How to Heal Your Oral Microbiome & Stop Bleeding Gums Naturally

Nick Urban [00:00:01]:
You’re listening to High Performance Longevity, the show exploring a better path to optimal health for those daring to live as an outlier in a world of averages. I’m your host, Nick Urban, bioharmonizer, performance coach, and lifelong student of both modern science and ancestral wisdom. Each week, we decode the tools, tactics, and timeless principles to help you optimize your mind, body, and performance span. Things you won’t find on Google or in your AI tool of choice. From cutting-edge biohacks to grounded lifestyle practices, you’ll walk away with actionable insights to look, feel, and perform at your best across all of life’s domains.

Nick Urban [00:00:55]:
If you spit a little pink in the sink when you brush, you probably shrug it off. My guest says new bleeding gums are often one of the first signs of insulin resistance. I’ve covered the mouth several times on the show, but never with a dentist who once led the British Academy of Cosmetic Dentistry. Dr. James Goolnik has spent over 30 years in the dental chair in London, and today we’re getting into What Your Mouth Is Telling You. James, welcome to the show.

Dr. James Goolnik [00:01:25]:
Thank you so much, Nick. Yeah, 30 years in the chair and next to the chair. There you go. Being a patient and a dentist.

Nick Urban [00:01:33]:
Do you prefer Dr. James? James?

Dr. James Goolnik [00:01:35]:
James. James is fine.

Nick Urban [00:01:37]:
James it is. Okay. We were talking offline a minute ago about the disparity in dental care. On one hand, you have the people spending $50,000 on a high-end, all-natural, regenerative dental experience. On the other, you have people who more like your average folk who are just like, okay, I want to have the best health possible. I also don’t want to spend my entire life fortune on one dental office visit.

Dr. James Goolnik [00:02:03]:
Yeah.

Nick Urban [00:02:03]:
Break, let’s break that down going from simple, like good, better, and best. What are the good things we can do? What’s the level above that, the better things? And then finally, what are like, what’s the high end?

Dr. James Goolnik [00:02:14]:
Great question, Nick. I mean, I would start off with, first of all, our job as dentists is to be detectives and to find disease and stop it in early stages. So often seeing disease before it happens. So as you said, pink in the sink, no, no. For us, we have a zero tolerance on bleeding gums. We know that’s inflammation, leaky gums, leaky gut, and can cause so many problems downstream. So looking out for the simple stuff that we can do first. So for the basic is no bleeding gums.

Dr. James Goolnik [00:02:44]:
And then looking at having no cavities. And we can talk later on about how we reverse cavities and what we do for that, because there’s some really great biohacking stuff come out that’s not expensive. And there’s also some more sort of medium end. So that’s the first thing is basic is we want no disease. And that’s something sometimes you can spot the signs of disease with blood, but a lot of the time you can’t tell it till it’s further downstream. So going to see your dentist at least once a year so they can spot those things. And if they do spot things, what can we do? That’s the sort of the basic level. The next level up is let’s see if we can optimize our mouth a bit better.

Dr. James Goolnik [00:03:18]:
Let’s look at our vitamin D status. Let’s look at our diet and our sleep. and perhaps track our sleep, whether you might have an Oura Ring or Whoop Band, Apple Watch or something, just to see how we can optimize that. And there’s some simple sort of hacks that we can do from that. And then the next level up is get rid of all the metals in your mouth because we know that metals are bad for us. And especially things like amalgam, which is full of mercury and various other metals, can cause lots of problems in lots of people. So when we find that we’ve got old legacy dentistry with amalgams, how can we safely remove that? And that could be what we call a smart amalgam removal, looking for a dentist that’s been certified to do that properly. And then that’s removing metals.

Dr. James Goolnik [00:03:59]:
You might have metal titanium implants that are failing, maybe replace them with something more biocompatible, the zirconia or ceramic. So they’re all tooth colored as well. And then improving your bite and improving your smile as well. Because the whole thing for us is we want great aesthetics, want a really sexy smile, but we also want it to function and we want it to last for the rest of our lives. So how can we sort of biohack that? So they’re the sort of the 3 So, there’s different levels of dentistry, but the bottom line is no disease, and that’s what we’ve got to work on.

Nick Urban [00:04:29]:
So, if we start from the most simple place, let’s just say that’s the bathroom. Let’s say that’s a toothbrush. What kind of toothpaste? Are you a fan of the, what’s it called? Non-nano hydroxyapatite?

Dr. James Goolnik [00:04:41]:
Hydroxyapatite. Yes. So, there’s a lot of marketing out there, and if your listeners are looking at this, nano hydroxyapatite, there’s micro, nano, there’s particle sizes, there’s 10%, 12%, and then they start getting into all this marketing stuff. But, we go right back the basics is why do you need toothpaste in the first place? So, for most people, you can brush with just water, and that will do a lot of the job. But the main reason we use toothpaste, there’s 3 reasons. One is for an abrasive. So, if somebody, if you’re having some tea, coffee, soy sauce, red wine occasionally, your teeth are very porous, so you need something to try and break down that staining. And that could be silica, that could be bicarbonate of soda, baking soda.

Dr. James Goolnik [00:05:23]:
Doesn’t have to be anything really expensive. The next thing is, for most people, when they’re brushing teeth, they want to have fresh breath. So, they might have mint or they have different flavors to just enhance their breath. And the last, the material that is sort of very sexy at the moment is what we use to remineralize our teeth. So, if we’re having snacking, if we’re having a lot of acidic foods, if you’re somebody that has sodas quite regularly, you need something to help harden the teeth because every time we eat and drink something, the natural pH of our mouth, which is around 7, around neutral, drops down. And once it drops be below a threshold of 5.5, that’s when our enamel starts dissolving. And we don’t want that to happen. So when we’re eating something naturally, the saliva drops down to around 5.5, but we want to try and bring it up as quickly as possible.

Dr. James Goolnik [00:06:12]:
And that could be with just having water after your meal, having some yogurt, something to neutralize it. And then these products like hydroxyapatite is naturally in our teeth, and that can help remineralize, that can help rebalance that acid in our mouth. And there’s different products that do it. And fluoride works as well, but fluoride works as a topical effect. So it only works on the surface. And there’s more and more growing evidence that fluoride is a neurotoxin.

Nick Urban [00:06:39]:
Yeah.

Dr. James Goolnik [00:06:39]:
So it can cause problems. But to be honest, any chemicals in a large enough amount is going to be toxic to us. So for us, we work on our patients. Can we work on their diet first? Are we looking at what they’re eating and drinking? And we are looking at The saliva, the magic stuff that we all have for free in our mouths, is the best remineralizing agent. So if you can try and allow that saliva to work for longer, you are gonna have less problems. So that’s all about intermittent fasting or time-restricted eating. So having a longer window when you’re not eating and chewing all the time, and then trying not to snack continuous throughout the day because the saliva doesn’t have a chance to remineralize. And then also looking at what else can we do to try and help that.

Dr. James Goolnik [00:07:23]:
And that’s all about trying to try and reduce sugars and carbohydrates. And for us, my patients are 80/20 rule. So 80% of the time they’re eating stuff that nourishes them, gives them loads of energy, they enjoy, and makes them feel great after a meal. And then 20% of the time they’re having the sodas and the chocolates, the candies, the sugars, all the things that they may have infrequently, but it’s how we can modify their diet slightly so it doesn’t damage the teeth. Because the teeth, the enamel is the hardest substance in our body. And if we are dissolving Then we’ve got problems. It doesn’t grow back and we’ve got to have these teeth for sort of 70, 80 years. So we need to really work on that.

Nick Urban [00:08:04]:
There’s the old experiment where they put the Coca-Cola and the tooth in the same Petri dish and Coke dissolves the tooth.

Dr. James Goolnik [00:08:11]:
Yes.

Nick Urban [00:08:12]:
Even with healthier things, I’ve noticed when I eat certain things these days, I didn’t notice it much when I was younger, but these days when I eat or drink, say I eat a piece of fruit, sometimes I notice that like it makes my teeth hurt afterward. And that’s even despite drinking some water right after knowing that it’s probably not good for my enamel. And then And I’ve also heard that like if you have that, you don’t necessarily want to brush because that can like exacerbate the negative effect.

