WEBVTT - Ep 179 Fluoride 2: Fighting tooth and nail 0:00:00.600 --> 0:00:05.520 Ouch. It's nineteen sixty four and I'm at the Fight 0:00:05.640 --> 0:00:08.920 of the Century and I just lost I got my 0:00:09.000 --> 0:00:12.520 tooth pulled. And why did I lose my tooth? I 0:00:12.520 --> 0:00:15.640 didn't really know then, but I do now. It was 0:00:15.720 --> 0:00:21.119 bacteria versus floride, and I didn't have any It was 0:00:21.200 --> 0:00:25.880 bacteria poop to be exact acid. I'm eating candy. My 0:00:25.920 --> 0:00:29.160 mom doesn't really know how much I'm eating cereal that's 0:00:29.160 --> 0:00:33.080 called sugar smacks or frosted flakes with a sugar bowl 0:00:33.280 --> 0:00:35.720 that we got to use sugar because my mom was 0:00:35.760 --> 0:00:38.080 sleeping and we didn't want to wake her because we 0:00:38.080 --> 0:00:41.199 were five kids and my mom needed her sleep in 0:00:41.240 --> 0:00:46.240 the morning. So hiding in plain sight in nineteen sixty 0:00:46.280 --> 0:00:49.800 four was fluoride. It had just entered the water in 0:00:49.840 --> 0:00:53.160 New York City and it was in some toothpastes. Blord 0:00:53.240 --> 0:00:55.520 knows if I brushed my teeth, I can't remember. We 0:00:55.640 --> 0:00:59.240 probably did, but we certainly didn't have fluoride treatments at 0:00:59.240 --> 0:01:02.240 the dentist. And so why did I lose my teeth 0:01:02.640 --> 0:01:06.200 at that time? Because it's not one thing, It's not 0:01:06.360 --> 0:01:10.560 one quantity of one thing. It's an approach to health 0:01:11.240 --> 0:01:15.920 reasonable amounts of sugar fluoride in the water to build 0:01:15.920 --> 0:01:18.800 the teeth strong. And I know that. And why do 0:01:18.880 --> 0:01:21.640 I know that? Well, I don't remember if I said 0:01:21.640 --> 0:01:24.920 this is Rafael, and it is, but this is doctor Santore. 0:01:25.040 --> 0:01:30.120 Also in nineteen seventy four, about ten years after I 0:01:30.160 --> 0:01:33.240 got my tooth pulled, I went to dental school and 0:01:33.280 --> 0:01:36.880 I learned a lot about how to fix broken teeth. 0:01:37.440 --> 0:01:39.880 I didn't learn as much how to keep them from 0:01:39.920 --> 0:01:43.720 getting broken, how to keep them from getting decayed. That 0:01:43.760 --> 0:01:47.560 came with time and maturity. And after forty five years, 0:01:47.760 --> 0:01:50.160 I have a lot of stories, but I only want 0:01:50.200 --> 0:01:53.360 to tell you one or two. So what happened In 0:01:53.480 --> 0:01:58.840 nineteen eighty I was treating patients and I was finished 0:01:59.040 --> 0:02:02.760 with all my resus and sees and things. And I 0:02:02.920 --> 0:02:07.640 noticed that I would fix teeth that had cavities on 0:02:07.720 --> 0:02:10.040 top of the fillings on top of the teeth that 0:02:10.200 --> 0:02:13.680 just had cavities. Boy, that lactic acid and all those 0:02:13.720 --> 0:02:17.920 things that bacteria produce and they erode teeth were working 0:02:17.960 --> 0:02:20.720 really hard against me. And I started to see a 0:02:20.840 --> 0:02:25.040 change in the late eighties. And in nineteen eighty seven, 0:02:25.680 --> 0:02:30.280 Willibrook closed and that is where we saw lots of 0:02:30.400 --> 0:02:33.760 patients who came to the hospital I worked at where 0:02:33.760 --> 0:02:37.400 I did anesthesia and taught pediatric residents how to do 0:02:37.520 --> 0:02:41.040 dentistry and how to think about healthcare for the handicapped. 