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Introduction to Dr. Bill Levine and Periodontal Disease [1:09]

Matt Feret:

Hello everyone. This is Matt Feret, author of Prepare for Medicare and prepare for Social Security Insider's, guidebooks, and online course training series. Welcome to another episode of The Matt Feret Show, where I interview insiders and experts to help light a path to successful living in midlife retirement and beyond. Bill, welcome to the show.

Dr. Bill Levine:

Hi Matt. Thanks for having me, appreciate it.

Matt Feret:

So tell everybody what you've do, how long you've been doing it, and how you help people.

Dr. Bill Levine:

Sure. Well, I trained as a dentist and I specialize in the area of periodontal diseases and implants and so basically I take care of people's gums and make sure that you are able to keep your teeth for life for as long as you possibly can and when you can't anymore and for whatever reason you've lost some teeth, it could be trauma, it could be neglect, it could be genetic disposition or whatever it is, we have methods to replace those teeth to make sure that we can keep your function, your smile, and your speech coherent. So that's what I do and I've been doing it now for about 35 years. I started out in the United States working in New York City where I trained. I had the benefit of working with some of my mentors and professors for a few years, and then my family and I moved to Israel and I've been practicing here part-time, academic part-time, clinical practice and a lot of research and frankly enjoying myself and hopefully providing good things for my patients.

Matt Feret:

Every once in a while, I'll read an article that pops up that says gum health or the lack of health ties into so many aspects of the whole-body health. Talk a little bit about how accurate that is or examples of how gum disease or oral health impacts your overall health.

Dr. Bill Levine:

So I'll share with you a little vignette that I think is actually interesting that just occurred to me as you were talking right now. Many years ago, doctors said that there was an issue that if you had an infection, some area of your body, it would've an impact on your whole body. So for example, if you had a to infection, you might have infections in other areas that you were not expecting. Well, afterwards, science poo-pooed that idea and really downgraded and said there's no such thing as focal infections infecting the body. Well, as science improved, we found out that they were right all the time, and if you have an infection someplace in your body, wherever it is, it will get into your bloodstream. It will promote inflammation in that area, and the inflammatory mediators, which increase your inflammatory profile will also increase and that will impact tremendously across all aspects of your health.

Let's take gum disease specifically since that was the topic that we started with. If you have gum disease, you have a low grade infection and inflammatory process going on, which can actually be if you spread out all the size of the gums across a wider area, it's about the size of the palm of a large hand. So it's not an insignificant sized infection. And if you have an infection like that with all the inflammatory mediators and the hyper inflammation that's going on in that area, you'll have an impact on pretty much every disease that we are used to describing: cardiac disease, increase in strokes, increase even in Alzheimer's disease, increase in arthritis, increase in diabetes. It's across the span and the reason is you're torquing up the body's negative immune system and you're influencing every disease to make it, whether it won't necessarily initiate a disease, but if you have a cardiac problem, it can make it worse.

If you have a tendency to strokes, it can make you have a greater tendency or more likely to get a stroke. If you have Alzheimer's disease, it'll promote it to move faster. So all those things get impacted and it's not just periodontal disease, it's just that periodontal disease affects 50% of the American public over the age of 35. So it's why this disease is so critical to manage and frankly why medicine and your family practitioner and your caregivers should always be aware to make sure that your oral health is in good shape so that you can make sure that you're managing the rest of your diseases properly.

Healthcare Practitioners and Oral Health [5:39]

Matt Feret:

Two things you've said in there right at the end are shocking. I don't think I've ever been to a primary care physician that's ever asked about my oral health. I mean, if I think maybe if they stick something in my ear and then maybe they ask me to say “ah,” is that what they're looking for when they're asking to open up?

Dr. Bill Levine:

I wish you were right, but you have to think about what the mouth looks like to a physician who's used to looking at you. My God, it's dark in there, so I can't really see a lot, so I'm just going to ignore it. And that's a lot of what happens. In other words, when you open up the mouth and you're used to looking at it, you'll see the inflammation. But unfortunately, most physicians find it easier to not really address that aspect. They're not that familiar with it. They did not get a lot of background in medical school because what happens is dentists and doctors go to school together for the first two years and study the basic medical system and then they divide up. So doctors don't really get a lot of information about dentistry, and actually I'm fine with that, except that they should be aware of the connection from an inflammatory perspective and if someone's going to see or someone has a cardiac problem that's being managed, he should have been given that advice. It's the way of treating that patient properly. Same thing with everything. I think doctors are a little remiss. Not every doctor, obviously there's some very conscientious doctors, but I think that's an area that is going to be increasing in terms of awareness. And interestingly enough, it's being driven by the public media more than the medical literature.

