Welcome to a new series of Fertility Foundations, where we go speak in depth with expert guests about how to prepare the foundations for healthy pregnancy. This week Sandra Greenbank is talking to Dr. Victoria Sampson about the connection between oral health and fertility.

Dr Sampson is well known for her work in developing saliva diagnostics, microbiome testing, and incorporating artificial intelligence into everyday oral care. Her work has been acknowledged worldwide, resulting in her becoming a scientific adviser, board member and clinical lead of multiple dental companies globally. She has published numerous papers internationally, with her most recent publication in the British Dental Journal being the most cited and viewed article ever published. Most recently, she was shortlisted as one of the most promising young scientists in Europe for the Forbes 30 under 30 in Science and Healthcare 2022, the first dentist to be shortlisted. She’s one of the cofounders of the Health Society in Mayfair, London, the first multidisciplinary health centre where she practices functional and precision dentistry, aimed at connecting the oral microbiome with general health. And she is a topical team member of the European Space Agency and NASA, creating guidelines for astronauts before long haul flights.

Listen to this episode of the Fertility Foundations podcast with Dr Victoria Sampson here.

Find Dr Sampson here: https://www.thehealthsociety.co.uk/victoria-sampson

Podcast transcript

Sandra Greenbank  00:04

Hello and welcome to the fertility Foundation’s podcast where we go into detail about how to prepare the foundations for healthy pregnancy. We dive deep into the underlying causes for fertility issues and natural solutions empowering you to take charge of your own path to parenthood. I’m Sandra Greenbank nutritional therapist, functional medicine practitioner coach and educator, Speaker specialising in fertility, pregnancy and postpartum help. Today I’m speaking to Dr. Victoria Sampson about the connection between oral health and fertility. This is a subject that’s really a special interest of mine and I’m really excited to talk to Dr. Victoria. Victoria obtained her bachelor in dental surgery from bots and the London she’s now known for her work in developing saliva diagnostics, microbiome testing, and incorporating artificial intelligence into everyday care. Her work has been acknowledged worldwide wide resulting in her becoming a scientific adviser, board member and clinical lead of multiple dental companies globally. She also has a postgraduate diploma in Periodontology. Victoria has published numerous papers internationally, with her most recent publication in the British dental journal being the most cited and viewed article ever published. Most recently, Victoria was shortlisted as one of the most promising young scientists in Europe for the Forbes 30 under 30 in science and healthcare 22,022. For efforts and devotion to healthcare, she was the first dentist to ever shortlist for Forbes. She has also won several national prizes for her research. And she’s one of the cofounders of the Health Society in Mayfair, London, the first multidisciplinary health centre where she practices functional and precision dentistry, aimed at connecting the oral microbiome with general health. She is also a topical team member of the European Space Agency and NASA aimed at creating guidelines for astronauts before long haul flights. So today, we’re talking about the connection between the oral cavity and fertility and pregnancy health. And I can’t wait to hear what Victoria has to say. Toria thank you so much for joining me. On my podcast, I’m so excited to talk to you. I’ve got a huge personal interest actually in the oral cavity and the oral health and how it relates to actually brain health and diabetes personally, but that’s not what we’re here to talk about today. But it’s so nice to get to finally catch up with you. Thank

Dr Victoria Sampson  02:34

you so much for inviting me. And I’m looking forward to talking all things oral microbiome with you.

Sandra  02:40

Yeah. So first of all, we talk about oral health, what are we? What is it we’re talking about, you know, apart from the absence of cavities, which we’re all trying to avoid?

Dr Victoria Sampson  02:52

So I think so the most people kind of just think that their, their, their oral health just means, like you said, absence of cavities, and I guess, no gum disease. But no one firstly, really, I think fully appreciate what gum disease is, and that it can appear in multiple different ways. And it’s a whole spectrum. So it’s not that your teeth are falling out, there’s a lot more that happens before that which is still very detrimental. I think the first thing to kind of start with is kind of what the the oral microbiome is. So your mouth is actually just a it’s a microbiome. And so what a microbiome means is that it’s an ecosystem of millions of bacteria, so about 700 different species of bacteria, which make 2 billion bacteria in the hole of the mouth. And it’s similar to your gut in the sense that your gut has a microbiome, and probably all of you who are listening have taken a probiotic or prebiotic or something for your gut because you’ve had some issues. It’s very similar to your mouth. And unfortunately, people don’t pay as much attention to their oral microbiome, as they do their gut microbiome. Often because they’re the symptoms of an imbalanced oral microbiome are pretty silent until it’s pretty late on and it’s a we’re at a quite a severe stage. So you’ve all these bacteria got your good and your bad bacteria. And you kind of want this whole ecosystem of them and the need to be in a balance. So it’s not that you only want fantastically amazing bacteria and your microbiome, you actually always will have a little bit of bad bacteria in there. And it’s about just keeping those at low levels and in check. And when you have high levels of those bad bacteria, then that’s when we start to see certain diseases. So when we stick with just the mouth, we’ve got the oral diseases like decay. So those are cavities and when you need to fillings, and then also things like gum disease, which like I said, is a spectrum so you’ve got from early stages of just maybe your gums bleeding a little bit Do then maybe your gums hurting. And then we have something called pocketing. So that’s when the gum start to kind of have a distance between them and the tooth. And so you can actually essentially put something down the gum and leave it there, and that’s a pocket. And then those buckets can get worse and worse and worse. And that leads to bone loss. And then at the very, very far end of the spectrum is when you start getting, you know, really bad breath, you’re getting infections around your gum, and ultimately to flosses is the last one, that’s your oral and then general, which I think is the reason I’m here is that the oral microbiome and when it’s imbalanced, has a lot of connections with other general diseases. And so it’s it’s not a separate entity to the rest of your body. And, you know, having a healthy mouth, it’s not just about reducing your risk of decay, but also reducing your risk of other diseases and problems with the rest of your body. Okay,

Sandra  05:59

and so how does it link then to the rest of the body, in terms of the Batsuit, the bacteria that there can travel? Yeah,