Dr. James Goolnik [00:08:35]:
Exactly, Nick. So every time you’re having something, fruit or anything acidic, the worst thing you can do is brush your teeth straight afterwards because you’ve got the acid in your mouth and your saliva will naturally neutralize it in 20, 30 minutes depending on the buffering capacity of your saliva. So what you want to do ideally, if you need to brush, rinse around for 30 seconds with water, have some xylitol gum or xylitol mints. something to neutralize, yogurt, kimchi, anything to neutralize that acid will work really well. Then you can brush your teeth straight away afterwards. But that’s the big thing. And I get lots of patients say, my teeth only hurt when I eat candies. Well, that, first of all, that’s your body telling you don’t eat the candies.

Dr. James Goolnik [00:09:14]:
But that’s also usually because they’ve had some gum recession. The gums have shrunk and the root is exposed and the roots have these lots of little micropores and the basically anything acidic is going into those pores, irritating the nerve endings, and giving you this like sharp stinging pain. So it’s your body telling you that’s not great, you’re doing too much of it. So for my patients, I try and get them to binge it when they’re having the candies. And I’ve got kids, so when we have Halloween trick-or-treat, they can have as many sweets as they want in an hour window. So they gorge as much as possible so they’re not left out with their friends. But usually after an hour, they feel really sick.

Nick Urban [00:09:53]:
Yeah.

Dr. James Goolnik [00:09:53]:
And then whatever’s left go straight in the bin. They don’t keep them because that’s the worst thing to keep those candies over 2 weeks and they’re just going to constantly be eating them.

Nick Urban [00:10:01]:
Yeah. Even for the listeners of the show who probably aren’t going to be binging on a ton of candy, that idea that you’re mentioning of like, if you’re constantly grazing, you’re eating snacks every hour or so, you’re not letting the saliva do its job coming back and to remineralize. Is the saliva actually doing the remineralization? How is that working?

Dr. James Goolnik [00:10:17]:
So the saliva is doing the remineralization. So most of us have calcium and phosphorus in the saliva. And what’s happening is, first of all, the flow of saliva is helping wash away the food and the debris and the particles in it. The calcium phosphate, it slowly brings the pH back up from sort of 3 or 4 that it was when you had your sodas or your candies. Because basically whenever we’re having anything sugary or anything with carbs, the bacteria in our mouth eats those carbs and the byproduct is acid, and which the acid is actually then dissolving the teeth. And some people are different. So you might have a couple that they both eat the same diet and one of them keeps having cavities and the other one never has. And that’s all about the microbiome.

Dr. James Goolnik [00:10:58]:
the bacteria in their mouth. So they may have more of a… there’s 2 bacteria that cause tooth decay, but the most prevalent one is one called Streptococcus mutans. And you can do a simple microbiome test where you can actually see how much of that bacteria you have. And if you have the same amount for your age or whether it’s higher or lower. And if it is higher, then you are more likely to have tooth decay. So therefore you should be snacking less, you should be eating sugar and carbs less. And then we look at how we can rebalance that. And that might be a course maybe a month of probiotics to try and rebalance it, or looking at prebiotics or something to try and change the balance.

Dr. James Goolnik [00:11:36]:
Because we need that microbiome. We need the bacteria in our mouth to help break down foods, help with enzymes, help produce a thing called nitric oxide, which is the magic gas that can help control our cardiovascular system, our blood pressure, and our arterial sort of support. And so we find that people don’t have much of that, they’re more likely to have high blood pressure and things like that. So a lot of times when we spend time with our patients, we’re going through all their histories and everything as we can. And if somebody is a high risk of any sort of blood pressure or cardiovascular disease, we get them to make sure they’re tongue scraping. That’s one of my most favorite things. Have you got a tongue scraper, Nick?

Nick Urban [00:12:16]:
Yep, did it this morning.

Dr. James Goolnik [00:12:18]:
Great. So it’s really important. And that’s a really simple thing. And actually people go to me, oh, I’ve gotta buy all this fancy thing. I said, no, you can just get a spoon from the kitchen. 3 scrapes and that’s it. But if you want to go up one, that’s the basic level, just the spoon from the kitchen. If you want to go up one, you want a copper one ’cause it’s much better.

Dr. James Goolnik [00:12:35]:
It’s antibacterial. They last for years. And it, basically you don’t need to use any chemicals or anything. 3 scrapes and then put it under the tap and rinse it off. Let it air dry once a day. Not only will your breath taste better, not only will you have less gum disease, but also you get an increase in nitric oxide production, which helps the blood pressure control as well. So that’s a really simple hack that people can do. And again, my kids from the age of 6 have done tongue scraping.

Dr. James Goolnik [00:13:02]:
And that’s something that a lot of your listeners, if they’re not doing already, go out and buy a tongue scraper.

Nick Urban [00:13:07]:
It’s one of those habits I picked up years ago because I started studying Ayurveda and it’s a part of that system. And once I did it and I was consistent for a week or so, a couple times when I didn’t have my tongue scraper, I’m like, oh man, this, I don’t feel gross. I feel dirty. Even though I brush my teeth, I use like the clean ethanol-free mouthwash and everything, like an essential oil-based mouthwash that had, I think it was coconut oil with like a drop of essential oil in it. Even then, I’m like, I still don’t feel nearly as clean. And I’ve also read about potential for lack of tongue scraping muting hunger signals. So it’s like when you, when you clean your taste buds off, your body has a cleaner input and knows, gets better feedback from the process of putting something in your mouth and going through the whole digestive system into like getting the feedback. Okay.

Nick Urban [00:13:57]:
I’ve had enough food. Maybe I should stop being hungry. I should stop eating. And it’s easier to overeat theoretically. There’s not any great, well-controlled research on this, but then like perhaps there’s a slight effect there as well.

Dr. James Goolnik [00:14:09]:
Yeah. I mean, if you’re looking at also reducing overeating, one big thing is to, for everyone to chew more. At the moment, we tend to have very soft diets. We almost inhale our meals. We don’t, we’re doing 2 things at once. I’m not even thinking about the meals when we’re having them. So actually sitting down, spending some time, actually slowing down, chewing, and helping develop the jaw muscles makes a big difference for people. And that will make a difference in, again, you will feel fuller quicker and not eat as much food than if you’re just stuffing it down.

Dr. James Goolnik [00:14:40]:
You won’t even have a chance to enjoy it. Yeah.

Nick Urban [00:14:43]:
You also mentioned nitric oxide. And I think people may or may not have heard of that, But what are some of the things that we do that are damaging to our oral health or overall health? And the clue I’m giving you has to do with nitric oxide.

Dr. James Goolnik [00:14:56]:
Yes. And mouth breathing is the big thing. So, so many of my patients, especially the younger ones, are breathing through their mouth. And if you’ve got… if you’re a parent listening to this, if you go into your kids’ bedrooms at night and if you see them falling asleep, usually on their back with their mouth mouth wide open. And if they wake up in the morning and they’ve got these sort of dark circles under their eyes, we call them venous pooling. And they tend to be a little bit more irritable in the morning and harder to wake up. And my daughter, who’s 12, is just like that. We find that if we mouth tape, we make such a difference.

Nick Urban [00:15:32]:
Yeah.

Dr. James Goolnik [00:15:32]:
So actually, it’s really simple. You can buy Micropore that just goes over your lips, or you can buy some fancy tapes from Amazon. But actually just encouraging people as much as possible to breathe through their nose throughout the day, but at is critical because if you’re somebody that wakes up tired and groggy, you wake up with bad breath or dry mouth, almost certainly you’re breathing through your mouth. And also, if you’re sleeping with a partner and you ask them if you make noises at night and if you disturb their noising, almost certainly you’re breathing through your mouth and you’re snoring. So really simple thing, doesn’t cost much, a few dollars, some mouth tape. And we always get people to initially try it. it at home when they’re on emails or watching TV or something, just to get used to the sensation of having something over their lips. Do it for about an hour a day for a week.

Dr. James Goolnik [00:16:21]:
Once you get used to it, then you do it all night and you’ll find that you’ll sleep better. You’ll feel more energized in the morning. You have better breath as well. And you’ll have a much better microbiome and increased nitric oxide production because we want to keep this saliva in. And obviously breathing through the mouth, we miss a lot of the immune system in your nose. The nose has got lots of cilia, lots of hairs, that filter foreign particles out. It warms up the air. It treats any bugs and bacteria beforehand, and it misses the teeth.