Matt Feret:

Oh, wow. Well what about my dentist? Does my dentist check me out or does he just clean my teeth?

Dr. Bill Levine:

Dentists know about it, but he's busy taking care of your oral health, so he's doing his job, but he's not going to say to your doctor, “Hey, you should be telling Matt what to do.”

Matt Feret:

When I go in for a checkup. Is the dental hygienist or the dentist giving a cursory look at least or taking a peek?

Dr. Bill Levine:

It's a very good question. It's a very good question. In other words, theoretically what you should expect from your both the hygienist and the dental practitioner, you should expect them to look around your mouth and check out the oral tissues to make sure that there's no lesions that are there. You can have in the mouth skin diseases like autoimmune diseases of the skin. You have them in the mouth too, and she should be checking for all that. She should be checking for pathology, potential cancer. There's a lot of oral cancer. She should be checking your tongue and the back of your mouth, the pharynx and all the area around it. And as well, she should be addressing the inflammation around your teeth. And the hygienist is always doing that. Most dentists do as well, but sometimes they get focused in for treatment or two on fillings and crowns or whatever it is that you need. But overall, most dentists are looking at your gums as well and hoping to manage that as well, and that's the right way to do it.

Matt Feret:

If they don't say anything when they're in my mouth, should I ask?

Dr. Bill Levine:

Yes, yes, it can’t hurt. I think most dentists appreciate being asked. So I think it's a good idea and I think just, making sure you're taking care of yourself.

The Oral Health Crisis with Dr. Bill Levine [8:59]

Matt Feret:

Yeah, thank you. The other thing you said was 50% of US adults have some sort of gum disease. Did I get that right?

Dr. Bill Levine:

I'll add one more word, 50%, and this is Center of Disease Control and the numbers are increasing steadily. Nobody's exactly sure why, because there is a greater awareness of oral health. But the statement that I will make now with the added word is 50% of the American public over the age of 35 have significant gum disease. In other words, gum disease gets divided up into two categories. Let me sort of step back, and I hope it's not too tiresome, but basically what happens is your mouth is normally filled with bacteria, but the teeth are actually anchored into your jaw bone, right? That anchorage between the tooth and the jaw bone needs to remain sterile and protected. It's an internal system. It should not be exposed to the external environment. So the body protects itself by having a special ring of protective and very, very immunologically active cells and sealing off the neck of the tooth so that the inner aspect can be fused to the bone, but the outer aspect will function in the mouth and that works well except that if there's too many bacteria there or if there's some other instigating factors, the mouth will respond and appropriately so will respond with an inflammatory response to control that infection.

Now, what happens if that protective system is abused and there are too many bacteria for too long of a period of time, or if you have a genetic predisposition or if you have a concomitant disease like diabetes or some other diseases which might weaken your immune system, then what happens is you stress that system to the point where it becomes like a computer, which you've opened up too many programs and it's frozen. It's still working, but it's sort of making noises and not really doing anything. So that's what's happening in your inflammatory system while instead of protecting you, it's firing on all guns. So it's really going wild. It's not controlling the problem. And what happens is it starts to destroy the local tissue and causes periodontal disease. So periodontal disease technically is when the diffusion of the gum and the bone to the tooth gets destroyed, and what happens is the tooth looks normal, but is actually a gap that develops between the gum and the bone.

We call that a pocket. It looks just like a pocket. There's an outside piece of tissue, but it's not really connected to the rest of the shirt or the tooth in this case. So let's say you have a lot of bleeding and a lot of inflammation and swelling, but it's actually and it's actually functioning, that'll be okay. It'll last for a period of time. The seal will remain intact and undisturbed. That's reversible. You brush your teeth a little bit, you get a dental cleaning, a couple of other treatments we use. Whatever you need to do to control that, that'll work. But once it goes to the next step where it starts to destroy the bone, then you're on a bit of a cycle downward and we need to really do some more thorough steps to control that problem.

Matt Feret:

I want to go back to that 50% of people. I mean, I walk around, not 50% of people aren't bleeding from their gums, thank God, but-

Dr. Bill Levine:

Actually most of them probably are, but it's just not a heavy duty bleeding.