Dr Victoria Sampson  06:09

so you’ve got a few different mechanisms. The first is, like you said, literally bacteria in your mouth travelling so that can either be through swallowing, and it goes straight to your gut, or it can be through your blood. So there’s tiny little blood vessels in your mouth, and the bacteria can actually travel through those blood vessels and travel elsewhere. And that can cause infection elsewhere. So imagine, if you are having an infection somewhere else in your body, and this bacteria from your mouth is travelling, and also just kind of like adding petrol to the fire. So it’s just adding more bacteria in there that’s just not needed. So a lot of infections that we see. So for example, COVID, which I did a lot of research on, patients who were suffering from COVID had a lot of oral bacteria in their chest, and in their lung cavity. And they were actually often dying of bacterial infections, which are associated with oral bacteria. So that’s the first mechanism. The second is that you’ve got this bacteria, it’s causing all these problems in your mouth. And the way that the mouth responds, or generally, the body responds to, to kind of insult or harm is it releases inflammation. So this is called something this is the low grade chronic inflammation. And this is essentially where you’re firing out lots and lots of inflammatory markers, but kind of a low level. So it’s not enough where maybe you’re like, Oh, my God, my mouth is in pain, or I’m having so many problems. But these inflammatory markers are able to travel again, elsewhere throughout the body. And for example, if you have another inflammatory condition, like arthritis, or even something like Alzheimer’s, or anything, which is it has a lot of inflammation, then those inflammatory markers that are being released in the mouth will travel and again, add petrol to the fire, and just make that inflammation 10 times worse. Yeah, so those are the two main ones are in the third one, sorry. One is that it can actually impact it can harm your blood vessels. So a lot of the inflammatory markers, and there are some enzymes which are released by bacteria in the mouth, and again, they travel throughout the body, and they can actually destroy blood vessels, they can make blood vessels get a lot thinner, or a lot smaller, so that they cannot kind of dilate and enlarge with, you know, blood flow or anything like that. And that’s where we see the connection with things like heart disease, even things like erectile dysfunction. And, again, because blood cannot travel because the blood vessels are being damaged. Okay,

Sandra  08:51

so that really makes sense. But they’re linked to heart disease, except that that’s very well established. And I think most people sort of might have heard about this, but then the link with brain how and pregnancy how I suppose it’s more, you know, you’re thinking then about the barriers and the blood brain barrier. And does it do these bacteria cross the placenta? Yeah. And the inflammation? Yeah, exactly. So it all of those mechanisms I just mentioned, are all

Dr Victoria Sampson  09:24

related to pregnancy and to infertility as well. And so with the placenta, yes, you’re right. So there are certain bacteria, one in particular, which is called fusobacterium nucleatum. And that bacteria can very easily cross the placenta and travel in and increase the risk of foetal toxicity. And just kind of introducing bacteria into place which no bacteria is meant to be, and that can cause a lot of problems like low preterm birth or a is early birth as well as the premature birth? And then also foetal toxicity as

Sandra  10:05

well. And is this way you get free dental treatment on the NHS when you’re pregnant? Or is it to do with just generally you do to kind of get a more vulnerable at that

Dr Victoria Sampson  10:17

time combination of both? Yes. So a lot of it is to do with just preventing those diseases, because I think the reason I’m so passionate about this kind of side of dentistry is that it’s so easy to prevent, and so easy to sort out, unlike a lot of other problems in our body, which take can take, you know, months or years or loads of money to sort out, you know, if you have a little bit of gum disease, just getting your hygiene done regularly and properly, could be enough to actually reduce your risk of other problems or using the right toothbrush and toothpaste, you know, it’s, it could be a 10 pound change in your life, but it could actually really have a huge consequence. So you’re right, yes, the NHS does provide free treatment for pregnant patients. And part of its to do with preventing problems like infections whilst a mother is pregnant, because the last thing you want to be doing is prescribing antibiotics whilst the mother was pregnant and for her to be having abscesses and infections and pain and problems. And then the other thing is that I can you’re right, you’re when you’re pregnant, you are a lot more vulnerable to dental diseases. So the hormones during pregnancy impact of the gums quite significantly. And so a lot of women will get something called pregnancy gingivitis, and if they don’t sort that out and kind of have their hygiene regularly, and etc, then that can become proper gum disease later on. And so it is very important. Yeah, to keep your your hygiene and your dental health very good whilst you’re pregnant.

Sandra  11:52

So that will make sense, but also kind of when you’re pregnant, the horse is bolted. Because what you know, there’s so many things then that you? Well, first of all, the preventative should start way before shouldn’t it and also, I’m sure you’re also limited as we are with something that we would like to do during you know what we would have liked to do it before pregnancy, because you’ve done become so limited as to what you can actually put in or the things that you can use therapeutically as opposed to actually fix the problems. So what are they is there like sort of like a checklist of things that you should do, and how long before you try to conceive ideally should be doing anything.

Dr Victoria Sampson  12:36

So I would say it’s a during actual pregnancy, like you said, you don’t want to be having problems at that point, you want to be completely fine. So that you do have to kind of sort that out before being pregnant. But during pregnancy, for all of my pregnant patients, I recommend they come in for hygiene every three months, I don’t care if they don’t think they need it, or they say Oh, it’s too often or something like that. It’s your gums are absolutely crazy during pregnancy, and they’re also usually very sore, they bleed a lot. And the saliva in your mouth also changes during pregnancy. So it’s really important that the gum health is very is kind of maintained. So every three months is your hygiene, then free pregnancy. Again, there’s been a lot of connections with fertility and gum disease. So just making sure that your hygiene is good that you are going and seeing the hygienist regularly. And you’re you know, taking care of your mouth at home as well. And then, if you are trying to conceive, I would also ensure that there’s no dental diseases. So having like full checkup, and just making sure that there’s no signs of infection. That

Sandra  13:55

sounds like really good advice. I think that we tend to work a lot on inflammation as well and reducing inflammation because that generally inflammation in the pelvic cavity actually does impact your egg development, your your egg health. And so it doesn’t make sense to kind of do that 360 You know, just sort of that service as opposed before, before you go and try try for a baby. But what about the male partner? Is there any research or any sort of non knowledge that we have that we can pass on to the male partner who might be a little bit less easy to convince?