Dr. James Goolnik [00:16:50]:
So if you can try and encourage people to breathe through the mouth… through the nose as much as possible, and look in if your kids are actually breathing through your mouth at night and try mouth taping. After a while, they stop it if you can train them, or you can do something called myofunctional therapy, which is like going to the to the gym for your jaw. We teach people how to breathe properly, how to swallow properly, how to strengthen their jaw muscles and their tongue, and get the tongue in the right position. And doing those things, those exercises are free, easy to do. And actually, as we get older, our muscles generally sag and lose some of the tone. So, if you’re somebody that does gym exercises, you should be looking at facial gym exercises as well.

Nick Urban [00:17:30]:
We are on the same page today. I was actually going to ask you about each of those topics. And specifically, when you mentioned the role of saliva, I’ve noticed that if I don’t mouth tape, at least a while ago, back before it was like a habit and I wasn’t accustomed to nose breathing, I’d wake up and my mouth would be so dry and I’d feel terrible. And then I don’t, when I use mouth tape, I used to actually cover my entire mouth. And now I just, I do it vertically to cover and to mechanically hold my airway in the right position. And now when I wake up, I feel completely refreshed. But the idea of like, if saliva is important and you’re going for 8 hours per night with diminished saliva production because you’re evaporating the saliva in your mouth when you’re breathing out. That seems like a really big window that you wouldn’t want to miss out on.

Dr. James Goolnik [00:18:18]:
Optimize, definitely. We need to protect the saliva as much as possible. And the ways most people damage it is the number one thing is mouth breathing. The next thing is actually using alcohol-based mouthwashes and sort of antiseptic mouthwashes. And a lot of the adverts on TV are like, kill everything, kill the bugs. And actually, we need these bugs. We live with those bugs. Our body is covered in bugs.

Dr. James Goolnik [00:18:39]:
We need them. So, it’s like not using any mouthwashes. And when we do mouthwashes with our patients, it’s usually for a really short period. If you’ve got an infection, you’ve got a canker sore or an ulcer, or you’ve had some surgery and we’re using mouthwash for short-term use. But no adult should be using mouthwash long-term. Think of it almost like a perfume or aftershave. You’re getting rid of the flavors and the smells. If you’ve had a curry or a lot of coffee, you can use that to hide it.

Dr. James Goolnik [00:19:07]:
But as a regular use, Mouthwash is a no-no. Mouth breathing is a thing we’re going to work on. The other thing is regular snacking so you don’t have chance for the natural saliva just to work well on everything. That’s a really important thing to keep the natural saliva. And then it’s also all about the micronutrients, macronutrients. So it’s all about having a balanced diet full of phytonutrients, lots of mixed vegetables, lots of seeds and nuts, and just having a varied amount of things. If you’re having the same thing all the time, Wow. Microbiome doesn’t like it.

Dr. James Goolnik [00:19:39]:
And we nowadays do, in the clinic, we do a live microbiome sample. So when somebody comes into us in London first time, we take a swab and we look on the microscope and we’ve got phase contrast microscopes in the clinic. And we look live to see what’s going on in that microbiome. Is it a happy microbiome? Is there more inflammation? Is there blood cells? Is there, what sort of, are there any sort of pathogens or anything else going on. And then from that, we then decide, do we need to do a full microbiome test where we actually take the sample, send it off to the laboratory, and they grow it, and then we can actually see what is going on completely in your microbiome. But these are the things that we are trying to do. Obviously smoking will affect it. So I’m sure none of your listeners are smoking, or vaping is also shown to affect it as well.

Dr. James Goolnik [00:20:25]:
So that’s another thing that will change it. And then the other thing is obviously alcohol. And not only dries it out as well, but regular alcohol can affect the microbiome. And antibiotics, which we try and avoid as much as possible. And if we ever give antibiotics to somebody, and if you are getting antibiotics for anything, ask them for some probiotics as well to match up as well, because it takes about a year, 6 months to a year for your microbiome to get back to where it was before the antibiotics. So really, obviously antibiotics are life-saving and and need to be done sometimes, but they’re given too often and we really want to try and avoid them.

Nick Urban [00:21:02]:
Yeah. You might’ve mentioned this, but the other reason that I avoid alcohol-based mouthwash is that when you use that in your mouth, you are also reducing the populations of the bacteria that convert nitric, I think it’s nitrates into nitric…

Dr. James Goolnik [00:21:17]:
Nitrates to nitrites.

Nick Urban [00:21:19]:
Yeah. Into nitric oxide. So you’re actually like putting your cardiovascular system at a disadvantage.

Dr. James Goolnik [00:21:24]:
Yep, definitely. So, I mean, mouthwash for me is just used to clean the toilet out. There’s nothing else. If you’ve got mouthwash, just give it to somebody else. You shouldn’t be using it. It’s got no clinical evidence on it now, again. So that’s the big thing. And when people talk to me about, you said the number one thing they start with is the brush, and it’s actually the technique of brushing.

Dr. James Goolnik [00:21:43]:
And a lot of people have not been shown how to do it properly. And with a toothbrush done properly for 2 minutes, a manual one, you get about 70% of the plaque or the microbiome disruption. But the last 30%, you can only get with some sort of interdental aids. And that could be floss, that could be sticks, that could be brush, that’d be a water flosser, a Waterpik, but something to get in between the teeth. And we want something that’s a real snug fit. So, it physically rubs the tooth either side and disrupts the microbiome. Because a lot of the bacteria in the mouth that cause gum disease are what we call anaerobes. They don’t like oxygen.

Dr. James Goolnik [00:22:20]:
So if we can flush them with oxygen, whether that is by disturbing them, by brushing them, whether that’s pushing them out of the way, or whether using… we use a lot of ozone in our clinic. So that’s medical-grade oxygen. We use it as a liquid, but also as a gas. So we can clean that and that helps disturb the microbiome without damaging it. And it gives us enough time to then repopulate it with more healthy species as well. So that’s something to ask your dentist if you go there and ask them, do they use ozone? It’s one of the most natural antimicrobials.

Nick Urban [00:22:54]:
Yeah. So, so far we have brushing technique. Oh, we have a lot of things. Brushing technique, avoiding mouthwash. We have tongue scraping. We have mouth taping, proper diet. We got a lot of things so far. On the lifestyle things, I’ve found that when I’m going to consume acidic Beverages, in this case, I use a straw.

Nick Urban [00:23:19]:
So I have coffee in front of me, a very acidic beverage, and I use a straw so that I minimize the contact with my enamel. Is that actually useful?

Dr. James Goolnik [00:23:28]:
Yes. So straw works, definitely. The other thing is you’ve got quite a big coffee there and it probably takes you an hour to go through it. So that’s the only downside is if you’re sipping something over an hour or so, you’ve got the acid in your mouth for a longer period. So ideally, Have it over a shorter period. Have some water. So have the coffee and the water afterwards to help flush it out as well. Try and avoid any sugars obviously in the coffee.

Dr. James Goolnik [00:23:53]:
But the other thing that a lot of people use and they don’t realize about is a lot of these artificial sweeteners like saccharin, sucralose, things like that, NutraSweet. They first of all trick the body to think something sweet’s coming.

Nick Urban [00:24:07]:
Mm-hmm.

Dr. James Goolnik [00:24:07]:
So your taste buds will then be excited by other sweet things, which means sour things taste really sour. The other thing is it also means that there’s been loads of studies showing if you have something with artificial sweeteners, you tend to snack more and eat more. So therefore, you tend to put on more weight as well, and it affects the microbiome in the mouth and in the gut as well. So these artificial sweeteners, for me, it’s a transition. If somebody’s going from full-fat Coke to Diet Coke, eventually to fizzy water, to eventually just still water. And I think people use them as that. If you use them all the time, it can really affect the microbiome. And we are finding more and more things now.

Dr. James Goolnik [00:24:49]:
And the biggest microbiome in our body is the stomach. And the second biggest is in the mouth. And the mouth is really easily disturbed. But the great thing is we can repopulate it and rebalance it within about a week.

Nick Urban [00:25:01]:
Wow.