Matt Feret:

Do they know it?

Dr. Bill Levine:

Yes, they'll see it on the toothbrush occasionally. They'll see it when they're eating, especially something hard. Now the tissue is inflamed. It's not dripping blood, but it is when you irritate it or touch something with like a toothbrush, it'll bleed. So you'll see blood on your toothbrush, blood when you spit out after you're brushing your teeth, after you're eating, sometimes you'll see a little bit of blood. You shouldn't be seeing any blood. You should not be bleeding. And if you're seeing any bleeding, you have a problem. By the way, if you find that number interesting, or even let's recategorize as staggering-

Matt Feret:

I do.

Dr. Bill Levine:

It increases with age. That's the lowest number. That's 35 years. Every decade it goes up at least five or six percentage points.

Matt Feret:

Oh my gosh.

Dr. Bill Levine:

I know. It's really, it's a major problem. I wouldn't call it a pandemic because nobody's dying from it, but they are being influenced negatively from a health perspective. And if you think about it, we don't usually think about it because we sort of take our bodies that are working for granted, but the teeth it's first, it's your smile, it's your speech, it's your way of communication. So if you don't have a healthy mouth and your teeth are moving, I literally had a patient in my office that he said, Doc, I think I have a problem. Every time he breathed out, his teeth moved out, every time he breathed in, his teeth moved in. I said, I think you might agree with me. You have a problem. So the point is that the people tend to take things for granted and not necessarily run for treatment. Listen, dentists have a bad reputation of causing pain. We do our best to not cause pain, but it's a sensitive and inflamed area. Sometimes that happens. So the thing is that we do want to control all that bleeding, and again, it's like I said, it's not oozing, but if it gets severe enough, you'll be having swellings and infections and it could be really, really nasty.

Cause and Prevention of Oral Disease [14:35]

Matt Feret:

When you were speaking earlier, you mentioned the word genetics. How much of this is genetics and how much of this is lifestyle or foods or lack of maintenance and care?

Dr. Bill Levine:

So it's a great question, and the answer is nobody really can pin percentage numbers on it. So I would say that if you have a genetic tendency towards it, you have a tendency towards it, you don't have a disease, you can manage that process. If you're blessed with a genetic disposition to not have periodontal disease, you really do have a level of protection. You can have that early stage periodontal disease where you'll have bleeding, but it'll be reversible. But those who have a tendency towards it, and clearly the numbers are high. When you look at the statistics, they can manage it. It doesn't mean they're doomed and by any form or fashion, it means that they need to see a dentist and a professional get a clear way to manage this disease. And it's not just going to the dentist, it's daily home care.

And that's a critical part, and we should really address that issue because what happens is our mouths are naturally infected. That's the way the mouth has to be. If we killed all the bacteria in the and our mouths, our mouths wouldn't function healthfully. Our body from our lips through the anus needs bacteria inside it. In fact, I know this is going to be a shocker as well, but if you take out the weight of the bacteria that exists, the normal human, normal adult male and female from the lips through the anus weighs about two kilos. You have two kilos of bacteria sitting in your digestive tract, so that's normal. We don't want to can't kill all those bacteria. We won't function normally. So we have to live with that environment. So in living with that environment, we need to just make sure that we're keeping that teeth and the junction of the gums and the teeth clean and healthy.

Matt Feret:

You said earlier, and I know I'm hung up on this, but I promise I'll move on after it. The 50% number is still shocking to me. So if it's genetic predisposition but not a death sentence, is it lifestyle, is it the foods we eat is the lack of routine care in the lifestyle piece? What's your take on that?

Dr. Bill Levine:

Actually the American statistics are the lowest. In other words, it's worse in the European countries for a number of reasons. I think first of all, smoking has a very big impact on the health of your gums because smoking will weaken the gum's ability to manage the disease. So in Europe where smoking is more prevalent, the disease is usually worse. Also, Americans are much more aware of their health than most other cultures and they take care of it. So the numbers in America are lower. So I quoted the CDC because it's more relevant to the population that's on the podcast, but the European numbers are significantly worse and not every country measures this.