Dr Victoria Sampson  14:35

Yeah, so Well, as you say, sorry, going back. A second, I forgot to say a study for a woman is that there was a study that they did where they basically improved the dental health of woman who are trying to conceive and what they found was that by having gum disease that slowed down the conception by three months. So if you had gum disease, you were less likely to conceive, or it would take you three months longer to conceive than someone who doesn’t have gum disease. And then also that the that there’s the certain inflammatory markers that are released in gum disease actually prevent the release of some of the hormones that are connected to conception. So you’re gonna add a true fan, and you’re utilising releasing hormone as well. So it reduces the levels of those, which then means that obviously, your chances of conception are reduced as well. From the male side of things, it’s actually, I would say, I mean, it’s really important, and like you said, Men are sometimes a little less enthusiastic to go for it. So the first one is with just infertility. So I’m working at the moment with a with a male infertility clinic. And basically the reason why is that the, but there’s a big study where basically, they had a couple of 100 men, and they did a full dental checkup on all of these men. And they found that all of these men, by the way, are sub fertile. And so they did a full checkup, and 95% of them had some sort of dental disease, be an infected tooth, or gum disease, or something needed to be done, basically. And then they split the team, the group in half, and half of the group had all of that dental treatment done, and then all of their infections resolved. And the other half were left to their own devices. And what they found was that those who had the, the treatment were significantly more likely to conceive within six months. So much so that it was I think, 90% success rate of conception within six months of having that dental treatment sorted out. And the other group who had no dental treatment, there was no change, there was like a 5% success rate. So it was like such a huge difference and change between them. And then, in terms of erectile dysfunction, there was also a big study, which showed that patients or men who have gum disease are 2.85 times more likely to suffer from erectile dysfunction. And the reason for that is, if you rewind back to the beginning of this podcast, where I was just talking about the mechanisms, and the last mechanism, which was about your blood vessels, oral bacteria can alter those blood vessels and when they constrict, so when they tighten, or when they dilate and they become larger. And so what happens is that less blood is able to travel to the penis. And so you have erectile dysfunction as a result of that. So that usually gets the men coming in for their dental treatment, when I say that, that but it’s I think you’re very right to to also put a lot of focus on men when it comes to conception. And, and that’s why I’m working a lot with male infertility clinics, because it takes two to tango, and a lot of the time the men are kind of like, oh, okay, well, you know, it’s not my problem, when actually, often is their problem that way. It’s partly their problem, too. That’s

Sandra  18:21

really interesting, because I’ve read a couple of studies that length, male factor infertility with heart disease later in life. So there’s a there’s a correlation. And that makes complete sense. Now that that could be one of the parts of the links with, you know, because we know that heart disease is something that you set the stage sort of 1020 30 years ahead of, you know, the event, and then, you know, those can be that can be that smouldering fire that’s kind of just going on in the background for all of those years. But the other the other reason why I ask is because a man just won’t go to the doctor, they certainly won’t go to the dentist, unless, you know, they are in severe pain. Let’s take that. But also, the microbiome is shared, right. So if you know that your partner’s oral health is potentially not as great as it could be, how is it impacting? potentially impacting you personally?

Dr Victoria Sampson  19:24

Yeah. So so your your community, right, it the oral microbiome is very much shared between partners. There’s been a lot of research to see whether or not it’s because of literally exchange of saliva and essentially from kissing, or if it’s to do with actually the fact that two partners will often live together at this point. They’re sharing the same foods habits, environment, and it’s it’s sometimes difficult to differentiate between the two. But there was a study which shows that if you kiss your partner more than 12 times seems a day. And that’s even a small, it’s not like a, you know, a big, long, sloppy smooch. It’s even just a pack more than 11 or 12 times a day, then you will probably have exactly the same oral microbiome as your partner. So there is a huge transfer of bacteria on your right. If one is taking very good care of their microbiome and brushing and taking care of themselves, and the other one is not then it kind of balances out to just being like, quite average, in a way. And so again, both people need to be really working hard to make sure that they have good dental health.

Sandra  20:34

Yeah, yeah, that doesn’t make sense. And so you mentioned some of the signs and symptoms like gum gums bleeding when you brush them, or when you brush your teeth. Pockets are visible. What about plaque? What is plaque? So

Dr Victoria Sampson  20:50

Clark is basically it’s your it is partly your microbiome. So plaque is essentially a combination of carbohydrates from your saliva so and things that we’ve eaten, which are then they create, like a nice bed or mattress for some bacteria, and those bacteria then are able to grow on that kind of carbohydrate mattress, if you want to call it that. And that creates a plaque. So it’s like a kind of thick or thin film. It’s also called biofilm by some some people call it that, and it can just cover the teeth. And if it’s left there, what we get biofilm and plaque growing immediately. So after a clean, for example, it takes an hour or two for the biofilm to grow back again. And so every time you’re not brushing your teeth, you’re probably having some sort of plaque. And this might sound gross, but I’m sure all of you have lists. And there’s been one or two days where you may have forgotten your toothbrush or you’ve not brushed well enough. And sometimes if you put your finger or you try and wipe it, you might get a little bit of that white stuff on your finger. And that is black. And that’s that’s a thick amount of black, but you always have some on your teeth. And if it’s left there for too long. So I’m talking, you know, a day to two days, then you are starting, then you start to get a little bit of inflammation because the gums aren’t able to breathe. And the plaque is essentially kind of suffocating those gums. And then as the time goes by, and you’re still not disrupting that biofilm or the plaque, then it becomes thicker and thicker and thicker, and more bacteria are allowed to grow. And then the kind of composition of bacteria changes, because all of a sudden, you now have a very thick amount of bacteria. And so some of them aren’t able to live with oxygen, some of them can. And that’s when we start to see more dental diseases, or general diseases starting to grow. And what’s interesting about the mouth is that it’s the only part of the body which is where the teeth are the only part of the body which is non shedding. And so what that means is that every part of your body, your skin, your hair, your your everywhere, it sheds, so we’re off, we’re always losing skin cells, or you know, hair follicles or all of that stuff, but the teeth do not shed. So if someone is not going on manually removing that plaque and biofilm and that bacteria, then it can stay there for years. And that’s where we start to start to see problems. And that’s why it is so important to brush your teeth. It’s not just to refresh brackets to essentially remove that plaque and biofilm so that everything can breathe and you don’t get those diseases. Okay, and that eventually needs to put on to a disease where your gums loosen, and then I suppose they eventually fall out. Yeah, yeah. So there’s gums loosen, and then that plaque can basically travelled down into those those pockets. And then, and then they become far more kind of pathogenic or dangerous bacteria because, and that’s where they’d start to really cause