Dr. James Goolnik [00:25:02]:
So it’s really quick to rebalance it. So when we see patients who’ve got bad breath, bleeding gums, they’ve got sore gums, sensitive teeth, we can actually have a look and see what’s going on in their mouth. We can go through the diet and the simple things. And it might be we’re working on their sleep because they’re mouth breathing or they’re waking up multiple times and they’re not getting deep restful sleep.

Nick Urban [00:25:23]:
Yeah.

Dr. James Goolnik [00:25:24]:
So we might work on their sleep and we might do what we call an overnight sleep test to see what’s happening. And then some people have something called sleep apnea, where basically as they fall asleep, all the muscles are relaxing, the jaw drops back, the tongue is attached to the jaw. And as that drops back, it shortens the airway and compromises the airway. So less oxygen is getting into the brain at night. And therefore you’re not going to deep enough sleep, but you’re also having lots of what we call these microarousals. So every 10, 15 minutes, your brain is trying to get more oxygen in. So it sort of makes you bite your cheeks or your tongue and you’re waking up a little bit and then you’re breathing in deeper and then you’re starting to fall asleep again. You never feel fully rested.

Dr. James Goolnik [00:26:04]:
So if you’re somebody that feels tired in the morning, needs caffeine to get going and is struggling with this and has a slump in the afternoon, would be worth It’s worth looking at your sleep, seeing what your oxygen saturation is at night. And you can do it with the rings and the watches and the bands, but they’re not as accurate as a full overnight sleep test. And then your dentist can help work on the figures and say, well, actually, let’s make you a, it’s called a mandibular advancement device. It’s basically like 2 gum shields joined together. And just before you go to sleep, you pop it in your mouth and fall asleep. As you fall asleep, the muscles relax, but it stops the lower jaw dropping back and stopping the airway. So, you can get a normal airway at night, you get as much oxygen as you need, and you’ll feel so much more refreshed in the morning. So if that’s something, maybe speak to your dentist about having one of these sleep tests and then seeing whether you need to wear a device, or there’s also a thing called CPAP as well that you can wear.

Dr. James Goolnik [00:27:00]:
So there are things to do. And I’ve got multiple patients who are not overweight now, and they have something called positional sleep apnea, which means when they fall asleep and when they go on their back, their jaw drops back and they stop breathing. But when they’re on their side, they’re fine. And we can just get them something from Amazon, like a wedge that goes under their mattress. So it just keeps them to be side sleepers. Every time they roll over onto their back, they hit the wedge and they roll back onto the front. And that’s something for $30. So it doesn’t have to be an expensive fix, but it is something worth really looking at sleep.

Dr. James Goolnik [00:27:33]:
Wow.

Nick Urban [00:27:33]:
Lots there. Okay. So if we continue, I want, I’m still curious about coffee because I have this one right in front of me. If I was to add like dairy or say coconut oil or MCT to it, would that change the pH and therefore how caustic it is to my enamel?

Dr. James Goolnik [00:27:51]:
Most of the time, if you add those oils, it brings the pH up closer to neutral. So it’s actually better. And I mean, a simple, simple test is to buy these little litmus papers you can get from Amazon or Costco and stuff. And you can actually put them in the, in the coffee, check the pH. You really want it between 5.5 and If it goes below 5.5, then you’re worried and it’s quite damaging on the teeth. So you can buy them for a few bucks and I’d check it, maybe do some testing to see when you put your CBD oil and when you put in Bulletproof Coffee and things like that, just to see how it changes. But the biggest thing for me would be whenever you’re eating and drinking, you’re affecting the microbiome. So try and reduce the frequency.

Dr. James Goolnik [00:28:29]:
For us is trying to make that eating and drinking window as short as possible. So you’re still fueling your body, you’ve got loads of proteins, you’re feeling energy, but you’re not chewing and eating and snacking all the time. You give you a chance for the microbiome to rebalance and also your stomach and your digestive tract to not continuously be working. So, that would be a hack, I would say.

Nick Urban [00:28:52]:
The other thing that I’m sure you may or may not have come across with water, you’d think that water would always be pH neutral, especially as people become… put more focus on remin… or filtering their water. They use reverse osmosis or distillation. I’ve I’ve done the test with the pH strips and I’ve seen it drop down significantly more acidic from what it was beforehand because of that. And assuming that people aren’t remineralizing, they could think that they’re doing their body a service by drinking water right after, not knowing that the water is still acidic, probably less acidic than a fruit juice or a coffee, but it’s still not the like balanced pH that they would otherwise be hoping for.

Dr. James Goolnik [00:29:29]:
Definitely. And again, that’s the thing about not eating and drinking throughout the day. I know we want to eat want to drink 3 to 4 liters of water and keep ourselves hydrated, but ideally not sipping all the way through the day if your water is acidic. So check the water and they’re all very different. And again, RO machines, we’ve got one in the clinic, so it filters out microplastics. It’s really good at getting rid of heavy metals. It gets rid of fluoride as well. But again, it might deplete all the minerals as well.

Dr. James Goolnik [00:29:56]:
So there are then looking at what you’re going to put back in again to try and balance it as well. So all things in life, there’s always a balance between it. So we try look at an overall picture of everyone. We look at their diet sheet, look at their sleep, their movement, their exercise, what they’re doing to keep their mouth clean. And then looking at their mouth and their past history. If somebody’s got a mouthful of metal amalgams and they’ve got a history of, a family history of Alzheimer’s and cognitive decline, we’re gonna be treating them very differently than somebody who’s got no amalgams and never, none of their family have got any issues with cognitive decline or Alzheimer’s. Because we are seeing more and more correlation, and especially with more and more studies that you can reverse early cognitive decline. And 3 of the big drivers from an oral health point of view is sleep apnea.

Dr. James Goolnik [00:30:49]:
We talked about that we’re not having enough oxygen and our brain’s not fully being refreshed at night. And we’re still having all these breakdown products that we can’t completely flush out.

Nick Urban [00:31:00]:
Yeah.

Dr. James Goolnik [00:31:00]:
The second thing is the metals or the mercury in the system, which have been there for years and years and years and slowly leaching out into our body, which are affecting us. And the third thing is gum disease and leaky gums. So if you’re somebody with a family history of Alzheimer’s or you’ve got the APOE4 gene, then it’ll be really working on those 3 things. And if you’ve got the metal amalgams, really make sure that they’re taken out really carefully with smart amalgam protocol so you don’t get a massive spike in methylmercury when they’re removed. And a very simple test you can do is a thing called a Tri-Test, which is a hair, blood, and urine test, which shows you what level of mercury you’ve got in your system and if you’re high risk or James, I’m sure people at this point have heard us talk about a bunch of different things, including the gums.

Nick Urban [00:31:42]:
And perhaps someone out there thinks, okay, so my gums bleed a bit. Like, big deal. Who cares? Why does it actually matter?

Dr. James Goolnik [00:31:51]:
Massively. So when you’ve got bleeding gums, you’ve got leaky gums, which means whatever the bacteria in your mouth is going through into this, into the gums, through your bloodstream, into the rest of your system. And there’s been so much evidence Type 2 diabetes has got what we call a bidirectional link. So, if you’re somebody that has gum disease, you’re then more likely to have type 2 diabetes. And your HbA1c, which is your marker for insulin resistance and how well you control blood glucose, is going to be much higher if you’ve got gum disease. And we’ve got thousands of patients who’ve got diabetes. We treat their gum disease, their HbA1c then decreases. So, you can actually improve it.

Dr. James Goolnik [00:32:32]:
So, there’s a big correlation between diabetes and gum disease. There’s also diabetes and cardiovascular disease, because we know once you’ve got the inflammatory markers, it will affect also your heart. Blood pressure, we talked about before. Leaky gums and arterial control as well. So again, there’s a connection with that. And all our physicians send our patients to us first to say, we’re about to do some cardiac surgery. We need to make sure they’ve got no gums that are bleeding, no dysbiosis, nothing in their mouth. Can you really do a full mouth cleaning and go through that with them? So that’s something that works.