Matt Feret:

Yeah, that's the thing, right? You get the health statistics from the countries that report, and then some reports obviously fudge numbers. And smoking has been curved or is curving its use over the last several decades in the United States, but I have also noticed where the transfer of the nicotine is moving from smoking into chewing tobacco and even these, I'm going to probably mispronounce it, snus or snoo. Anyway, the stuff that comes over from Europe that's a non-spit chewing tobacco. You've got these other nicotine pieces. I would have to assume smokeless tobacco is horrible for your gums. Tell everybody how horrible it is and whether or not if you're addicted to nicotine, these little nicotine things that you can put in there with no tobacco, are they a better alternative or just as bad?

Dr. Bill Levine:

So it's a good question and the data is not clear, but there's two factors. The heat together with the nicotine is the worst combination for a gum disease. It just increased the penetration and it causes a lot of problems. All tobacco causes problems simply because all tobacco releases nicotine and some of the other carcinogen into your mouth, but chewing tobacco and you called it snus. I forgot the name of it.

Matt Feret:

I think it's spelled SNUS.

Dr. Bill Levine:

Originally from Sweden. Yeah, right. Do you know what it is? Actually, it's a like a teabag with little tiny glass particles and you put it into your gums and you sort of mash it down and it basically causes micro lacerations and that's why you get a big rush of nicotine into your body so quickly. So when you know what it is, you're a lot less tempted to use it, I think. But all of these packages where you place the tobacco in its rough form, and usually people use it in a specific repeating area, will tend to cause an increase in that spot of oral cancer. And it could be really, that could be life-threatening. So even though you may have less periodontal disease, you've increased your risk to a lot of other issues.

Matt Feret:

How do I check my gums at home? How do I know besides, let's say spotting bleeding or I mean, gosh, yeah, if I'm gushing blood, I'm going to get into the dentist, but how do I get in front of this without it getting to any of those points where I've got blood on my toothbrush?

Dr. Bill Levine:

So a look for soreness, sore gums, swollen gums and bleeding are the easiest ones to notice. You may notice a little bit of redness that's disproportionate and others your gum should be a healthy pink color. I can't really describe it. I don't have that sense of the colors, but it's a healthy pink and you should see it if you have a generalized redness around a series of teeth, that's probably gum disease, but sometimes you have a bad dentistry that took place or an inappropriate dentistry where it doesn't fit exactly the way it should, and there what will happen is you'll get a very focal area of redness and maybe bleeding in one spot there. It might be very easily correctable. So think about checking that with your dentist or possibly a new dentist.

Matt Feret:

This might be an elementary question at this stage, but I'm going to ask it anyway. Are there foods I should avoid? I mean, I've been told since I was a child, don't crunch your ice. You mentioned the heat and tobacco and then I've also, these things are popping up, right? If you drink scalding hot coffee, that's bad. Are there certain little easy things that we can do or avoid that are impactful to the gums?

Dr. Bill Levine:

So the gums, it's really just heat for foods. You want to make sure you maintain a normal, balanced, healthy diet so that your body will function normally. If your body's functioning normally, your gums can be healthy. You want to avoid two things that are too hot that may burn your gums. There are certain foods which have been shown actually through the data to improve gum health in a statistically significant way such as green tea. So there are things that are good for the gums. Nobody really has done a thorough research project where they really have looked at all of these types of foods. But one thing that you should be careful of is not having too many strong acids on an ongoing basis, and that's not so much for your gums, it's more for your teeth because things like hot lemon juice with very concentrated lemon may be good for you in terms of increasing vitamin C and other components that your body will use, but it actually, the acidic hit onto your tooth can cause erosion of the tooth and wearing of the tooth, and we've seen cases where we've had a rebuild teeth because they've just worn out or almost dissolved the outer surface and sometimes all the way into the inner surface from, and I found that lemon juice is the worst offender.

Matt Feret:

So anybody listening or watching with kids out there that like to impress adults by biting into raw lemons, tell them to stop.

Dr. Bill Levine:

And also tell them, once in a while, it's actually not bad for you. It's only when you use on an ongoing basis.

Common Hygiene Practices to Prevent Gum Disease [23:37]

Matt Feret:

So I'm going to get into some practical stuff here. Again, these are elementary questions for you, but toothbrushing, do you brush after every meal? Do you use a certain type of toothbrush? Soft, automatic? How does the toothbrush and your daily care factor into gum health?

Dr. Bill Levine:

Okay, so I'm going to divide it up into two, when to brush and how to brush. So when it comes to brush, what you're really accomplishing with a brushing is you're not getting rid of the food, you're getting rid of the bacterial layer that coats the tooth. Yes, you want to get rid of the food. So most people though, when they wake up in the morning and have a little bit of morning breath prefer to brush right after they get up, it's part of their morning routine and then they move forward and eat breakfast and go on with that. So other people say, well, you're eating dirty food. Food is not dirty, it just is. And if your teeth are clean at that point, you're not going to have any short-term issues with it. There are those who like to brush after every meal, but you can over brush.

