‘Oral Health and Systemic Disease: Assessing the Oral Microbiome to Improve Clinical Outcomes’

Would mouthwashes like Ecodenta be ok? They contain things like aloe vera, charcoal and no alcohol.
I am not a big fan of mouthwashes. I like to think of them like an aftershave or perfume. If you have consumed garlic, coffee or a curry they are good to use occasionally to mask smells. We use them for short term use after surgery or if you have a mouth ulcer but no more than a week. We use warm salt water (1 teaspoon of salt in a cup of warm water). Long term use any mouthwash will disrupt the microbiome. If you do choose one make sure SLS free, alcohol free. I am concerned about charcoal as it is abrasive.
On that particular mouthrinse I would be cautious with the essential oils / fragrance allergens. Mentha piperita (peppermint) oil, “Aroma”, menthol, limonene, pinene, Can irritate or trigger burning, dryness, perioral dermatitis, or recurrent mouth soreness in some people. Limonene/pinene are common fragrance allergens.

Do you have any specific recommendations for clients undergoing Invisalign treatment, particularly regarding dry mouth, or oversalivation, gum health, sensitive teeth and potential concerns around prolonged plastic exposure and hormonal balance?
All aligner use will make it harder to clean your mouth and make you more prone to cavities and gum disease. Firstly don’t eat or drink with them in, try not to snack and limit to 2-3 meals a day. They are usually only short term use 4-18 months. So make sure you clean the aligners regularly (something like Retainer Brite). They are usually swapped every two weeks. See your hygienist regularly during the process so they can sport potential issues early. If you are prone to clenching and grinding your teeth perhaps choose a different orthodontic option such as fixed braces I you are concerned about microplastics.

What is the best way to stop gum recession?
Firstly look for root cause to the recession. Is it overbrushing, clenching/grinding of your teeth or gum disease. Most commonly it is over brushing, perhaps choose an electric toothbrush with a pressure sensor.

Possible good toothpaste brands please
I like brands with Hydroxyapatite such as Gutology, Boka, Dimples, Fygg and Zing.

Is it normal for teeth to shift within a couple of hours after completing invisilign? I find unless I wear a retainer the teeth shift very quickly on the lower.
Teeth like to be a position of harmony with their neighbours and the soft tissues. Sometimes they are moved by an orthodontist to a position that looks aesthetic but is not functional. You could get a fixed wire retainer fitted to stop this happening.

You mentioned good properties for toothpaste, do you have the best recommendation for supermarket ones that can i recommend to patients?
I like brands with Hydroxyapatite such as Gutology, Boka, Dimples, Fygg and Zing. Healf and Amazon sell most of these. Gutology offer a free sample for our patients, just pay for shipping. Type in “Optimal Dental Health” https://gutology.co.uk/pages/toothpaste-signup

For a case of hypo-mineralisation in a child – age 8, recommended four teeth extracted. Would you recommend this as a suitable course of action or are there less invasive routes to try?
Would need to examine the child first. Generally we try and avoid any extractions at this age. If they are not getting any pain. We normally photograph, monitor and if badly broken down place provisional crowns.

Thoughts on the effect of tooth-whitening treatments on the oral microbiome?
In office whitening treatments have almost no effect. Actually tooth whitening trays was discovered by using these gels to disrupt the microbiome for patients with gum disease. Take home trays I would use 10% carbamide peroxide gels. As it produces oxygen it will affect the anaerobic bacteria. As only using for up to two weeks no long term damage and should help any gum disease.

Where are the key limitations or deficiencies in today’s oral microbiome test offerings?
I would like to see the price drop to make them more accessible. Also like to see specific toothpaste recomendations depending on the microbiome sampled.

What is your go to toothpaste?
In an ideal world we don’t need toothpaste, can brush with just water or baking soda. If I am using toothpaste to remove stains then I like brands with Hydroxyapatite such as Gutology, Boka, Dimples, Fygg and Zing.

Would a snack of Almond Butter also have a negative influence on oral health, or is it mainly the carbs that cause the problems?
Ideally choose one without added sugar or sweeteners. Also tend to be sticky so can be hard to get off the teeth afterwards. Pair with something crunchy to help clean ff teeth such as carrots, apple or celery.

What about water flossing?
Not quite as effective as flossing or interdental brushes but a close second. Really like them. Get your dentist or hygienist to show you how best to use.

Would metal braces affect hormones on a female teen
If no metal allergies then generally not. You could consider ceramic brackets if there’s significant sensitivity history.

Is the Kingfisher brand of toothpaste a good alternative?
I like the fact it is UK based with no artificial colourings, flavourings, sweeteners or preservatives and they offer Fluoride free options. As I mentioned I am not tied to one particular toothpaste. Your brushing technique is more important that the toothpaste you use.