0:02:41.520 --> 0:02:45.480 And we saw over about ten years before Willibrook closed 0:02:46.280 --> 0:02:50.360 and even after, while we were treating the handicapped in 0:02:50.440 --> 0:02:54.680 the larger New York area mostly Brooklyn, but larger New 0:02:54.720 --> 0:02:58.560 York area, that the kids were getting less cavities. We 0:02:58.639 --> 0:03:02.080 started speaking to the parents and we start looking at 0:03:02.120 --> 0:03:06.160 the data, and we realized that there was a revolution, 0:03:06.360 --> 0:03:09.960 that the bacteria was starting to lose the battle. And 0:03:10.000 --> 0:03:13.160 we weren't quite sure why. It seemed common sense that 0:03:13.240 --> 0:03:15.079 people brush their teeth, but it had to be more 0:03:15.120 --> 0:03:18.120 than that, because the handicapped kids could not brush their 0:03:18.120 --> 0:03:22.160 teeth well, their parents were always exhausted caring for them, 0:03:22.400 --> 0:03:27.920 and it was a difficult environment. In about nineteen ninety one, 0:03:28.520 --> 0:03:31.720 varnishes came out that we dentists could use in the 0:03:31.800 --> 0:03:35.840 teeth and before we put the restorations in them. And 0:03:35.920 --> 0:03:40.600 in nineteen ninety six, my son, my firstborn son, was 0:03:40.640 --> 0:03:44.440 six years old and he had no cavities. And I 0:03:44.520 --> 0:03:47.240 noticed because I treated the kids in his class that 0:03:47.240 --> 0:03:50.200 they had no cavities. And I started to put together 0:03:50.720 --> 0:03:56.640 the relationship between good healthcare and systemic fluoride as well 0:03:56.680 --> 0:04:01.320 as topical fluoride, and they do different things, and we 0:04:01.520 --> 0:04:03.760 argue to this day about which one is better, and 0:04:03.800 --> 0:04:09.920 they are both important. But the thing about systemic fluoride 0:04:10.520 --> 0:04:14.240 is it's the quiet giant that works behind the scenes. 0:04:14.640 --> 0:04:17.920 And that's what I came to realize as a dentist 0:04:18.560 --> 0:04:22.520 in the trenches, so to speak, trying to prevent teeth 0:04:22.680 --> 0:04:27.680 from being destroyed. In the year twenty twenty five. I 0:04:27.720 --> 0:04:32.480 can tell you without a doubt from treating different communities 0:04:33.040 --> 0:04:39.920 with different advantages and access, that fluoride in all its forms, 0:04:40.279 --> 0:04:44.960 properly used is a gift to children. And I share 0:04:45.000 --> 0:04:48.760 that with every parent that comes in and I show 0:04:48.839 --> 0:04:52.600 them X rays. I have so many X rays that 0:04:52.720 --> 0:04:56.400 show such a long history that we went from decay 0:04:56.520 --> 0:05:00.520 and fillings to very little decay or almost mos none 0:05:01.120 --> 0:05:05.279 and no feelings. And I thank you for listening to this, 0:05:05.880 --> 0:05:09.360 and I hope you heard a simple message with all 0:05:09.440 --> 0:05:12.360 the honesty that I meant for you to have and 0:05:12.480 --> 0:05:12.839 to hear. 0:05:13.120 --> 0:05:50.279 Thank you. 0:05:59.760 --> 0:06:01.680 I've that so good. 0:06:02.480 --> 0:06:06.360 Ray, Thank you so so much for sharing that with us. 0:06:06.680 --> 0:06:08.960 Yeah, thank You're the best, the. 0:06:08.880 --> 0:06:13.520 Best, A man who goes by many names, Raphael, doctor Santore, 0:06:13.880 --> 0:06:20.000 Uncle Ray, my husband's uncle Ray. So but I really 0:06:20.040 --> 0:06:24.480 did appreciate that perspective of like, here's a noticeable difference. 0:06:24.560 --> 0:06:24.760 You know. 0:06:24.839 --> 0:06:30.000 I feel like sometimes big public health measures we don't 0:06:30.040 --> 0:06:32.599 see the impact right away, right, we only see the 0:06:32.640 --> 0:06:35.359 impact when they're taken away. But I love that with 0:06:35.680 --> 0:06:38.760 that additional fluoride to the water, it was like, here 0:06:38.880 --> 0:06:41.880 is a very clear night and day difference. 0:06:41.680 --> 0:06:44.200 Right, we can really see the effects. And from someone 0:06:44.240 --> 0:06:48.200 who's on literally the front line of it, right, holding teeth. 