So I would encourage using a soft brush twice a day if it makes you feel better, you can do a third time a day, but not too much more than that. We also recommend mouth rinsing as well, but I'm going to go back. You asked me about toothbrushes. So most of the time if you're adept enough and you know what you're doing, a regular toothbrush should be sufficient, but some people don't have the agility or the hand control to really brush effectively, and sometimes that impacts the elderly population who some of them or the, let's say the adult population where they have a caregiver brushing for them. For those kinds of patients, if they've lost some of their hand control or they have a caregiver, they should definitely be using an electric toothbrush because the electric toothbrush brushes for you. All you need to do is put it on the surface.

Whereas if you're brushing with a hand brush, you're actually finding the right location, the right angle, and moving the brush at the same time. And that could be a little bit more difficult for somebody who's lost some of their hand control. We also recommend strongly the use of a mouthwash afterwards, and there are two different types of mouth rinses. The reason for that is that when you swish around, you're actually moving a flow of fluid that's cleaning off the teeth and enveloping the bacteria that are there and killing them and protecting your gums if you're using the right mouth rinse. And so that actually is a good add-on an important add-on to your normal brushing. So brush with a fluoride containing toothpaste brush properly, so you make sure you get every area and follow that with a mouth rinse afterwards, even though it reduces the fluoride, the fluoride is really disperse throughout the mouth very rapidly because it promotes saliva production, so you're getting a lot of dilution right away. So it's the initial contact for a few seconds that the fluoride is sitting there. You can't really keep it there effectively for much longer than that, even if you try because the saliva is increasing. But then with the mouth rinse afterwards, what it does is there are two different types of mouth rinses, three actually. One is a fluoride, it protects the teeth. That's all it does, and that's important depending on what your problem is. If you suffer from a lot of cavities, you should be using a fluoride toothpaste.

Matt Feret:

Can I stop you there? Even in adulthood, I can remember as a kid, definitely you go to the dentist, they stick the goop and on you get wait five minutes and then they go away. But I don't know if I'm getting fluoride treatments as an adult.

Dr. Bill Levine:

So fluoride works by children. You can actually take a fluoride pill and it'll strengthen the teeth because it goes through the bloodstream and goes into the teeth as they're forming inside the bone. So when they erupt in, they're strengthened with that fluoride already. But when you use topical fluoride like you're describing that goop, that helps throughout life because the fluoride contact to the root surface and to the enamel, it is sitting there in a concentrated bath for about three to four minutes, makes that outside surface of the tooth stronger and more resistant to any acid, the mineralization that the bacteria may produce. It's remarkably effective and in our practice we use that depending, we custom design the program, but a minimum of twice a year, a minimum, and it's the least expensive, most effective way of preventing caries today.

Matt Feret:

So in my mouthwash, I should be looking for one with just fluoride or fluoride included.

Dr. Bill Levine (28:21):

So, there's floride mouth rinse and there’s antibacterial mouth rinse, which is probably the bulk of the market, which are mostly for fresh breath. But if you're brushing well, you're killing most of the bacteria or removing most of the bacteria to start with. But one of the projects we were involved with is developing a mouth rinse called PeriActive. PeriActive was designed really for your gums. So people with periodontal disease, bleeding gums, people with implants should be using PeriActive because when it works differently than the other rinses, it doesn't just swish around your mouth and kill the bacteria. It does that because that's an important facet. What it does is it actually, it's based on botanical materials and we've maximized their therapeutic benefit through a scientific process and it actually penetrates into the gums directly to strengthen them and to reduce inflammation or manage that inflammatory process so that you're not having ongoing gum disease. So people who have a tendency to gum disease or have been treated for gum disease, they should be on fluoride toothpaste and PeriActive rinse. People with a high carry rate should use a fluoride mouth rinse. The ones that kill bacteria are only if you're not brushing effectively or if you have a fresh breath issue.

Matt Feret:

Yeah, when I'm at the store and I'm looking for mouthwash, some things will blare out, no alcohol. Does that matter?