Dr. James Goolnik [00:33:08]:
There’s been now studies that show bacteria in the mouth. There’s one called Fusobacterium nucleatum, and it’s only a mouth bacteria. It’s only an oral bacteria. But we’ve found it actually in the studies of people who’ve got colorectal cancer, and the bacteria has been found in those cancers. And we are worried now that they’ve had gum disease, it’s gone into their bloodstream and then got down into their bowels and has triggered some of the cancers. And we don’t know whether cause the cancer or is it just a correlation or causation? But we know that that isn’t, that bacteria shouldn’t be there. And the only way it can get there is through the gums. So if you’ve got this leaky barrier, things are getting through and you are triggering your immune system multiple times throughout the day.

Dr. James Goolnik [00:33:54]:
So what we want to do is tighten those gums up, stop them bleeding so that we can actually suppress one of the really simple things of our immune system and our mouth health. There’s countless other connections. There’s 57 different connections between gum disease and various different things.

Nick Urban [00:34:08]:
Whoa.

Dr. James Goolnik [00:34:09]:
Rheumatoid arthritis, same pathway. It’s all down to chronic inflammation. So anything with chronic inflammation. So if you’re somebody who suffers from that, any systemic lupus erythematosus, anyone else who’s got Alzheimer’s has been correlated as well. So looking at all the different things that can happen and what we want to try and do is allow our immune system to work properly and reduce some of the extra burden it’s having on it. And one of the simple things is gum disease, because we can fix it in a week. So if you’re somebody who’s got leaky gums, it’s your body telling you something. We need to try and fix that.

Dr. James Goolnik [00:34:46]:
And it might be just seeing with a hygienist and cleaning everything, but then looking at all the other things. What are the other root causes? And we look at, looking at the functional medicine timeline to see when did this first started, if there’s any triggers, Because is it that you’ve had multiple course of antibiotics and now that you’ve got this dysbiotic, you’ve got this irregular balance of bacteria. So now we need to do targeted antimicrobials to try and rebalance it back again so then the gum then heals again. Is it ozone therapy? Is it changing the toothpaste? What do we need to do to help the quickest way to reverse it? And I said, it’s very quick and some of it is free, but it’s actually getting people to sort of love their teeth and gums and listen to the signs that your body is telling you that there’s something going on. Hmm.

Nick Urban [00:35:34]:
Did you say 57 different conditions?

Nick Urban [00:35:37]:
Yeah.

Dr. James Goolnik [00:35:37]:
It’s crazy. It’s crazy. I’ve got a whole correlation. We’ll share it with some of your viewers if they want the evidence and things. And we are starting to now look at tongues a lot more and Chinese medicine where we can, there’s AI software now. We take photos of somebody’s tongue, put it through the software, and you can get 94% accuracy for type 2 diabetes, vitamin B12 deficiency, and anemia just from a photograph that then software will say, say, you’ve got type 2 diabetes, you go and get blood tests and we find you have. And so looking at the signs, a lot of normal dentistry just fixes holes. You come in, I’ve got toothache, I’ve broken my tooth, something’s hurting, get you out of pain and they say, bye-bye, come back again when you break another one.

Dr. James Goolnik [00:36:20]:
Whereas we’re trying to look more at functional or biological dentistry where somebody comes in, okay, you’ve broken your tooth, we’re going to fix it. We’re going to use the materials that are most biocompatible for you. We’re going to rebuild it, but then we’re go, why did you break it? Well, I broke it because I’m clenching and grinding my teeth. Why are you clenching, grinding my teeth?

Nick Urban [00:36:38]:
Yeah.

Dr. James Goolnik [00:36:39]:
Actually, my ferritin levels are really low. My iron storage is low. Therefore, my muscles are more excitable. Therefore, I’m clenching, grinding. Okay, let’s rebalance the ferritin. Let’s look at your diet. Let’s send you to a nutritionist or your GP or your doctor and then go back. Well, actually, I’m still grinding.

Dr. James Goolnik [00:36:53]:
Okay, what’s going on in your sleep? Let’s make you a mouthguard. That’s the problem. So looking, going back and what we can do as detectives to find out what is happening and what we can do to reverse it. And if somebody’s seen me a year ago fixing their mouth, if they come back in a year and they’ve got more disease, then I feel like I’ve failed. I haven’t excited them about their mouth health or I haven’t given them enough sort of guidance and help to help. So let’s see, what can we do more? How can we coach you? How can we make you more accountable to look after it? Can we take photos, put them on the bathroom mirror? Can we send you WhatsApp messages? to remind them on it? Can we show them a big photo of all the bugs and the amoebas in their mouth and that we’re going to get rid of those and we’re going to take another video in 8 weeks’ time and we’re going to see how it goes? So, how can we excite people about working on their oral health?

Nick Urban [00:37:46]:
Yeah. I’ve learned about the oral health and the oral microbiome and all this previously. And then, it feels like every time I revisit the subject, there’s just more information about how important it is. And what I find especially striking about this is when it comes to things like hemoglobin A1C, a 3-month snapshot of blood sugar. People look at that and they see an elevation. They see that they’re eating clean and they just figure, you know what, perhaps I’ll just add some berberine, maybe in more extreme cases, some metformin, dihydroberberine, something, and I’ll bring that back down into range. But if you do that, it might be better than letting it run rampant out of control. But at the same time, if you have an issue in the mouth, every time you’re eating, you’re exposing your immune system in a negative way to the that foreign substance and it has to mount a response and create inflammation.

Nick Urban [00:38:32]:
You might be lowering your blood sugar on one hand, but you’re still having the same like stress burden on the body. And at the same time, you could be getting a better result with that, with fewer side effects from just addressing the root cause, which in that case would be the mouth.

Dr. James Goolnik [00:38:48]:
Yeah, definitely. And I think it’s all about trying to reduce the stresses on your body, whatever they can be, and looking at them as a sort of more rounded effect. And people come in with Loads of different things. They come in now because they’ve seen loads more podcasts and they say, I’m worried that there’s a root canal on this tooth on the bottom and that’s triggering my fibromyalgia. And I’m worried that this is happening. I’d like to have a look. My dentist has taken some x-rays. He said it’s all fine.

Dr. James Goolnik [00:39:16]:
We then take what we call a cone beam, which is a 3D scan from the angles. And we see there’s a huge abscess on the tooth and say, look, this is the options. We can redo it again. We can take it out. We can leave the gap. We can put a ceramic implant in. Take it out. the symptoms disappear.

Dr. James Goolnik [00:39:32]:
And they’ve had that root canal for 10 years and their dentist has been telling them it’s fine, it’s fine, it’s fine. It’s a dead organ and it’s leaking. And the only way you can tell is to take a 3D scan or various blood markers. There’s certain blood markers you can tell for things, but most people, the simplest thing is a 3D scan.

Nick Urban [00:39:50]:
I want to explore that because that’s a really important topic and I had that in my notes of things to cover with you anyway. So we will definitely get there. Before we Something that’s a little more approachable for people at home perhaps, and seems just as important is the integrity of the oral microbiome and addressing gut or not gut, but oral dysbiosis. Yeah. You mentioned that it’s very plastic, meaning they can change quickly.

Nick Urban [00:40:15]:
Yes.

Nick Urban [00:40:15]:
How would you go about that? Are there things to do, things to avoid to make sure that we have the best possible oral health? And I assume that’s more than just swallowing a probiotic Yes.

Nick Urban [00:40:25]:
Yes.

Dr. James Goolnik [00:40:26]:
I mean, for me, I’m a dentist, but also a nutritionist. So, it’s all about food first. So, for me, I need to know what you’re currently doing at the moment, because we know there’s dysbiosis, whether that’s bad breath, whether that’s bleeding gums, whether that’s gum inflammation, bone loss, whatever’s going on in your mouth. So, I know something’s happening. So, I want to know what you’re doing at the moment. So, we look at a 7-day food diary and seeing if they’re snacking, what they’re eating, what they’re currently doing at the moment to get their mouth into that. And it might be really simple. They’ve got a new partner which they’re kissing, and that partner’s got gum issues, and it’s been transferred over to them.

Dr. James Goolnik [00:41:03]:
And that is something. So that’s looking at time now and asking these intimate questions about who they’re kissing and where they’re kissing them to see if that is affecting the microbiome.

Nick Urban [00:41:12]:
Explain that. That’s an important one. I just saw a study a couple weeks ago about how the people that you spend the most time with, basically people you live with, you share a microbiome with them.