0:06:47.960 --> 0:06:49.000 Day in and day out. 0:06:49.360 --> 0:06:53.880 Yeah, yeah, yeah, we really appreciate it, super super appreciate it. 0:06:54.480 --> 0:06:54.680 Hi. 0:06:54.960 --> 0:06:58.200 I'm Aaron Welsh and I'm erin onmant Updike And this 0:06:58.360 --> 0:07:00.240 is this podcast Will Kill You. 0:07:00.320 --> 0:07:05.520 Part two of Fluoride Part two. Yeah, it's on me today. 0:07:06.160 --> 0:07:08.640 I am just thinking how weird it is, and like, 0:07:09.320 --> 0:07:10.560 I don't know if I get it. I don't know 0:07:10.600 --> 0:07:13.040 if it's like nice, if I'm like comfortable not having 0:07:13.560 --> 0:07:18.040 anything to say, you know, nothing to hold anybody. I mean, 0:07:18.040 --> 0:07:20.160 it's not I get to just like sit back and relax. 0:07:20.440 --> 0:07:21.680 I liked it last week. 0:07:22.040 --> 0:07:24.480 I would love to do more of those. Very nervous 0:07:24.480 --> 0:07:27.160 about this week. But so last week, if you missed it, 0:07:27.320 --> 0:07:32.640 we went through Aaron Welsh went through the history of fluoride, 0:07:32.840 --> 0:07:35.320 how we figured out what it does, when we started 0:07:35.320 --> 0:07:39.960 putting it in our water, slash when it was always there, 0:07:40.040 --> 0:07:40.960 we stopped. 0:07:40.640 --> 0:07:43.200 Putting it in our water in some places. 0:07:43.200 --> 0:07:46.960 And the history, yes, of the anti fluoridation movement. So 0:07:47.040 --> 0:07:52.080 today I am going to talk to us about Honestly, Erin, 0:07:53.200 --> 0:07:55.160 this is going to be just a very long winded 0:07:55.240 --> 0:07:57.880 episode for me to end with essentially the same conclusion 0:07:57.880 --> 0:08:02.680 that you stated last week that as of right now, 0:08:02.800 --> 0:08:06.400 there there is no data of harm to our health 0:08:06.720 --> 0:08:10.640 from drinking water with fluoride added to it at the 0:08:10.680 --> 0:08:14.920 specific concentrations that we add to it, right that's the 0:08:14.960 --> 0:08:18.600 TLDR TLDL tld listen. 0:08:18.720 --> 0:08:19.360 Yep, there you go. 0:08:21.000 --> 0:08:23.440 But let me tell you it took me a very 0:08:23.480 --> 0:08:26.240 long time, quite a lot of research and a real 0:08:26.280 --> 0:08:28.760 emotional journey to get to that conclusion. 0:08:28.880 --> 0:08:32.320 So okay, I'm curious about the emotions. Number one. Number two, 0:08:33.200 --> 0:08:37.600 I think that that illustrates how challenging it can be 0:08:38.080 --> 0:08:40.920 yes if you have questions to get to the bottom 0:08:41.000 --> 0:08:44.199 of one hundred questions per. 0:08:44.720 --> 0:08:46.520 But we will do our best to do that today 0:08:46.840 --> 0:08:49.800 with first going into some detail on like what a 0:08:49.880 --> 0:08:52.040 carry or a cavity like we talked about last week, 0:08:52.080 --> 0:08:53.800 really is how it forms? 0:08:53.920 --> 0:08:55.800 Quick question, is it ya carries? 0:08:56.360 --> 0:08:57.040 I don't know. 0:08:57.320 --> 0:08:59.600 Erin, I still don't know, and I'm probably just going 0:08:59.640 --> 0:09:01.400 to call it cavity because that's my word. 0:09:01.760 --> 0:09:05.400 Okay, I'm finally carries seem so weird, I know, I 0:09:05.480 --> 0:09:09.640 kept I kept trying to like adjust the verb noun. 0:09:09.800 --> 0:09:13.720 It's like the dental carries. Okay, how dental carries form? 0:09:13.760 --> 0:09:14.280 How about that? 0:09:14.679 --> 0:09:20.960 How dental carries forms? What carries carries is? What's the 0:09:21.000 --> 0:09:27.079 singular of carries? Yeah, we need we clearly do. I 0:09:27.120 --> 0:09:28.720 think it's like deer and deer. 0:09:29.760 --> 0:09:32.720 No that I can't accept that. I think it might 0:09:32.840 --> 0:09:38.800 see the end, but carries is plural and singular whatever 0:09:38.880 --> 0:09:39.760 Aaron listen is. 0:09:39.800 --> 0:09:43.960 We're going to talk about how they form, how fluoride 0:09:44.080 --> 0:09:47.400 actually works to protect against the formation of dental carries, 0:09:48.000 --> 0:09:50.200 where we're getting that fluoride from, and then of course 0:09:50.320 --> 0:09:54.000 all of the controversies if that is the right word 0:09:54.600 --> 0:09:55.839 about the supposed or. 0:09:55.800 --> 0:09:57.920 Possible negative health effects of fluoride. 