Sandra  23:55

destruction. And all of this time, it’s also affecting your heart, your brain. Every every every cell in your body basically, going into the bloodstream. Okay. So you mentioned testing, though, I know, obviously, you work closely with in vivo labs, and I love them as well for, you know, all of their microbiome testing. And that’s Could you talk us through a little bit about oral microbiome testing and you know, not necessarily just through libre, but what is the kind of clinical significance or usefulness of this and who should be thinking about this?

Dr Victoria Sampson  24:39

Yeah, so. So the oral microbiome testers were the one from in vivo is we collect essentially, your saliva, and we send it off to the lab, and then that saliva is kind of investigated, and we look at all of the bacteria in your saliva, and that bacteria is essentially what your oral microbiome is made out of. So when you look at the top 20 ish bacteria in the oral microbiome which are associated with gum disease and decay, but also they can start to give you insights into other parts of the body. So things like gut dysbiosis, or imbalanced gut, or even that chronic inflammation. And then we also look at fungi as well. So if you have any thrush or candidal infections, too. And the benefit of doing an oral microbiome test is that it gives you a snapshot into what’s going on in your, your mouth, if for example, you are trying to conceive, and you know that you have really high levels of some of the worst bacteria associated with gum disease, and you have really high levels of fusobacterium nucleatum, which I was just saying is the one associated with foetal toxicity and, and with preterm birth, then you might be more compelled to sort out your microbiome from my side. And by having all of that knowledge, it allows me to create a more personalised and focused treatment plan. So in my opinion, it’s not enough just to tell someone to brush better or to use a toothpaste. It’s about what toothpaste, what mouthwash what foods, supplements, everything that we can do to try and get rid of those bad bacteria, and then to replace them with better and good bacteria. So I do a lot of oral microbiome testing in my clinic. And we create personalised prevention plans for these patients. And it’s a combination of things that they do at home, mixed with things that we do in the practice using certain gels and all of those types of things which are focused on each bacteria, which are elevated to then get rid of them. So I’d say that’s like your main reason for doing all microbiome testing. I get a lot of people who are just interested, and they just want to optimise their health. And that’s completely fine, too. If you have gum disease, I would say and now I make every patient who has gum disease do an oral microbiome test. Because in what I found is that by doing that test and creating that personalised treatment plan, their response to treatment is significantly better than if we were to kind of do like a blanket, generalised treatment for everyone who has gum disease, because we’re all different.

Sandra  27:22

Okay. I mean, I think that we’re all convinced about how important it is to look after oral health. So aside from seeing your dentist regularly, and how often do you see it, should you see your dentist,

Dr Victoria Sampson  27:37

and so that should be kind of dependent on your risk of dental diseases. So generally, I would say the bog standard is every six months for checkup. Some people it might be every three months, if they have a lot of problems, or lots of stuff going on in their mouth. And for someone who’s absolutely phenomenal, and, you know, really, really amazing hygiene and no fillings maybe every 12 months. But if you’re not sure, six months,

Sandra  28:04

and the hygienist I mean, my doctor has Oh my My dentist has never ever sent me to the hygienist. I’ve never been to the hygienist and I don’t have any feelings either. But I sort of think, you know, should I go? I mean, you know, again, how often should you see someone new three every three months during pregnancy. But aside from that, so again,

Dr Victoria Sampson  28:26

it depends on your risk, and every person’s mouth is different. But I would say the average is every six months at my clinic, we do probably every four months, is what we recommend, so every three to four months. And the reason for that is because we do a special type of hygiene, which is called Guided biofilm therapy. And what that means is that we basically disrupt the biofilm and the bacteria and the plaque that I was talking about. And the more regularly you do that, then the better the microbiome is, and the less painful your hygiene is because you’re not allowing for all of that builder. Well, you know, the worst thing and the reason why people find hygiene so uncomfortable is that they don’t do it often enough. And then when they you know, let’s say they don’t come for two years, and they come in, they have so much build up and their gums are really inflamed. So when we try and go in there, everything’s painful and they hate it. So if you go more regularly, it’s less painful. And you’re less likely to have dental diseases. There are a lot of people who like you who don’t see hygienist necessarily their dentist might do a clean and you know everyone’s different. I’m a dentist but I do do quite a lot of hide things as well. What I would say is it doesn’t matter who does it necessarily but more that you are having a devoted appointment to your hygiene. What I don’t agree with is you know, having a checkup and someone just after was doing a quick five minute cleaning and just being like, yeah, okay, cool, you’re all good. That’s not enough. Everyone’s got bacteria, everyone’s got stuff that needs to be cleaned. And I think you should, everyone needs to have a devoted appointment for their hygiene, a good 30 to 40 minutes, at least every six months to keep that check. And I always compare it to any ladies out there, if you’re having, if you, for example, don’t wax. And all of a sudden, once every two years you do it bikini wax, it is the most painful thing in the world. Let everything you know, grow. And it’s really, really painful. And it’s the same with the hygiene. If you let everything just build up, you’re gonna hate us. So you need to come regularly. And you’ll it will be a lot more enjoyable for you

Sandra  30:46

to. Okay, so don’t necessarily listen to your dentist when they say you don’t need one. Yeah. Anyway, yeah, I

Dr Victoria Sampson  30:53

mean, I just think everyone needs one. And it’s not always about removing like visible calculus, it’s about disrupting the biofilm. It’s about getting under those guns, because you’re never getting under those guns when you brush your teeth. But you shouldn’t be. That’s something that only your dentist or hygienist should be doing. But everyone needs a little bit of a little bit of it once in a while just to keep everything in check. Okay.

