any harm in doing it. 

Jacqueline: Wonderful. Well, we've covered so many questions that I just was again, always wondering, like, is this effective or not? Thank you both so much for your time. There's still so much to cover. I feel like we've just scratched the surface, but I'm excited. We finally got a chance to connect and [00:45:00] chat.

, but I do want to be conscious of your time. So with that, where can listeners find you and learn more about Risewell?

Kori: You can find us at risewell. com or on our Instagram, which is risewellco. And I believe that we can get a promo code set up for your listeners as well. So we'll 

Jacqueline: Awesome. 

Kori: get that to you.

Jacqueline: That would be great. Yeah. I love your Instagram. It has such incredible, dental tips and, and health hacks, so I'll definitely be linking that in the show notes.

Kori: Thank you so much. This has been great.

Jacqueline: Yeah, absolutely. And my last question for you both, and this is often my favorite to ask, and that is, what does being well and strong mean to you?

Derek: Well, I think being well and strong all leads back to, uh, living healthy. And so, a healthy body goes back to a healthy mouth. Uh, the mouth is the gateway to the body. It's the beginning of the digestive tract. keeping things debris free, going back to nutrition, eating high fiber, high protein, leafy greens, fruits and vegetables.

Uh, all that contributes to living well and strong nutrition and preventative medicine.

Kori: For [00:46:00] me, I'd say it's, it's really kind of feeling my best. Um, cause when I'm feeling my best, I'm able to sort of put my best foot forward and be the best to, to my kids and partner and family and friends. And so that's really what all of this is about is having sort of a good, a good life that's nourishing and feels good.

Jacqueline: Beautiful. I love that. Well, it was so nice to connect with you both. I look forward to staying in touch, and yeah, I'll let you guys know when the episode, uh, goes live.

Kori: Amazing. Thanks so much, Jacqueline.

Derek: Thanks Jacqueline. That was a lot of fun.


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Jacqueline Genova

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