0:09:58.000 --> 0:10:01.600 Okay, okay, so we're gonna talk about today, but first, 0:10:01.880 --> 0:10:03.680 but first, it's quarantine. 0:10:03.720 --> 0:10:06.520 It's quarantine. Ay time, we're drinking the same thing we 0:10:06.559 --> 0:10:09.520 did last week, and that is pulling. 0:10:09.160 --> 0:10:12.120 Teeth, pulling teeth. Yeah, yeah, okay. 0:10:11.960 --> 0:10:15.840 It's we don't quite remember the ingredients. But that's okay 0:10:15.920 --> 0:10:19.160 because you know what, you know, it would have been 0:10:19.160 --> 0:10:22.959 so easily accessible in my notes. Yeah, but that's okay 0:10:23.000 --> 0:10:26.280 because you know where you can find that on our website. 0:10:26.640 --> 0:10:28.280 Yeah, this podcast, podcast. 0:10:28.880 --> 0:10:30.679 Or all of our social media channels. 0:10:30.679 --> 0:10:33.800 We're there, Instagram, this podcast will kill you Blue Sky. 0:10:35.200 --> 0:10:38.120 I don't remember either tpwky or this podcast will kill 0:10:38.160 --> 0:10:39.120 you Facebook. 0:10:39.160 --> 0:10:42.720 We still exist there, TikTok. Also, you know what I mean, 0:10:43.080 --> 0:10:45.080 just just follow us. 0:10:45.160 --> 0:10:46.280 Check it, check it out. 0:10:46.320 --> 0:10:50.000 There's mint in it, there's elderflower. It's like it's delicious. 0:10:51.600 --> 0:10:57.319 Let's let's do a web a website spiel. We've got transcripts, 0:10:57.360 --> 0:10:59.839 We've got sources. Because I know that you're gonna want 0:10:59.840 --> 0:11:01.880 to re up more on floride. 0:11:02.160 --> 0:11:02.679 Yeah you are. 0:11:03.080 --> 0:11:05.640 We've got some. We've got some sources. We've got a 0:11:05.679 --> 0:11:07.880 link to where you can submit your first hand account. 0:11:08.440 --> 0:11:10.800 We've got links to the books that we feature on 0:11:11.200 --> 0:11:16.160 these episodes, and our book club episodes and more things 0:11:16.320 --> 0:11:19.120 that was a terrible website should beel You did your best. 0:11:19.520 --> 0:11:19.840 Thank you. 0:11:20.640 --> 0:11:21.000 That's all. 0:11:21.160 --> 0:11:21.880 It's all I can do. 0:11:21.960 --> 0:11:24.680 It's all I can hope for rate review and subscribe 0:11:25.080 --> 0:11:26.440 on your favorite podcaster. 0:11:26.840 --> 0:11:27.520 Yeah you can. 0:11:27.559 --> 0:11:28.520 We're on YouTube. 0:11:29.080 --> 0:11:35.160 YouTube the let's go, let's go. Okay, after a break, 0:11:35.400 --> 0:11:35.880 we'll do it. 0:11:52.800 --> 0:11:56.040 I just want to also set the stage really quick, okay, 0:11:56.679 --> 0:11:59.920 and remind us of what a global public health prop 0:12:00.480 --> 0:12:01.600 Dental carries are. 0:12:03.360 --> 0:12:04.520 Gonna use them as a plural. 0:12:05.480 --> 0:12:07.760 It's both a plural and a singular. So you're in 0:12:07.760 --> 0:12:11.880 the clear, okay, I cannot get it wrong. So the 0:12:11.920 --> 0:12:14.600 World Health Organization estimates, and this is a little bit 0:12:14.600 --> 0:12:17.400 old data, but it's still what is cited that two 0:12:17.440 --> 0:12:22.600 point four billion people across the globe have untreated dental 0:12:22.600 --> 0:12:26.240 carries in their permanent teeth, and six hundred and twenty 0:12:26.240 --> 0:12:30.319 one million kiddos have untreated dental carries in their primary teeth. 