Sandra  31:18

And so I’m going to ask you a few questions in a minute about, you know, products and some of the things that we can use. But just before I do that, what should we not do? So,

Dr Victoria Sampson  31:30

smoking is one of the worst things for the gums. Because it reduces your blood flow, it reduces your chances of healing, but also because it’s reducing your blood flow. What we were saying earlier about one of the biggest or the first symptoms of gum diseases, bleeding gums, if you’re a heavy smoker, you won’t get bleeding gums, you will have gum disease, but it’s actually kind of camouflaged by the smoking. And so we were like, Oh, my gums don’t bleed, they’re completely fine. And then they have horrendous gum disease, because they’ve actually missed that for a symptom. So smoking, I literally actually just read a paper this morning, and I just wrote a post about it about general lifestyle. So now there’s a lot of research which is showing that a good diet. So Mediterranean diet has been shown to be the most beneficial, good physical activity, reduce stress, and everything that we all know. And also good sleep quality are strongly correlated to better results from gum treatment and reducing your chances of gum disease. In terms of diet with sugar, it’s more about the number of times that you have sugar a day, as opposed to how much sugar you’re having. So I have a massive sweet tooth. I love sugar, I’m probably the worst dentist but what I do is I just basically all my sugar in one go. Like, sort of like after lunch, for example, I like to have some dessert. And but I only have it once and I eat it I could eat, you know a whole cake if I wanted to, or you know, 15 chocolate bars. But if I do it all in one go, it’s much much better from my mouth than if I was to eat a chocolate bar every hour. And we can go smaller to for example, m&ms. If you’re to have an m&m Every hour, then it’s worse than just having a huge bag of m&ms in one go. And that’s because your your saliva is constantly under attack. And that’s where we start to see patients who have lots and lots of decay. Because their their saliva was never able to get back to a healthy place to then remineralize and strengthen the teeth. hydration. So dry mouth is also a really, really big problem for dentists, because your saliva is your best friend. And just divers got lots of good proteins and enzymes and all of the food for all of that bacteria in your mouth. And it also reduces the risk of decay. So if you have a dry mouth, and that could be medically induced from medication that you’re taking. Or it could just be some people have a bit of a dry mouth, then making sure you’re keeping it hydrated. And also maybe stimulating your saliva flow. So that could be through chewing on something sugar free gum, or chewing on like a pastels or I like these probiotic pastels. I chew them quite a lot. And that’s just to kind of lubricate the mouth regularly and make sure that it’s all in check. Okay,

Sandra  34:34

probiotic pastels. I’ve never heard of those actually. Yeah,

Dr Victoria Sampson  34:37

they’re really good. They’re just like a, it’s like a mint. But it’s got some probiotics in it. And you just do it and tastes quite nice and sugar free. And it’s by love biotics. Which mean there’s, there’s quite a few but that’s the one that I liked the rest.

Sandra  34:52

Okay, that’s really interesting. And also it’s really interesting what you say about all of the things that you just mentioned the Mediterranean diet, you hoping that you know, it’s all the same. It’s all good for your fertility anyway, so. Okay, so I’ve got some sort of quickfire questions that those sort of been playing on my mind for ages. And I would love for you to kind of just say, Yes, this is a good thing or no, you should avoid it or use this instead. So first of all, fluoride.

Dr Victoria Sampson  35:21

Yeah, this is always the the, the one that everyone

Sandra  35:26

million dollar question. And you’ll

Dr Victoria Sampson  35:29

hear lots of different responses depending on who you ask. For me, personally, I’m kind of in the middle. So I believe in having a little bit of fluoride in your toothpaste, but not having too much fluoride. So the reason for that? Well, while I guess, firstly, the reason people don’t like fluoride, and they’re scared of it is because there has been some research to show that having high levels of fluoride and ingesting it can have neurotoxic effects. And it can also have impact on your bone. And, you know, those types of problems. The problem I have with that argument, and with that research is that we’re not ingesting or toothpaste, and the research that has been done on it is talking about eating, you know, very high levels of fluoride, like like having, you know, 2000 tubes of toothpaste in a day kind of situation. So, you know, anything gets such extreme levels is going to be dangerous and bad for you. So that’s why I’m not to I’m not anti fluoride completely. And the pro fluoride argument is that fluoride is very, very protective for the enamel. It reduces your risk of decay significantly. And so patients who are putting fluoride in their toothpaste have a much lower risk of decay and have the problem. So I’m in the middle. So I like to have a little bit of fluoride because I’ve also seen so many patients who switch to fluoride free toothpaste, and all of a sudden, within a year, they need 10 to 15 fillings. And it’s such a it’s so horrible to see. So, yeah, I would go for it. I still like fluoride, and I still recommend it to a lot of my patients. It’s about how much and also obviously, if you have children, making sure that you’re going within the guidelines for children and their age groups as well.

Sandra  37:26

Yeah, because children probably do swallow a fair amount of toothpaste as they’re sort of just awesome, especially if it tastes nice, some of them bubblegum flavour, and not, you know, what about hydroxyapatite that I use.