Dr. Bill Levine:

Yes, unfortunately, yes. There were some mouth rinses, I don't want to cite any names, but probably the most popular mouth rinses was originally designed when you used to go to the barber or the hair designer, and they had those bottles with the brush and the combs inside it on the countertop right below the mirror, and it was a colored fluid in there, that was basically the originator of a mouth rinse. And someone said, well, if it kills the bacteria on your brush and your comb, well then it might do the same in the mouth. And it did, but it was a high concentration of alcohol and it actually, it dries the tissue out. There are some reports that it causes an increase in cancer. There are some doctors who believe that's true, some doctors who don't, they're not large studies, but there are indicators that it will be harmful for you, but it's for sure drying out your tissue and making it more susceptible to periodontal disease. Killing bacteria but drying out your tissue. So if you can find an effective alcohol free mouth once you're better off.

Benefits of PeriActive Mouth Rinse with Dr. Bill Levine [30:56]

Matt Feret:

Thank you. And then go back and talk about your product a bit more. It's specifically aimed at gum health.

Dr. Bill Levine:

Yeah, so I mean, I'm a practicing periodontist and I like to think I take good care of my patients and I'm looking in the mirror and I'm saying, listen, there's a lot of refractory disease. Refractory disease means you've treated somebody well, but boom, the disease started up in a spot over here and a spot over there. They had some downturn in their overall health and it weakened their immune system, and all of a sudden they're spinning out of control. How can we help prevent those episodes? It's not a small number, it's between 17 to 24% depending on the study, refractory periodontal disease on an ongoing basis. You have this disease for life once you have it. So that can affect a lot of people's lives on an ongoing basis. So what we did is we started to set up a project where we said, okay, let's use natural products that are known to be safe, but let's make sure that they're designed appropriately so that they're as effective as drugs.

So what we did is we took the natural products, we tested them for years. This is 10, 12 years of research, and we looked at how they would impact on the inflammatory process and how that would impact on the healing process, and we found which elements exactly in which natural products are effective. Then what we did is we designed a special breeding program where we grow the material. We don't actually grow, but we know what we look for. We look for specific markers inside and we harvest at the right time, and we designed that extraction process from the natural product to your bottle in a sense, you don't stick the apple in there, you basically have to pull the materials out and you basically, we optimize that material. So we created a formulation which will enable it to hit your gums, penetrate in, and really act on those processes. It'll stimulate your gums to heal and get stronger, so you have an increase in collagen, better design of the blood vessel system and thicker blood vessels there. And then you also have the reduction of the inflammatory process, which is a very complicated synergy of a lot of different biological processes going simultaneously, and you can't just stick it in one spot. You really need to design something that's going to multi target that and down-regulate that entire cascade of activities so that you can get a profound effect. So that's what PeriActive does.

I mean, it's many, many years of research and the product actually works.

Matt Feret:

That's phenomenal. I don't think I've ever heard of anything that specifically targeted the gums. It wasn’t out there, so you decided to make it?

Dr. Bill Levine:

Yes, and you know what? I don't even know what to call it, the naivete of the youth. Well, we need this. Why shouldn't I just do it? I'm a little tired just thinking about it.

Matt Feret:

And is it sold worldwide?

Dr. Bill Levine:

Well, we initially sold in Israel where I developed it and now it's being sold in the United States and we're getting enormous positive feedback and rapid growth, and originally we didn't sell it to the public, we just sold it to dentists and basically our orders kept increasing to the point where the dentist kept ordering first, they would order a box to try it, then they would order 2, 3, 4, and it kept continuing and during Corona, when the dental offices were closed, the patients were calling the office and say, well, how can I get this? Then we started selling it online, direct to the patient, so now we're going to revamp our entire sales system and sell to the dentist as well. We treasure those relationships and the dentist should be providing this to his patients, but more importantly, we want to sell this direct to the consumer because people need it, and whereas we want you to see your dentist for care and we want you to have someone who's helping you take care of your mouth. Most of the work that you need to do has to be done at home on a daily basis. You need something to help you with your gums.

Matt Feret:

Yeah, we're going to stop this podcast at some point. I'm going to go back and go 50%, my word. That's not something that you hear about every day.

Dr. Bill Levine:

I think it might rate number two after the common cold.

Oral Health and Aging [35:18]

Matt Feret:

Oh my word. Well, at least we've got some solutions, hopefully, and a lot of good advice, the difference between oral health, periodontal disease, and inflammation. I have to assume every other organ in your body goes through life cycles and recovery takes longer, and these things are at times age-based. I guess disease can start at any time, but are there differences in care or differences in frequency of visits to professionals that one needs to consider as they move into middle and older ages?