0:12:31.600 --> 0:12:35.400 So this is a huge public health problem. There was 0:12:35.559 --> 0:12:39.160 a really great Nature review Nature Reviews Disease Primer's paper 0:12:39.160 --> 0:12:42.240 from twenty seventeen that I used heavily for the carries section, 0:12:42.679 --> 0:12:45.680 and it estimates that sixty to ninety percent of children 0:12:45.720 --> 0:12:48.319 and the vast majority of adults are affected by dental 0:12:48.320 --> 0:12:51.000 carries at some point in their life, and they're actually 0:12:51.080 --> 0:12:54.040 considered the single most common chronic childhood disease. 0:12:54.160 --> 0:12:57.960 Like what I mean, I'm not surprised, I know, And 0:12:58.360 --> 0:13:02.880 like many chronic infectious diseases, we do see disparities in 0:13:02.960 --> 0:13:06.320 prevalence as well as access to care, with children of 0:13:06.360 --> 0:13:10.320 color and children in lower income areas having significantly higher 0:13:10.320 --> 0:13:12.640 prevalence and difficulties in access to care. 0:13:13.160 --> 0:13:15.920 Although globally it is still the case, though this is 0:13:16.000 --> 0:13:19.440 changing due to dietary changes. Higher income countries actually tend 0:13:19.440 --> 0:13:22.000 to have slightly more carries than lower income countries, So 0:13:22.000 --> 0:13:27.800 that's largely dietary differences and how much sugar we eat. Okay, 0:13:27.840 --> 0:13:29.520 and that's the end that I'm going to say about sugar, 0:13:29.559 --> 0:13:33.680 because today is about fluoride. Okay, Let's talk about how 0:13:33.800 --> 0:13:37.760 dental carries form. There's two main components that exist for 0:13:37.880 --> 0:13:41.960 the formation of dental carries. First is issues with the 0:13:42.160 --> 0:13:46.240 enamel itself, and the second is the components of the 0:13:46.440 --> 0:13:51.520 oral microbiome. So let's start there. Our oral microbiome is 0:13:52.400 --> 0:13:56.040 just so varied. We have so many different things that 0:13:56.080 --> 0:13:59.360 live in our mouth. We've got bacteria, yeast, viruses, protozoa, 0:13:59.480 --> 0:14:02.160 even our did you know that I did. 0:14:01.960 --> 0:14:03.160 Not know neither. 0:14:03.520 --> 0:14:04.640 How did they get there? 0:14:04.800 --> 0:14:08.240 How did they get there? Many of these organisms are 0:14:08.400 --> 0:14:12.240 commensals or even beneficial to our mouth and to our health, 0:14:12.679 --> 0:14:15.560 but some are what we call kryogenic. 0:14:16.160 --> 0:14:17.520 And all of. 0:14:17.400 --> 0:14:22.520 These helpful and unhelpful organisms, because I can't just say bacteria. 0:14:22.560 --> 0:14:24.120 It's more than just bacteria. 0:14:24.360 --> 0:14:27.440 They live together, and they grow and form this very 0:14:27.440 --> 0:14:30.800 complex biofilm on our teeth surface that. 0:14:30.800 --> 0:14:33.120 We call plaque plack. 0:14:33.440 --> 0:14:37.920 And each surface of each one of our teeth is 0:14:37.960 --> 0:14:42.880 its own little micro environment, with its own little microbiome. 0:14:43.680 --> 0:14:46.720 So there's like there's like whole mouth. 0:14:46.640 --> 0:14:49.040 And then there's like each little surface of its tooth. 0:14:49.040 --> 0:14:51.760 It's going to be a little bit different. Yeah, isn't 0:14:51.800 --> 0:14:52.720 that great to think about? 0:14:53.520 --> 0:14:56.600 I am very curious, Okay, And so I assume that 0:14:56.640 --> 0:14:59.400 there's like a fairly there that there's a gradient from 0:14:59.440 --> 0:15:02.360 front to too, like if you're closer to the back 0:15:02.400 --> 0:15:04.920 of your mouth. What's going on there? 0:15:05.280 --> 0:15:08.120 For no idea? We should do a whole episode on 0:15:08.160 --> 0:15:09.239 the oral microbiome. 0:15:10.040 --> 0:15:13.960 Really we should, though, we should like flossing. Listen, we 0:15:14.000 --> 0:15:15.040 should talk about floss. 0:15:15.160 --> 0:15:17.120 You know, we've talked a lot about floss. 0:15:17.160 --> 0:15:19.840 You and I you talked a lot about more than 0:15:19.840 --> 0:15:20.560 you would expect. 