Dr Victoria Sampson  37:42

So hydroxyapatite is great. So it’s, it’s basically what your teeth are made out to. And so what we hydroxyapatite doesn’t toothpaste is well, the aim is to try and replace that maybe last hydroxyapatite through decay and through problems with the stock or toothpaste. It’s very good, it’s, it’s still a bit up and coming in the sense that there aren’t lots and lots of Hydroxyapatite toothpaste on the market. And so another problem is that the particle size of the hydroxyapatite is very important. So if you’re trying to replace your hydroxyapatite in your enamel or in your tooth, it needs to be the right particle size. And unfortunately, there’s lots and lots of Hydroxyapatite toothpastes on the market, where the the particle size is either way too big, where it’s not going to do anything, or it’s way too small, and it’s actually causing harm sometimes. So I’m yet to find hydroxyapatite toothpaste that I am really, really loving and happy with. And I’m still a little bit on the fence of, of replacing fluoride toothpaste with a fully hydroxyapatite toothpaste. So the one I recommend, mainly is something that has a little bit of both. So it’s called Bioman. There, I’m not sponsored by them, by the way, so but it’s got calcium and phosphate, which is also what hydroxyapatite is made on a lot. And also it’s got fluoride, but your normal fluoride toothpaste, if you were to go and buy something off the shelf is usually around 2000 to 2500 parts per millimetre of fluoride. And this has about 500 Or maybe 700 parts per millimetre of toothpaste, or fluoride. And so it’s a much lower level of fluoride. But the way that it’s delivered is the means that it’s got the same effect as high fluoride toothpaste. So that’s where that’s why I like it’s in the middle. It’s got a little bit of fluoride, but not too much so people can’t be too scared of ingesting it or any problems. It’s going to pass on your phosphate from the Hydroxyapatite prospective. And it’s also not too expensive. That’s another problem with hydroxyapatite is that some of the very expensive, they’re like, I can’t ask my patients to spend 25 pounds on Tuesday. So you know, and get it shipped from the US and you know, it’s, it’s not easy. So yeah needs I think for most people, that’s a good middle ground.

Sandra  40:09

So what was it called again?

Dr Victoria Sampson  40:11

Bioman e i o m i n? Yeah, so they’re a good one. There’s What else was there? Yeah, it depends on what you’re using your toothpaste for as well. So I always kind of prescribed toothpaste depending on what the patient needs. Amen. So Bioman is a good all rounder, if you want to whitening toothpaste, there’s another option. If you have gum disease, you might prefer another one, you know, it’s like skincare. So always trying to make sure that you use something that’s perfect for your your body.

Sandra  40:39

The whitening toothpaste actually work.

Dr Victoria Sampson  40:44

It depends on the ingredients in the whitening toothpaste. So, most whitening toothpaste are, they are very abrasive. So they usually have like, like charcoal or salty stuff in there. And what they’re doing is basically exfoliating your tea to remove those stain particles from the outer layer of the tooth, which is really bad. Because, as I said earlier, your teeth are the only non shedding surfaces of the body. So you only have one set of teeth, you only have one set of enamel. And so if you’re grinding away that enamel every time you’re brushing, then slowly over years, you will actually remove all of your enamel and you can’t grow it back again. So I’m very against those types of toothpastes, there is a few which have just come on the market, one by Colgate, which is the it’s called Max white ultimate. And they use a different ingredient which basically uses basically oxidises, the stained particles, so there’s nothing abrasive about it, it’s safe for your normal. But it basically releases lots of oxygen particles, which then burst the steam particles. And it does actually wait and see if it actually does work, in my opinion, and it’s not dangerous.

Sandra  42:02

It’s like something I use in my washing machine that gets your microbiome well. Yeah,

Dr Victoria Sampson  42:08

so it’s not it’s not bad for it. It’s not to be adding any crazy benefit that doesn’t have probiotics or anything like that. But it’s not bad for either. And

Sandra  42:18

what about teeth whitening like bleaching? So

Dr Victoria Sampson  42:21

it’s fine. It depends on what ingredients we’re using and the percentage. So most whitening uses hydrogen peroxide, or carbamide peroxide, which is kind of like bleach but a much lower concentration. And that’s why it’s so important that you do get it done professionally with a dentist who knows what they’re doing, and how much of what percentage they’re using on you. The in terms of if it’s harmful, it’s the equivalent of having a Coca Cola. So every day that you waiting is the same as you drinking a Coca Cola. That’s how damaging it is. So kind of No, it’s fine. In terms of your microbiome, weirdly, hydrogen peroxide is a very effective anti microbial. So it’s actually very good for killing bacteria. And there have been times where I have patients who have really high levels of bad bacteria. And I’ve actually recommended that they’re waiting their teeth, because it kills the Yeah, it kills the bad bacteria that needs to be killed. So it’s, it’s very good for that. And then a top tip that I would recommend is making sure that you take some probiotics and prebiotics afterwards, just to basically re nourish that microbiome and make sure that you haven’t lost your good bacteria too.

Sandra  43:35

And when you say take it, you take them out there’s or a probiotic mouthwashes as opposed to swallowing the pills, or would you choose a capsule or I prefer

Dr Victoria Sampson  43:46

mouthwashes, because there’s more of a direct contact and supply. So I use one from NVivo. And it’s called binary oral. And in my experience, it’s the best one at the moment on the market, which actually does deliver the probiotics into the mouth, and then you actually swallow it so you can swallow it. And then it has like a double whammy effect and it can help your gut too. So I use that. And then there’s a few toothpastes, which have some probiotics in them too. And then prebiotic wise, it’s mainly food recommendations that

Sandra  44:22

I give what probiotic toothpaste would you recommend? So

Dr Victoria Sampson  44:25

there’s one called zendium, which is pretty good. So it’s got some probiotics in it. And it’s also it’s very good for people who have sensitive mouths. And that could be because you’re going through maybe a lot of treatment. So if you’re going through like chemotherapy or let’s say if you’re pregnant and your gums are just so sore and everything hurts you and then James are really nice option and it’s quite soothing for the gums calms them down.

Sandra  44:56

I’ve been I’ve used designs for health before. I think they’re plural Free but they also have a silver toothpaste with probiotics. Have you heard of that one? What do you think?