Dr. James Goolnik [00:41:22]:
Yes, you do. So, and obviously the more bodily fluids you transfer between them, the quicker it transfers. But I think it’s, we get, we commonly get partners who come in, we do the right things and we find that their treatment is not as successful as we expecting to. So we then get their partners to come in and we find that they’ve got a very similar inflammation in their gums. We treat them and they both then So actually, getting the whole family in together is a win-win just to make sure our treatment is more successful. So that’s the first thing. If you’re somebody with gum issues and bleeding, really get your partner in as well and get them checked to see. And we can test that as well.

Dr. James Goolnik [00:41:59]:
But I think that’s really important. Looking at what they’re currently eating and drinking, the mouth taping, looking at their history and just seeing what they’re currently doing to affect it. And Again, for some people it’s affected by mold. So it might be that we’re doing some mold testing in their apartment to see what’s happening and seeing if that’s a trigger on their immune system and that’s stopping them heal. ‘Cause there’s usually some sort of barrier to doing it. So that works really well. Then looking at maybe increasing phytonutrients, increasing some vegetables, things like that, and fiber in their diet to see if we can naturally change the microbiome. I try not to do probiotics and prebiotics as supplements if we can avoid it.

Dr. James Goolnik [00:42:44]:
If we can do it with food, even better. But sometimes we do the supplements just short-term to get a win, get the symptoms back, and then we either replace them with food. ‘Cause the long-term, I don’t want to be taking anyone taking any supplements. The only supplement I take is vitamin D3 and K2 and creatine. They’re the two that I take. And I try and avoid any other things and try and get most of my stuff with food, which is getting harder and harder in the modern day. But we try and really work on it. And for us, it’s We have a philosophy that’s sort of test, not guess.

Dr. James Goolnik [00:43:14]:
So if we’re not sure what’s going on, take some blood sampling, do pH testing of the saliva, do microbiome testing as well. So we’ve got an idea of where their benchmark is and where their baseline is. And then we can see, has the treatment been successful? And work on that. But it’s really simple things that we need to do and habits of getting people to stop smoking or cut down on frequency of snacking. There’s lots of different things that we can do to just to help people improve their microbiome. And they’re not a lot of money really. So it’s just trying to think logically about it.

Nick Urban [00:43:48]:
When you say to get it from the diet, that’s great. I love that idea. In practice, how do you actually do that? Because a lot of the foods that are supposedly high in probiotics, I guess prebiotics are a different conversation. They tend to have the same bacterial strains that are added to the starters and they culture them over time. But like, it’s not like a really diverse Right. That you’re getting from your grocery store yogurt.

Nick Urban [00:44:12]:
It’s tricky.

Nick Urban [00:44:13]:
Perhaps if you find like high quality, like raw dairy, then if it’s clean, then you’d be able to get that. But it seems like it’s difficult to get it purely from plants.

Dr. James Goolnik [00:44:21]:
It’s really difficult, but for us it’s about diversity. So trying to get people to have more types of vegetables, different kimchi, rather than the same brand every single time, try something a bit different, trying to add more, more of different things because you have a look at it and you break it down and realize they’re not having enough of certain things. And also So just more variety makes it more fun as well. So yeah, going to different supermarkets rather than always going to Whole Foods, go to somewhere else, go to Trader Joe’s, go to wherever so they can try a little bit different types of tomatoes, try and have things seasonal as best they can as well. ‘Cause we know that if they’re not imported, they’re gonna have more poor micronutrients inside them as well. But yeah, it is tricky in this environment, but again, Yeah. I mean, cooking from scratch if you can, so at least you know what’s in things, but just doing the best you can do and being aware of it. And again, as I said, if that is just stopping that snack before bedtime, that might be enough to add a bit more protein in that last meal at night so you don’t have to have those nuts or seeds before bed or something like that.

Dr. James Goolnik [00:45:25]:
So it’s simple things you can do to switch it. And again, we do a lot of work with continuous glucose monitors. So some patients would wear those for 2 weeks and just see with the CGM, how their body responds to certain foods, especially if they’re trying to rebalance their HbA1c. So, I think there’s lots of different ways of looking at it, but I think simple things first and not giving people a whole big shopping list. So, for me, when somebody comes in and they’ve got lots of bleeding everywhere and they don’t floss any of their mouth at the moment, and there’s one area on maybe a lower molar that’s the worst, I’d say, right, what are you gonna do now, Nick, is you’re gonna floss just that one tooth every single night. You’re gonna hang that floss over your toothbrush every night. You’re gonna brush your teeth for 2 minutes and you’re gonna floss that one tooth. I don’t want you to do it anymore.

Dr. James Goolnik [00:46:13]:
And that’s it. And I’m gonna see you in 8 weeks. So you do that for 8 weeks and you come back and go, Nick, you’re a flosser. You’ve been flossing every single day consistently for 8 weeks. How about we do the one? And then we do the bleeding score and we see that that one’s not bleeding anymore and we take photos. And they said, look how pink that one is and healthy that one is. But the one behind it is still inflamed and bleeding. So let’s do the one behind next.

Dr. James Goolnik [00:46:32]:
And then we just slowly habit bit stuck. So, we’re not trying to do too much at once and we make people feel like they’re winning and they’re doing bits. And within 3 or 4 months, they’re flossing every single mouth. They know the tooth, they’re feeling the benefits of it, which is a great thing. They know when they come and see me, I’m going to be checking them. So, I’m accountable for them. And that really helps them try and get that habit in place. And I think that’s the thing.

Dr. James Goolnik [00:46:58]:
If you try and get a lot of dentists and hygienists out there will try and get somebody who doesn’t floss at all to suddenly floss the mouth, which they’ll do for maybe 2, 3 weeks and then they’ll give up. Something happens and they go back to normal again.

Nick Urban [00:47:11]:
Well, it’s nice to hear that you’re also a fan of other forms of mechanical cleansing of the mouth beyond just the toothbrush and the floss, because I know for a lot of people, myself included, like I sometimes use the traditional flosser, but I also like the water flosser. I found that to be very convenient.

Dr. James Goolnik [00:47:28]:
Yeah. So it’s just using whatever you can use regularly. I had one patient a couple of months ago that he was using a business card to clean between his teeth. That’s what it is. And I was like, okay, as long as you’re doing, as long as it’s a clean business card, that’s fine. And he was doing something regularly. And that’s the important bit is like, don’t get hung up on it. Eventually when you’re doing it every single day and you’re enjoying it and you’re noticing the difference, then we can start working on, well, this size could be better, more efficient for you than this size and working on the nuances.

Dr. James Goolnik [00:47:58]:
But initially it’s just getting somebody into that regular habit, then congratulating them for doing it, seeing the benefits and thinking, okay, my mouth feels better.

Nick Urban [00:48:07]:
I’ve got less bleeding.

Dr. James Goolnik [00:48:07]:
I don’t need to see the hygienist as often now. So, I’m saving money as well. And there’s a win-win. And I’m getting a sticker every time I go to the dentist, or I’m getting praised when I go and see them. So, this is a benefit and I’m going to carry it on. So, I think that’s the big thing rather than getting everyone to do everything at once and giving up.

Nick Urban [00:48:27]:
So far, we’ve jumped around a lot of different topics. When people ask you, like, what is your philosophy? What camp of dentists do you fall into? How do you describe your approach? Okay.

Dr. James Goolnik [00:48:38]:
So there’s a lot of camps in dentistry now. There’s the functional dentistry camp. There’s the biological dentistry camp. There’s the holistic dentistry camp with all these things. I think I do good dentistry. I’m using, I’m a little bit from the holistic. So I don’t want to use petroleum jelly, for example, on somebody’s lips. So when somebody comes in, I use propolis.

Dr. James Goolnik [00:49:01]:
I try and use natural products. I don’t use fluoride. I’m fluoride-free. I try and use the chemicals that have got enough evidence that cause… that can help me, but without causing some damage. So there’s lots of these bamboo toothbrushes that are really great for the environment, but within a week of using them, smell awful and they start decomposing and you throw them away. So that’s not good for the environment. So I would say much better to use a plastic toothbrush that’s maybe used from recycled plastic, that’s got a nylon head, medium bristles that actually does the job and you’re going to use it and you’re going to keep it for 4 months than buy these eco ones that you throw away. So for me, I’m more biological.