0:15:20.600 --> 0:15:20.880 I know. 0:15:21.320 --> 0:15:24.320 Okay, but listen, let's get back to the oral microbiome 0:15:24.480 --> 0:15:25.920 in the contee. 0:15:25.520 --> 0:15:27.040 Of visual teeth, et cetera. 0:15:27.200 --> 0:15:33.440 Yeah, so, under certain environmental conditions, for example, high concentrations 0:15:33.480 --> 0:15:38.960 of fermentable carbohydrates like sugar, or conditions like say a 0:15:39.040 --> 0:15:43.560 reduction in saliva, we can see a shift in this 0:15:43.680 --> 0:15:49.520 microbiome to favor certain bacteria, including various species that are 0:15:49.640 --> 0:15:53.600 more either acid producing, so they make more acid from 0:15:53.640 --> 0:15:58.160 these fermentable carbohydrates, or they're just very tolerant of this acid. 0:15:58.680 --> 0:16:01.120 And it's not just like one, one or two species 0:16:01.160 --> 0:16:02.880 of bacteria. We used to think it was just like 0:16:02.960 --> 0:16:06.160 maybe a couple different species that were the main causes 0:16:06.160 --> 0:16:06.920 of dental carries. 0:16:06.960 --> 0:16:07.280 It's not. 0:16:07.440 --> 0:16:12.640 It's this whole ecological community that shifts to favor acid production, 0:16:12.880 --> 0:16:15.520 and that is the first step in the formation of 0:16:15.600 --> 0:16:18.800 dental carries. Is this shift in the oral microbiome to 0:16:18.920 --> 0:16:22.240 favor acid production, and we most often see this due 0:16:22.280 --> 0:16:24.440 to things like regular exposure to sugars. 0:16:24.680 --> 0:16:27.480 Okkay, so we've got this. The first thing, like the 0:16:27.840 --> 0:16:30.840 inciting incident, is the sugar, and then that just sort 0:16:30.840 --> 0:16:35.240 of selects for this ecosystem exact acid or caryogenic. 0:16:36.200 --> 0:16:40.040 Then we have the hard stuff, our enamel. So as 0:16:40.160 --> 0:16:43.760 the acid production from these bacteria starts to build up 0:16:43.800 --> 0:16:47.640 in our mouth, the pH of course is going to drop. 0:16:47.840 --> 0:16:51.120 Acid has a low pH, and that drops the pH 0:16:51.280 --> 0:16:54.360 at the surface of our enamel, which is the outermost 0:16:54.400 --> 0:16:58.840 part of our teeth that surrounds the denteene right. Enamel 0:16:59.040 --> 0:17:02.640 is mostly made of a substance called hydroxy appetite, which 0:17:02.640 --> 0:17:06.399 is basically just a compound of calcium and phosphate and hydroxyl, 0:17:06.440 --> 0:17:09.720 which is like oxygen and hydrogen. And in the presence 0:17:09.720 --> 0:17:13.240 of acid, what happens is that this becomes soluble. So 0:17:13.560 --> 0:17:17.679 there's a partial demineralization of this outer surface of the tooth. 0:17:18.560 --> 0:17:23.320 And as this hydroxy appetite starts to demineralize, then you 0:17:23.359 --> 0:17:26.960 have an increase in porosity, right, So then this acid 0:17:27.119 --> 0:17:33.000 can diffuse even deeper and cause further demineralization, releasing more 0:17:33.040 --> 0:17:39.119 calcium and more phosphate from this enamel. Right, and this process, 0:17:39.280 --> 0:17:40.640 don't ask questions yet, aarin. 0:17:41.400 --> 0:17:43.720 I can see you take a see me up. 0:17:43.880 --> 0:17:47.639 Yeah, this process and the fact that, like we have 0:17:47.720 --> 0:17:50.119 saliva in our mouth which serves as a buffer. Eventually 0:17:50.200 --> 0:17:54.280 we're gonna wash out some of this acid. Eventually you 0:17:54.359 --> 0:17:58.639 will have remineralization, right because the calcium and phosphate are 0:17:58.680 --> 0:18:02.159 being released, Your saliva is coming into buffer and eventually 0:18:02.440 --> 0:18:05.000 things even out to where the calcium and phosphate is 0:18:05.040 --> 0:18:10.880 gonna redeposit and you can remineralize this unless you can't 0:18:11.440 --> 0:18:14.439 because if you continue to have acid