Dr Victoria Sampson  45:04

Yeah, so I like that for gum disease patients. So the the silver is very good for it’s very anti microbial and the designs for health one, it’s got things called grapefruit seed extract, which is antifungal. It’s got a couple of things in it, which is really good. I usually put patients who are who have active gum disease on that toothpaste. And then even though it’s fluoride free, we can afford to maybe step down on the fluoride Ross we’re working really hard on the gums. Then once everything stabilised, we put them on like an all rounder toothpaste which has a bit of fluoride in it

Sandra  45:39

will make Could you perhaps alternate? So if you’re brushing your teeth, so every every other time with one of them or whatever you Yeah,

Dr Victoria Sampson  45:48

yeah, I do that at home. So I brush what I use Bioman in the morning? No, I use by minute nighttime. So because it’s very remineralizing and greet for the enamel. And then in the morning, I use the whitening toothpaste I was telling you about Colgate Maxwell ultimate, just to give me a little bit of a boost during the day.

Sandra  46:08

So interesting. And so should you brush twice a day?

Dr Victoria Sampson  46:10

Yes, twice a day, first thing you do in the morning. And the last thing you do before you go to bed before breakfast. That’s dependent on what you’re eating for breakfast. So I do I brush person because it’s just easier for me and I don’t, I don’t eat breakfast. So like I fast in the morning. So but if you’re having you know, a fruit salad for breakfast with lots of citrus and an orange juice, then you don’t want to go and brush your teeth straight away afterwards, because you’re basically brushing all that acid into the teeth. If you’re having a porridge and something very neutral, then you go ahead, you can brush your teeth afterwards. So it’s very dependent. If you’re unsure, and you’re worried that I would just brush before it’s you can’t go wrong with that.

Sandra  46:56

Okay, because I do actually tell my children to brush before breakfast, but they often have some sort of berries or maybe like some apples or something like that. But it’s that kind of okay, ish. Yeah, sort of citrus or

Dr Victoria Sampson  47:08

Yeah, it’s more about the citrus and citrus and sugar, which is your problem.

Sandra  47:13

Okay, so they could brush before or after? Doesn’t really matter. Yeah, that’s really interesting. Yeah. And what about mouthwash? I know, obviously, you mentioned the one from invivo, which is really good, and one that I use, but the commercial ones.

Dr Victoria Sampson  47:28

So I generally don’t recommend people to go to the shop and buy some mouthwash because if you don’t know why you’re using it, then often you can actually disrupt the microbiome and imbalance it unknowingly. So if you have no problems, then don’t go and use a mouthwash, you don’t need it, you should just be fine with brushing your teeth twice a day using the right toothpaste and having the right diet, that’s all you need. If you have gum disease, then you should be going to a dentist who should recommend a specific mouthwash for you. If you have bad breath, and you just want something to you know, pick you up once in a while, then you can just use like I use, like a hydrogen peroxide mouthwash. So like peroxyl, for example. And that just kind of like kills the bacteria which release sulphur in your mouth. So again, it’s very dependent on why you’re using the mouthwash. But it’s not recommended that people use mouthwash every day unless they need it. And if you’re dying to use mouthwash every day, and you really want something, then the probiotic mouthwash by binomial is a good option for just kind of good maintenance. But what I think people need to be aware of because I see a lot is people who they know they have a problem like gum disease. And then they’re like, Ah, great, I’m gonna go and buy some mouthwash and I’m gonna use it every day. And that will sort out their problems. And they use it and you know, it probably does mask some of the problems, but you need to be seeing a dentist for that. So it’s it should be used in conjunction with dental treatment.

Sandra  49:05

Okay, interesting. Should we use an electrical manual toothbrush?

Dr Victoria Sampson  49:11

Generally electric. So, it’s been shown that using electric toothbrush improves your brushing and your efficiency significantly. So yeah, I would use that. And then for kids, I generally like them using a manual toothbrush. First until they’re kind of early teens are like 10 ish. Reason being is I think everyone should know how to brush using a manual toothbrush, you know that you’ll there’ll be one day where you’re at a hotel room you forgotten your electric toothbrush charger and you need to know how to use it and I think every kid should learn how to use it properly. But once they’ve learned then they can kind of upgrade to an electric toothbrush and they will have much better results.

Sandra  49:55

How often should you change your toothbrush or toothbrush head?

Dr Victoria Sampson  49:57

Every three months?

Sandra  49:59

What about So flossing, we haven’t mentioned plussing, but I know this is really important as well. And that’s to clean in between. And, you know, what about those water floss that are really popular on sort of online. They seem to pop up on my feed all the time anyway, I don’t know where we’re targeted. So, high pressure washer for your tea. Yeah,

Dr Victoria Sampson  50:22

basically is flossing is really, really important like normal flossing. Everyone should be doing that, I recommend it, to do it twice a day. So every time we brush you should last. Because I know that if I tell people to do it twice a day, they most likely we’ll do it once a day. So the reason being is that 30% of the bacteria in is actually found in between your teeth. So when you’re brushing, you’re not actually removing that bacteria in between the teeth, flossing, the only way of doing that. So you do need to do that in terms of a Waterpik or a water flosser. It’s kind of like a level up, it’s not necessary. And again, if you just have good basic hygiene, and you’re brushing well and using floss and the right toothpaste, then you don’t need to be using a water flosser. But some people like to use it, just because it makes them feel good or freshen things up. But again, I don’t want people to think that that is a replacement for having a hygiene, for example, I see a lot of people are like, Oh, but I want to floss every day. And I’m like, It’s not the same thing. You know, there’s a reason people have gone through, you know, seven years of training to become a dentist. And that’s because there are places in areas that you cannot get to with a water flosser. And I think that’s the danger of the Water Flosser is that people think it’s like, oh, it’s a replacement. That’s fine. I don’t need to see the hygienist anymore. So yeah.

Sandra  51:44

It can it cause damage, though, because they imagine that it can this Can we could it disrupt your guns potentially, or? Yeah,

Dr Victoria Sampson  51:51

so if you use it incorrectly, or at the wrong frequencies, so there’s some dodgy ones out there, like random, unknown brand with a very high frequency and they can damage the enamel. Or they can dislodge the gums and hurt the gums or fillings or veneers or crowns. So that’s why I generally don’t really recommend it unless someone really just wants something kind of like an extra level of hygiene and they’re okay with that risk. And if you do want to get a Water Flosser, please make sure it isn’t a normal known brand. Nothing which is a high frequency or says that it’s going to remove everything like you don’t want that it’s too damaging.