Dr. James Goolnik [00:49:44]:
So I said, when somebody comes in, I want to look in their mouth to see what they need to get them to return to health. And then looking at what materials are the most biocompatible for them, which cause the least reaction to their immune system and maybe allergy allergies as well, and then rebuilding their smiles to give them beautiful smiles as well. But I want something that actually is going to last a long time. I’m not going to be a short fix. I’m not a big believer in veneering everything when you can actually whiten somebody’s teeth naturally rather than putting chemicals and things in somebody’s mouth. So, that’s where I am. And I think in 10 years’ time, there won’t be this biological holistic dentistry. It’s going to be dentistry.

Dr. James Goolnik [00:50:26]:
That is it. it. The consumers do not want chemicals. They don’t want fluoride. They don’t want metals in their mouth. They don’t want all these things. So they’re going to go, you know what, doc? Why, what material are you using? Why are you using that? Is there a better alternative? Give me a chance to reverse the disease. If we catch it early enough, it’s like, do I really need that cavity filling? Or can I reverse it with xylitol? Can I reverse it with… nowadays we’ve got peptides in dentistry and there’s one called Curadont, which is a liquid that we paint on a tooth when there’s early Okay, and it sucks out the minerals from the saliva to re-harden the tooth.

Dr. James Goolnik [00:51:04]:
And it works really well in a few months, as long as you’re cleaning the tooth regularly and you’ve cut down on the acid. So you’ve not got this dip going down under 5.5 regularly enough. So there’s loads of things we can do to reverse things. But again, microbiome testing, you might find a really high strep mutans. Let’s rebalance that. So we’ve got it lower, therefore the cavity can reverse. You might find that actually you’re somebody that’s got lots of cavities and you don’t have a lot of sugars and refined carbohydrates, but actually your vitamin D level is really low. So we need to try and work on supplements of vitamin D.

Dr. James Goolnik [00:51:41]:
Can you get some more in the sun? We retest the vitamin D, much higher, therefore the immune system is working again. So it’s trying to find out what is the thing that’s driving the disease. And getting people excited by it, but then connecting the mouth to the rest of the body rather than just fixing these things and then realizing that actually it has an overall effect on everything else.

Nick Urban [00:52:04]:
So you mentioned root canals previously. That is an age-old argument between the conventional and the holistic functional biological dentists. And I have friends who have done deep dives into the research behind both of them. And it seemed very clear to me for a while that root canals should never take place. And then I looked at some more data and I’m like, now I’m more confused than I was previously. What’s your take on that landscape?

Dr. James Goolnik [00:52:30]:
It’s tricky, root canal. So for example, if I was a 10-year-old kid, fell over, broke my front tooth, the nerve was exposed and it needed a root canal, I would 100% have a root canal because there’s enough evidence on it that one, it’ll get somebody out of pain. Two, it is a medium-term treatment. And while the child is still growing and developing, we want that bone to grow. And we know if a root canal is done properly, and the biggest thing there is properly, and now there’s lots of specialists out there called endodontists. And what they do is use different chemicals to disinfect and clean it. And the tricky bit of the root canal it’s not just the nerve inside it, but there’s so many little nooks and crannies and microvessels, it’s impossible to completely clean it. So we clean it as best we can, and then we fill it with a biocompatible… now there’s biocompatible sealers out there, materials to seal it.

Dr. James Goolnik [00:53:29]:
And then you need to check it every 3 years. Check it once a year with symptoms and signs, check its healing, but also check it with a CBCT every 3 years to check that it hasn’t got reinfected. And the evidence shows that a root canal done well is going to last you 10 to 15 years. Most root canals fail after that period of time, and it’s usually because the dentist on top hasn’t sealed it well enough. So it might be the filling or a cap or a veneer or a crown that eventually leaks, bacteria goes into it and reinfects the root canal. So if you’ve had a root canal, make sure that the seal on top is done really well. Make sure it’s scanned every 3 years. is, but it is still a dead organ.

Dr. James Goolnik [00:54:10]:
The ligament that holds the tooth into the bone is still alive. So you can still feel things, you can still bite on it and you still chew on it, but you don’t get the same feedback. So if you bite really, really hard on your normal tooth, you can still feel it. You can feel it and feel it and you’ll stop yourself. But with a dead tooth, a root canal tooth, you can keep biting until you crack the tooth. So that’s a worry. But also because it’s dead, it cannot repair. And we talked about remineralizing a lot today.

Dr. James Goolnik [00:54:37]:
You can’t remineralize a dead tooth. So, if you’re having a lot of sugars and acids, no matter what you do with your hydroxyapatite and the rest of it, it’ll eventually decay. So, it’s much more vulnerable for decay. So, you’ve got to keep an eye on that as well. So, that’s the reason. So, I would do everything possible I can do to avoid a root canal. So, there are materials now that you can actually work, and there’s something called biodentine, which is a bioactive glass that when a really deep cavity or you’ve got the nerve that’s exposed, you can sterilize the area, paint this on, rebuild it, and you’ve got to have a really good seal and then review it regularly. And you can regenerate the nerve if you have a healthy immune system.

Dr. James Goolnik [00:55:20]:
So we need to make sure your CRP is low. So that’s the first thing is, do I need a root canal? If there’s no sign of infection, it’s just inflammation, we can treat that. So go in, see your dentist as quickly as possible, get them to seal it, ask them about bioactive glasses to seal it. And then if it’s done properly, it can last 10, 15 years, but you need to check it with the CBCT, which not all offices have, to check how the healing is going. And then if it fails, you have the option of redoing the root canal. You will never get as long on the second time. So when it’s cleaned and disinfected, if you got 10 the first time, you may get 6 or 7 years the second time. By that time, the material And the treatments are evolving all the time.

Dr. James Goolnik [00:56:05]:
So now we have ceramic implants. So if somebody has a dead tooth, we can take it out properly, clean out the ligament, disinfect it, ozonate it, build up the bone, and put a ceramic implant all in the same visit. So you can replace it, reduce the number of surgeries, and then you can put a cap or crown over the top of it to protect it. So, and that will last much, much longer for them.

Nick Urban [00:56:27]:
Yeah.

Dr. James Goolnik [00:56:28]:
However, in 5 years’ time, we may be able to regrow teeth from tooth germs and stem cells. So, it might be that you’ve got a root canal tooth, we take it out, drop some liquid in, there’s some stem cells in, within 6 months, a tooth comes out. So, I think I wouldn’t be ripping out a tooth that’s had a root canal that’s not got any symptoms. I think you need to get it checked regularly, but the technology’s evolving rapidly, and eventually we will not be doing root canals. anymore. So I think I try and avoid them as much as possible, but for short-term and for pain relief and holding a tooth, there are still times when we need to do a root canal.

Nick Urban [00:57:04]:
Yeah, I think that’s a really important point because medicine is changing. It’s progressing and evolving. And I don’t like the idea of decisions that are made today that eliminate the future potential of new technologies and new things that come out. Because who knows in 5 years, 10 years, what there will be. But if you make a decision today that eliminates that entire branch of possibility, then you’re setting yourself up for a worse spot. At the same time, you don’t want to put your immune system under load all day, every day, and increase inflammation in your body as a result. If that’s your trade-off, it’s harder to say.

Dr. James Goolnik [00:57:44]:
It’s hard. And I mean, so that’s why get it checked properly, get a CBCT, which is a 3D scan, ideally get a full blood panel. panel and a CRP to look at inflammation. And a CRP won’t tell us it’s coming from the root canal, but if you’ve got a high CRP, we know there’s inflammation coming from somewhere. You can do other tests. So we can actually do tests with different local anesthetics where we can actually numb that root canal tooth so your body actually feels like it’s not there for 8 hours. So there’s something called procaine, which is a longer-acting local anesthetic that your dentist can inject. And if somebody thinks they’re getting symptoms from somewhere else in their body from the root canal, we do procaine injections all around that canal, the brain thinks that tooth’s not there anymore for 8 hours.

Dr. James Goolnik [00:58:27]:
And if those symptoms decrease, we know that tooth’s causing it, then we’d sort the tooth out. So there are things that you can do. There’s acupuncture pressure points. There’s so many different things you can do to isolate and see if that tooth is before you pull it out. Because once you pull it out, you’ve got now raw symptoms. And the tricky bit is, okay, great, ceramic implants are brilliant, but you’re still going to be spending $4,000 to $5,000 on So it then becomes unaffordable for a lot of people.