Is there a vitamin D test you would recommend?
We use the Igloo POC (finger prick) test at Optimal Dental Health with results in 15 minutes.

How would you interpret the microbiome test in order to extrapolate a plan to provide to the client?
Firstly look at the diversity and then depending on clinical signs and symptoms drill down further. For me the test without a history or examining the patient is of very limited use. What it can do is help you decide where to focus first (caries vs periodontal disease vs halitosis/dysbiosis vs inflammation) and how aggressive to be with stabilisation.

Are there concerns about microplastics or plasticisetrs from toothbrushes and interdental brushes?
There is growing interest in microplastics and plastic additives, but at the moment there isn’t strong evidence that toothbrushes/interdental brushes are a major health source compared with food, water, and environment. Still, if you want to reduce exposure and waste, we can suggest recycled/recyclable products, replace heads rather than whole brushes where possible, avoid very abrasive scrubbing, and consider bamboo or reusable-handle options.

What care do you advise patients post extraction to prevent cavitations?
Most important is how the tooth is removed. Need to carefully remove the periodontal ligament that holds the tooth, thoroughly clean out any infection in the surrounding bone. This can be done with instruments or Ozone. Then close the area up, can use Platelet rich Plasma plugs as well. Post operatively no rinsing or heavy exercise for 24 hours.  Ideally no smoking for a week, anti-inflammatory diet and rest.

what do you advise for smokers?
Smoking impacts the mouth quickly, it increases gum disease risk, staining, bad breath, delayed healing, and (most importantly) oral cancer risk. Our approach is:

1. Support: help you quit or reduce, using evidence-based stop-smoking services (and we can also collaborate with a coach/hypnotherapist if that suits you).
2. Protect: more frequent dental and hygiene reviews to keep gums stable and spot early changes.
3. Personalise home care: meticulous brushing and interdental cleaning, plus tailored advice for staining, dry mouth, and inflammation.
4. Whole-health habits: improving sleep, stress, diet, and alcohol intake can make quitting easier and reduce overall inflammatory load.

The good news is the damage can reverse quickly I you can cut down or stop.

If someone has been clenching at night and ‘popped out’ one of their fillings, what is the best plan of action moving forward? What fillings are the least harmful? Many have to be glued on & plastic used etc? Is it better to just keep it clean and not refill?
I would always replace a lost filling. In the meantime keep it really clean. There are lots of great BPA- composite options now. We also look at why you’re clenching. Is it a mineral imbalance, bite not even, unmanaged stress or sleep disordered breathing?

Is there anything you can do you reverse gum recession?
Gum recession rarely “grows back” on its own, but we can usually stop it progressing and improve symptoms. First we identify the cause (often over-brushing, sometimes gum disease, tooth position or clenching) and correct it, an electric brush with a pressure sensor can help. If coverage is needed, a gum graft can often restore and thicken the tissue in suitable cases. Supplements may support gum health, but they don’t replace fixing the cause. Growing evidence CoQ10 and Vitamin D can help. Start with an examination and testing for nutrient deficiencies.

Mercury fillings also badly affect the microbiome. With a patient who has a large number of mercury fillings that cannot be removed due to lack of remaining tooth, cost etc. how can we improve the microbiome sustainably?
I would start by photographing each filling so we have a bench mark to see if they are deteriorating further. Make sure you are not clenching/grinding your teeth and if you are wearing a custom mouthguard at night to prevent mercury release. Keep the mouth neutral as much as you can avoid acidic foods/drinks and when you do look at neutralising them soon after think xylitol gum or swill with water.

What is your opinion on red light therapy for periodontal disease?
Promising as an adjunct (it may help inflammation and healing), but it doesn’t replace the fundamentals: meticulous cleaning, reducing pocket bacteria, and addressing risk factors. I would see it as “nice add-on” once the basics are nailed.

Support for cancer patient who is on chemo , suffering with mouth ulcers
Get the oncology team involved early, chemo mucositis can escalate fast. Gentle oral care, bland rinses (salt/bicarbonate), keep hydrated, avoid alcohol/perfumed mouthwashes and any product with SLS (sodium lauryl suphate), and we can help with protective gels/pain control and infection checks.

Is there evidence that tongue scraping reduces gum disease?
It can help breath, improve taste, regulate blood pressure (through Nitric oxide production) and reduce tongue coating, but evidence for it treating gum disease is limited.  I add it on or my patients once you have nailed the brushing + interdental cleaning + professional periodontal care.

What advice for a tooth greying that had trauma 15yrs ago
Greying can mean the nerve has died. It needs an exam + X-ray (and sometimes 3c CBCT scan) to check for silent infection and the nerve is still alive. If all is healthy we can monitor and discuss whitening options; if it’s non-vital or infected, root canal (and then internal bleaching) is usually the route.