Dr. Bill Levine:

First of all, it's a fantastic question. The response I'm going to give is a little bit complicated because when you're a caregiver, you have to make sure you're taking care of your patients. Now, an elderly or a patient may have some complications also in just getting to your office, and yet at the same time, if you do get that patient to your office, they may not have the strength and the ability to sit for very long appointments and they have medical complications, which also impact. So what we have to do is try to take these patients, design a program for them where the bulk of the work can be done at home in a nonthreatening manner, which in a sense blends with the capacity that they have. The caregiver has to be brought in, but even regular adult patients have a higher tendency to periodontal disease, and I would say they need to get onto peri as part of their program because that's what we designed it for. It is an easy to use twice a day rinse. It doesn't impact in any way your life function pretty much every age can rinse and it's safe and healthy, so if worse comes to worse and you swallow a little bit, also not a big deal.

Matt Feret:

So we're still looking at six months every six months for cleanings.

Dr. Bill Levine:

Those days are over, Matt, those days are over. Yeah, six months for cleanings is for cavities. You and I grew up with that. I know, I know. And it's very funny. I sometimes go back to the early days of flu and they say, look, mom, one cavity right now, this kid is coming to the dentist twice a year. That's two cavities a year. That kid on that commercial was six years old, seven years old. That's a lot of cavities. I don't think we were doing so well in preventing in those days. But the thing is that when it comes to periodontal disease, you should be seeing the dentist three to four times a year.

Matt Feret:

Wow.

Dr. Bill Levine:

The dentist or the hygienist, don't forget. Hygienists is an integral part of this healthcare program, so you may not need to see the dentist that often, but you need to have a professional intervention into the cleaning as well as cleaning,

Matt Feret:

And that's so challenging, at least here in the United States, if you have dental insurance, you've got a schedule of benefits that will say, we'll give you two cleanings, which backs into that whole six month thing, and then once a year you can have a more comprehensive oral exam. It doesn't seem like the insurance benefits we're all using is caught up the times.

Dr. Bill Levine:

Well, I think it's even a little bit worse. There is not a real alignment here in the world of your insurance and their focus and your health and that focus, and I do believe that in time those two programs will meld how it'll happen. I don't know, because there are a number of countries over the years who have had fantastic public healthcare programs that worked except they went bankrupt. So we have to figure out a way to manage that greater minds than I are thinking about it. It's really a challenge. And how much do you see the, or dentist or medical doctor and how much, what tests to run? You nailed it when you asked the question because the insurance is definitely not aligned with your health. They have to run it as a business, and they're not wrong. They're not a government healthcare organization. They're a business and you pay them for a service, then they try to give you that service, but they're not going to over service you.

Matt Feret:

So in that case then, if you've got dental insurance and you've got periodontal disease or the beginnings of it, it sounds like you're saying don't let the schedule of benefits in your insurance get in the way of you taking care of your oral health, even though you may have to come out of pocket for it if you're going three or four times a year.

Dr. Bill Levine:

I didn't say it as clearly as you did, but that's exactly what I meant. So thank you.

Matt Feret:

Well, thank you. It just occurred to me that's a definite, that's a break, right? Recommended practice versus the finances that most people who have any sort of dental insurance have to go through.

Dr. Bill Levine:

Yeah.

Matt Feret:

Yeah. Wow, this has been great. I want to ask more questions that, again, I used the word elementary two times. I'm going to do it again. This is purely from a personal approach, regular toothbrushes or the mechanized type.

Dr. Bill Levine:

So again, I think the mechanized type or first of all, there are different types of mechanized type. So the older ones where they oscillate back and forth horizontally no good. The ones that oscillate in a circular fashion, they're good, and what they do is they basically put it on the tooth, it oscillates around and does your brushing for you. They work. You can over brush with anything. Any tool can be overused, but if you're agile, use a regular toothbrush because why spend the money and you don't need to replace it except for when it wears that it's not a big cost item. Whereas if you have some compromise or for some reason or another you're not doing it effectively, your dentist or hygienist may mention it. Then switch over to the oscillating toothbrush, the electric toothbrush.