Nick Urban [00:58:53]:
Yeah, that’s the other thing. Like, what… how do you approach this in an affordable manner? And I also forgot, that’s a whole other conversation about the acupuncture points, the energy meridians.

Dr. James Goolnik [00:59:04]:
Yes.

Nick Urban [00:59:04]:
That run through the teeth and how issues with different teeth can manifest in different parts of the body. And that seems like it’s pretty well documented at this point.

Dr. James Goolnik [00:59:12]:
Massive. We’ve got a huge chart in our office with all the different things that people come in. It’s tooth number 11 that’s hurting me, and that means it’s my small intestine.

Nick Urban [00:59:19]:
Let’s look at it.

Dr. James Goolnik [00:59:19]:
So we look at all the different connections between them all. So there’s a big correlation between the meridians and what’s going on in the teeth. But I think…

Nick Urban [00:59:27]:
And it’s bidirectional too. So if you have an issue with a tooth, it can manifest in your small intestine.

Dr. James Goolnik [00:59:32]:
Yes. And I think that’s the interesting thing. And again, when you talked about at the beginning, and I love how you framed it with the sort of the entry point and the midpoint and the high end, you’ve got to look at these things and say, okay, what is the best use of my money I can do for this particular oral health, then it might be actually, rather than spending the money on that, taking that root canal and doing the ceramic implant, let’s spend the money on a CBCT, a blood panel, and seeing the dentist slightly more regularly so we can check it before it needs treatment and before it fails. And then get in there because you might get another 5, 10 years out of that restoration rather than just taking it out and then suddenly committing yourself to a ceramic implant. And again, if you take the tooth out and do nothing, the bone will shrink and the body, if you don’t use an organ, it will decrease in grease. So you’ll find that the bone shrinks and shrinks. The teeth either side will drift into the space. The teeth above it will move down.

Dr. James Goolnik [01:00:29]:
Suddenly also your chewing ability will change and then you’ll be chewing on another side. And then some people get TMJ and other bite issues because they’re changing their thing. And there’s all these different things that can knock on from just taking the tooth out without thinking further down the line. So actually keeping that tooth and having the bite force on it could be a lot better. And at least it’s there as a space maintainer to stop anything else drifting into place. So I think these are the things that we need to think about from short, long term. And I think that’s the one thing is my previous clinic, I was there for 26 years. This clinic is a new one.

Dr. James Goolnik [01:01:05]:
It’s called Optimal Dental Health in London. We’ve been going 2 years now, but we’ve signed a 20-year lease. So I think when you see a dentist, you want a long-term relationship to say, look, I don’t want you to just fix this tooth and pull it out and you won’t be here in 6 months to follow me up. I want somebody that’s going to build that long-term longevity with me as well on the journey. As you learn, I learn, and we can then take loads of photographs of the tooth and know where it is now. It may not be a pretty looking tooth, but it’s not causing any systemic illness.

Nick Urban [01:01:34]:
Yeah. Because of all the second order and third order effects, I almost want to just like do what I can for my oral health and just cross my fingers that everything goes well because it seems like it’s so difficult to foresee all of the potential issues or benefits, I guess, that could arise from this. So, because people are going to be now exposed to the idea of biological, functional, and holistic dentistry, and it’s emerging, it’s not all one unified field right now. When people are looking for a dentist like yourself, what are the either glaring red flags or green flags so that they can help navigate this? Because some people will hopefully be able to visit you in London.

Dr. James Goolnik [01:02:14]:
Yeah.

Nick Urban [01:02:15]:
And others will be across the world and might not be able to Yeah. To afford the around-the-world travel.

Dr. James Goolnik [01:02:20]:
Yes, definitely. Well, if you’re coming to London, come and say hi. We’re in Baker Street near Sherlock Holmes. So you can do a trip to Sherlock Holmes as well, at the same as us. I think you want to ask, whenever you go to a dentist or your hygienist and they give you a treatment plan or they suggest something’s doing, I would always ask them why. Why did this happen? And see if they can give you a root cause and a reason why this has happened, especially if you’re somebody that’s looking after your health Generally, and then once they say okay well this is why it’s happened, how can I prevent this happening again? Or how can I prevent this happening to another tooth? So if you’ve got some gum issues on one tooth, you say okay how do we fix it and how can I prevent it happening from another thing? And if they don’t have that dialogue or they’re not interested in the prevention thing, I would find somebody else. I think that’s that’s that’s a big red flag for me. So asking the questions, asking what’s in your materials.

Dr. James Goolnik [01:03:15]:
So when somebody is giving you an injection. Or giving you a filling or something, ask what the options are. And that, because nowadays people have more and more composite fillings or white fillings, they’re made of different types of plastic, but not all of them are biocompatible. So not all of them are BPA-free, bisphenol-free. So actually seeing what chemicals are in them, because they could be almost as bad as having those metal amalgams in if they’re full of mixed resins as well. So asking about what is materials. In the States, there’s a really good organization called the International Academy Academy of Oral Medicine and Toxicology, IAOMT. And you can go on their website and they have a list of all the biologically trained dentists in the world.

Dr. James Goolnik [01:04:00]:
So you can go on them, we’re listed in there. But also if you want something, if you’ve got somebody who’s got metals in their mouth or you’ve had issues with cognitive decline or Alzheimer’s, they have people that are what we call SMARTS trained, which is the process that you have to go through, the training and also the examination to go through to remove metals safely. So again, if you’re going to have metals replaced, please make sure somebody’s SMART certified beforehand. And that’s really useful and they’re global, so you can find them all over the world. So I think that’s the important things to do. But ask questions. And if you’re somebody that’s into longevity and they don’t ask you about your supplement stack or what you eat or drink or anything else like that, and they’re straight into the dentistry, then you need to sort of ask a question. You want somebody that that can connect the dots and collaborate with your physician, collaborate with your osteopath, with your chiropractor, or the other people that are trying to get you back onto healthspan.

Nick Urban [01:04:58]:
Perfect. And if people want to work with you, to connect with you directly, to visit you in your clinic, where do you want to send them?

Dr. James Goolnik [01:05:06]:
Yeah. So you can come to the website, it’s optimaldentalhealth.co.uk. And I’m old school. I love LinkedIn. So you can find me @jamesgoolnik. And I’m also on Instagram as well. So, definitely do that. And if you go on Amazon, I’ve got this book called Kick Sugar.

Dr. James Goolnik [01:05:22]:
It’s a cookbook just trying to help people to reboot their taste buds as well. So, you can find that on Amazon. And so, if you come to London, come and say hello.

Nick Urban [01:05:31]:
Perfect. Well, Dr. James Goolnik, thank you for joining the podcast. Covered a lot of ground today. I still have a million more questions, but our time today is limited. Any final parting advice or thoughts for people who’ve made it Brilliant, Nick.

Dr. James Goolnik [01:05:47]:
I think, ask the questions. And if your dentist won’t give you the answers, get copies of all the x-rays and the scans and things like that. Because I think that’s the big thing that a lot of people don’t do, is they don’t have really good benchmark records. And nowadays we have 3D optical scans that you can do. So, if somebody’s had gum recession and their dentist is not checking it regularly get a 3D scan and you can then see that. They’ll send it to you by transfer and you can actually monitor your own mouth and your own health. So, if you move to another dentist, it’s really good to get all that data across so you can actually see. But generally, look after your oral microbiome, stop snacking, and you’ll do well.

Nick Urban [01:06:31]:
Well, Dr. James, thank you for joining the podcast today. I’ll put a link to your practice, to your social media profiles, to your book in the show notes for this episode. And thank you all for tuning in, for sharing your time, your energy, and your attention with us today. Until next time, be an outlier.

Dr. James Goolnik [01:06:50]:
Thanks, Nick.

Nick Urban [01:06:54]:
Thanks for tuning in to High Performance Longevity. If you got value today, the best way to support the show is to leave a review or share it with someone who’s ready to upgrade their healthspan. You can find all the episodes, show notes, and resources mentioned at outlier.com. Until next time, stay energized, stay bioharmonized, and be an outlier.