Sandra  52:33

Okay. What about Invisalign? On top of that kind of little shields that you sort of wear day to day Are they find that they okay.

Dr Victoria Sampson  52:44

Yeah, so a lot of patients of ours do Invisalign. And so you’re right. So Invisalign is like a it’s an orthodontic treatment to align your teeth. And it uses like clear aligners, which you pop in and you wear those for 22 hours a day. And week by week, you change those aligners and you keep will move into the correct position every week, they’re fine, as long as again, you’re doing it with a dentist or an orthodontist who knows what they’re doing. I don’t recommend going to any of those kinds of direct to consumer aligner companies so I will not mention any but there are some where basically they try and cut out the the dentist or the orthodontist. And so you become your own dentist and the problem with that it’s not that I’m salty or jealous and I want everyone to come to me but the problem is is that if you don’t have someone want to strain your your orthodontic treatment and your teeth moving then you can get a lot of problems with your gums where even with the teeth I’ve seen people whose teeth have fallen out you know all of this because they haven’t had the right support and monitoring on the dentist so please make sure if you’re doing it do it properly.

Sandra  53:59

Okay, yeah. What about those kind of gum shields that you get with your teeth grinding i i actually was prescribed one of those and I worried that it’s made from plastic and I’m gonna sort of swallow loads of plastic and grinding it in the night.

Dr Victoria Sampson  54:14

Yeah, it’s a difficult morning if you can try and make sure that your your night guard is BPA free, then that’s the best way. Also some people who are very very scared of having plastic in their mouths at nighttime. I recommend actually Botox in their muscles here. And that just stops them from grinding completely and clenching as well. So if you don’t want anything in your life, that’s a nice alternative. But yeah, the night guard that’s unfortunately there’s nothing on the market so far which is not made out of plastic. So as long as it’s BPA free, fits in properly and you’re getting it replaced every kind of relatively regularly starts every few years. Now. Sometimes I get these night guards that have been like chewed like a dog for I was like, for 20 years and you’re like, oh, you know, don’t let that happen. Because the more you grind into it, the more things will be released from it.

Sandra  55:08

Lastly, which is isn’t probably not going to be a quick question, but should you remove your marquee refilling,

Dr Victoria Sampson  55:14

so removing the mercury fillings. Again, this is a bit of a controversial topic. And it depends on who you speak to me personally, I recommend that if you if your mercury fillings broken, or it looks like it’s chipping definitely needs to be replaced, because that can be leaching out mercury. And, and that’s the problem with them. If I have some patients who have you know, like 20, amalgam fillings in their mouth, and for them to replace all 20 is a huge deal. It’s very expensive, it’s a loss of treatment. So what I would recommend in those situations is doing a mercury toxicity tests. So just making just seeing, or heavy metal toxicity tests or just checking if you have high levels of heavy metals. And if you’re able to clear those heavy metals from your body, if you have extremely high levels, then I think that is an indication and I’m happy to do it. But for someone who, you know, I don’t think everyone needs to have it done. And the reason being is that actually removing those amalgam fillings releases more mercury than actually keeping them in the mouth sometimes. So I only think it’s indicated when the the advantage of removing it is more beneficial than keeping it in the mouth. And they’re completely intact, and there’s no problems with them. So, again, it’s really dependent on which person’s mouth. And

Sandra  56:39

is it true that use a dentist can also check if they are really if they’re releasing anything, or if it’s anything leaching from the fillings. So apart from the test that you just mentioned, were to see what’s actually going on inside the body. But on a surface level, yeah. So

Dr Victoria Sampson  56:56

just clinically, you can see that so if they’re starting to die, they start getting a bit kind of crumbly, a bit, chipped or broken, then that’s enough for me to want to remove it and replace it. So every person who comes in for a checkup, I do check in if they have anything like that, it’s it has to be replaced. It’s just that, like I said, The problem now is that we have called with a heavy metal nation, and it’s kind of the the 40 to 60 year olds who have a lot of metal in their mouths. And it’s just that unfortunately, dentistry at that time, there was a lot of Malcolm going on. And so the problem with that is that people I get a lot of people who come in, and they’re like, great, I want to change all of my amalgam fillings, and amalgam fillings can be very destructive to the teeth, it might mean that you need, you know, 23 fillings to be replaced, it’s a lot of mercury release. There’s a lot that people don’t see. And they think it’s really easy, and it’s not. So again, they kind of chip away at it slowly and just remove the ones that are leaching out mercury. So

Sandra  58:03

if you know you’ve got something that needs replaced, or your dentist says, you know, this is this is disintegrating, or whatever is about to fall out, we’re going to take it out. How long were at what point? Do you always have to do that before you get pregnant? Or is it something that can wait? And if you have to do it, how long before then you actually start to try to conceive? Should you do it?

Dr Victoria Sampson  58:26

So there’s there’s no guidelines on that at the moment. For me personally, I would say it should be like three months before you’re trying to conceive, you should try and remove them if you know that they need to be removed. If like during pregnancy, absolutely not, don’t try and replace any of your feelings. Not worth it. And then also breastfeeding as well. Don’t try and replace those feelings. So either three months before trying to conceive for probably a year and a half after birth. And you start thinking about replacing those again.

Sandra  59:00

Okay, great, because it’s been so interesting. Thanks so much, Victoria. I’ve kept you longer than I planned already. But if anybody wants to come and see you, how can they find you?

Dr Victoria Sampson  59:11

Yeah, so I have a clinic and Mayfair. So it’s called the Health Society. We’re just on these places. So you can just Google us, or you can find me on Instagram, at Dr. Victoria Sampson, and then I can direct you there.

Sandra  59:26

Thank you so much. My pleasure. Thank you so much for having me. I’ve really enjoyed this chat with Victoria and I hope you enjoyed listening to this episode. Please like share and review this podcast as it helps us reach more listeners.