Teeth Whitening and Oral Health [41:25]

Matt Feret :

Thank you. One more selfish question, which I bet a lot of people listening are going to wonder too. Teeth whitening, you've strips, and then there's some teeth whitening toothpaste out there that seems pretty granular and when I use it, I'm like, I dunno if this is so good for me. It feels a little bit like sand. And then the third piece is mouthwash. I've tried teeth whitening mouthwash before and it hurts my gums. It's painful, so I don't do that. What's your take on anything in and around teeth whitening?

Dr. Bill Levine:

So years ago we thought teeth whitening might be damaging to the teeth in the gums. It's not if it's done carefully, but you're right, the materials that they use to whiten can cause increased sensitivity. So I think people really are entitled to whiter teeth, but the mouth rinses don't work that well. The strips are a bit better. The professional whitening is very expensive. There's actually navigating a new system which is in the middle of, it's just now getting launched and getting ready, but it does work using LED lighting that you can actually whiten your teeth professionally at home. I think that's going to be a big add-on actually to people's overall aesthetic. Look, it's not a health issue. It's really an aesthetic issue. So the strips actually, some people report good effects with it all depends on how well you place them, what type of whitening, but what you're using, the granular material is actually stripping off stain from the teeth.

So let's say you have a stain that tends to build up on your teeth, then the granular toothpaste once a week might be a good idea. More than that, you're going to cause some erosion. Okay. You can also do that, by the way, and I mean take a little bit of baking soda and a little bit of water and just brush the front six or eight teeth with it. It'll take off some of that stain. Don't do it every day. It can wear the teeth out too. Anything that's granular, it's sort of like sandpaper in a milder form, right?

Matt Feret:

Yeah, that's kind of what I was saying.

Dr. Bill Levine:

Your inclination was correct.

Matt Feret:

Yeah. When I buy whitening toothpaste and spend the extra couple of bucks to go, oh, maybe it'll whiten, get a couple of coffee stains off. Yeah, very much so. Go. This says sand in it. I'm not sure this is good every day.

Dr. Bill Levine:

Well, you were right. So natural intuition is often correct.

Matt Feret:

So if I buy teeth whitening toothpaste, it'll work, but you're telling me not to use it every day, right?

Dr. Bill Levine:

No, no. It depends on the whitener. Some of them are granular, some of them are not. Some of them are simply peroxide uses that stuff that people use to make their hair lighter and blonde. It's not so different. It's just different types of peroxide. They're all peroxide. But don't use your Tilly hair stuff on your teeth. I didn't say that.

Matt Feret:

Or the stuff in the barber's bucket, the blue stuff. Don't do that either.

Dr. Bill Levine:

Yeah, that really is a turnoff, I must say.

Conclusion and Outro by Matt Feret [44:26]

Matt Feret:

This has been fascinating. I've learned a lot and thank you for answering all of my questions. No matter how small or selfish they were, I hope it helps people and you certainly helped me. So at the very least, I learned a lot. Thank you. What questions about gum disease and the mouthwash and everything that we've talked about? Did I not ask that I should have?

Dr. Bill Levine:

Well, we covered a lot of ground, we covered a wide range of topics ranging from prevention and care over different age groups and differences between toothbrushes, et cetera. But I think one of the most important parts of your oral care is using PeriActive twice a day. And what you didn't ask is how do patients get ahold of this?

Matt Feret:

You're right. I neglected to ask that question. So where can people find this? How do we get this?

Dr. Bill Levine:

Right now it's available on a website called https://www.getperiactive.com/ but I think more importantly, I was involved in developing this mouth rinse, and I'm a big believer in it. I have almost all my patients on it. Don't forget, I treat periodontal disease, gum disease and implants. And so the company actually, after seeing the results and looking at this in the responses from a lot of different dentists who carry this in their offices, is prepared to offer a guarantee. Basically, bleeding gums stopped in 60 days or your money back. So they're pretty confident about the effects here and so am I.

Matt Feret:

Wow, that's awesome. Thank you so much for being a guest and for bringing all of these topics to light. Shocking statistics, some of them. And also, I'm going to go back into my bathroom and poke around my gums a little bit too now, and I hope everybody listening or watching does the same thing. It sounds it's way more important and impactful than I even realized, and I think that's probably true for a lot of folks.

Dr. Bill Levine:

I did what I hoped that would accomplish. I made this people more aware of what they should be doing.

Matt Feret:

Yeah, you sure did. Thank you so much for your time.

Dr. Bill Levine:

Pleasure. Thanks, Matt.

Matt Feret:

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