production, if you 0:18:14.480 --> 0:18:18.600 don't have enough saliva, et cetera, then this demineralization process 0:18:18.640 --> 0:18:21.320 can continue until you end up damaging the pulp of 0:18:21.359 --> 0:18:26.200 the tooth, which can then damage the canal, the root canal, 0:18:26.240 --> 0:18:27.960 and then you end up meeting a root canal or 0:18:28.000 --> 0:18:35.200 an extraction. But this process demineralization and then remineralization, mineralization, 0:18:35.320 --> 0:18:38.000 it's hard word to say this is happening in our 0:18:38.000 --> 0:18:39.840 mouth all the time. I think that we think of 0:18:39.880 --> 0:18:42.200 our teeth as like static, right, they're just like little 0:18:42.240 --> 0:18:45.320 bones sitting in our mouth, But they're not. They're alive 0:18:46.080 --> 0:18:49.840 and they are constantly changing in response to the environment 0:18:49.920 --> 0:18:50.480 of our mouth. 0:18:51.359 --> 0:18:55.600 Okay, can you tell me about why low saliva is bad? 0:18:56.000 --> 0:19:01.040 Saliva is a buffer in power in that acid base system, 0:19:01.320 --> 0:19:03.320 and so with out the saliva, then you don't have 0:19:03.359 --> 0:19:06.440 that buffer. Yeah, and then why there's probably more. 0:19:07.200 --> 0:19:11.280 But the short answer why acid? Like why do these 0:19:11.320 --> 0:19:15.240 microbes produce acid? Is it like a competition thing with 0:19:15.480 --> 0:19:18.040 other microbes that's just to kind of like stake out 0:19:18.040 --> 0:19:20.600 more space and claim that's a deeper dive. 0:19:20.640 --> 0:19:21.040 I don't know. 0:19:21.119 --> 0:19:22.919 Is it just that that's like a byproduct of the 0:19:22.960 --> 0:19:25.400 production of sugars, right, That's what it seems like. It's 0:19:25.400 --> 0:19:28.439 like they produce mostly lactic acid as a result of 0:19:28.480 --> 0:19:30.760 the production or the digestion of sugars. So it's just 0:19:30.760 --> 0:19:35.439 like they're poop right right, Yeah, Okay, but that's just 0:19:35.480 --> 0:19:37.840 like all of that was just dental carries. That's just 0:19:37.880 --> 0:19:39.720 what's happening in our mouth. Where the heck does fluoride 0:19:39.720 --> 0:19:41.760 come in? I haven't even said the word fluoride yet. 0:19:42.600 --> 0:19:44.480 It's just lurking in the background. 0:19:44.160 --> 0:19:46.000 It is. It is erin. 0:19:47.680 --> 0:19:50.359 So it is like you said last week, Aaron, you 0:19:50.440 --> 0:19:53.240 kind of went into this fluoride is it's just a 0:19:53.280 --> 0:19:56.480 mineral salt that's present in our environment. Like all of 0:19:56.560 --> 0:20:00.359 us are being exposed to fluoride through various sources. Fluoride 0:20:00.440 --> 0:20:04.480 is like the ion form of fluorine, the element which 0:20:04.520 --> 0:20:08.480 is I learned, the thirteenth most abundant element in our 0:20:08.560 --> 0:20:13.119 Earth's crust. It's just there, it's around, it's in a 0:20:13.119 --> 0:20:16.479 lot of different mineral compounds, and it's absorbed very well 0:20:16.640 --> 0:20:18.360 via our GI tract when we are. 0:20:18.359 --> 0:20:19.120 Exposed to it. 0:20:19.640 --> 0:20:22.880 But how does it work in our teeth to protect 0:20:22.920 --> 0:20:27.480 them from dental carries. There are several mechanisms that we 0:20:27.560 --> 0:20:31.919 know of now. How fluoride works. First is that it 0:20:32.080 --> 0:20:38.960 delays that initial demineralization process. Basically, fluoride itself you can 0:20:39.000 --> 0:20:42.639 think of as acting like a buffer it because of 0:20:43.240 --> 0:20:48.680 when fluoride precipitates versus becomes soluble compared to calcium phosphates 0:20:48.840 --> 0:20:52.800 and the hydroxyl groups that's in hydroxy appetite. In the 0:20:52.840 --> 0:20:56.160 presence of fluoride, you have to have a lower pH 0:20:56.359 --> 0:21:00.560 a more acidic environment before that de mineralization starts. 0:21:00.600 --> 0:21:01.320 Does that make sense. 0:21:01.760 --> 0:21:04.880 Yeah, yeah, yeah, like lowers or it raises the bar 0:21:05.680 --> 0:21:07.600 or like you got to be even more acidic if 0:21:07.600 --> 0:21:08.880 you want to do damage. 0:21:08.520 --> 0:21:10.040 Here exactly exactly. 0:21:10.600 --> 0:21:13.000 And then on top of that, again because of the 0:21:13.119 --> 0:21:18.439 chemical properties, it also hastens that process of remineralization. It 0:21:18.520 --> 0:21:25.600 returns that neutral pH faster to favor remineralization. Right, so 0:21:25.640 --> 0:21:29.159 you're like less demineralizing and more remineralizing. 0:21:29.520 --> 0:21:32.800 Wow, Okay, so it's like a twofold. It protects you 0:21:33.160 --> 0:21:35.960 and it also helps to repair fast exactly. 0:21:36.080 --> 0:21:39.640 Yeah, and there are more mechanisms too. It also can 0:21:39.640 --> 0:21:43.480 interfere with like the bacteria themselves that form this biofilm, 0:21:43.720 --> 0:21:47.960 they can fluoride can interfere with glycolysis, so some of 0:21:47.960 --> 0:21:51.680 the specific like metabolic processes in that bacteria that live 0:21:51.680 --> 0:21:54.880 in our mouths, especially those carryogenic ones, so that they're 0:21:54.920 --> 0:21:58.280 just not as efficient. It's thought that this is probably 0:21:58.280 --> 0:22:01.120 not like the most important mechanism, but it is yet 0:22:01.119 --> 0:22:05.760 another mechanism by which fluoride is helping the oral microbiome 0:22:05.880 --> 0:22:08.960 of our teeth, which is cool. And all of these 0:22:09.400 --> 0:22:14.399 events happen even at very low levels of fluoride in 0:22:14.440 --> 0:22:18.480 our mouths, like less than one part per million. At 0:22:18.720 --> 0:22:23.199 high levels of fluoride, it can also penetrate through the 0:22:23.240 --> 0:22:27.399 plaque and then be incorporated into our enamel itself. So 0:22:27.520 --> 0:22:31.960 instead of that hydroxy appetite, you can have fluoride there 0:22:32.000 --> 0:22:34.560 instead of the OH group. So it's called fluoro appetit. 0:22:35.000 --> 0:22:38.000 Did you know that shark enamel is made almost entirely 0:22:38.040 --> 0:22:38.960 of fluoro appetate? 0:22:39.960 --> 0:22:42.560 All like what they. 0:22:42.480 --> 0:22:45.520 Don't ask watertails are like, is there a lot of 0:22:45.560 --> 0:22:48.160 fluoride in salt water in the ocean. There's like one 0:22:48.280 --> 0:22:51.240 to one point five parts per million in saltwater. So nah, 0:22:51.400 --> 0:22:55.480 not really, I mean there's so amazing Okay, Yeah, So 0:22:55.520 --> 0:22:59.000 that that's some of the other ways. And like we 0:22:59.080 --> 0:23:02.879 talked about last week, erin if we are ingesting fluoride 0:23:02.920 --> 0:23:06.679 systemically in our water, in our food, whatever pre eruption 0:23:06.960 --> 0:23:10.120 i e. When we are little before our first teeth 0:23:10.200 --> 0:23:13.600 pop out, it also has been shown to make our 0:23:13.760 --> 0:23:17.320 enamel more resistant to the development of carries later on, 0:23:17.680 --> 0:23:21.640 especially the deep, craggly bits of our teeth that aren't 0:23:21.680 --> 0:23:23.919 ever going to be exposed to topical fluoride. 0:23:24.320 --> 0:23:28.480 Ah okay, And this is both for baby teeth and 0:23:28.600 --> 0:23:29.399 permanent teeth. 0:23:29.720 --> 0:23:34.080 All these mechanisms. Yes, yes, And I want to actually 0:23:34.640 --> 0:23:37.240 stop here for a second and take a pause, because 0:23:37.280 --> 0:23:40.320 this already what I have said, is one of the 0:23:40.480 --> 0:23:44.240 points that many of the papers and the rhetoric that 0:23:44.400 --> 0:23:48.920 pushes back against the idea of community water fluoridation really 0:23:48.960 --> 0:23:51.879