MARTIN: Greetings, everyone. This is Martin Pytela for Life Enthusiast podcast. You will find me at Life-enthusiast.com. And with me today, doctor Brett Gilbert, an endodontist. And welcome, Brett.

DR BRETT GILBERT: Thank you so much. Great to be here with you, Martin.

MARTIN: Right. Actually, it would be good to explain just how endo is built on top of regular dentistry and how it all fits. Because I suspect many people don't know.

DR BRETT GILBERT: Sure. Okay, so, I wanted to thank you for the opportunity to be here with you. We've connected before for a podcast on my show "On the cusp." And certainly endodontics, root canal treatment, is a specialty of dentistry. And dentistry has become more and more specialized over the years. I know that amongst many communities and schools of thought, there have always been concerns about the safety of root canal treatment. And so I'm very grateful for the opportunity to speak from a place of expertise, from a place of experience and a topic that I have spent my life studying and practicing. And so dentistry has a lot of facets to it. There are general practitioners that do all the procedures, And then there are the specialists that really focus on just one. And so my training through the University of Maryland is as a specialist, I'm also a board certified specialist from the American Board of Endodonics. I do a lot of teaching around the world. I help to educate other dentists and students on the art and the craft of root canal treatment, which really starts and ends with diagnosis and ultimately the execution of the treatment with some really amazing technologies that have helped us to advance the effectiveness of the treatment. And certainly the outcomes are really important to publicize, because a lot of the thought processes and a lot of the theories in regards to the safety or lack of root canal treatment is based on information from the early 1900s. And since we have advanced so much over time, I think it's important to talk a little bit more about what we actually are able to accomplish with root canal treatment in today's day and age in a way to help a lot of people understand that it is a good option to save a natural tooth. But obviously we want everyone to understand that that's what the premise is that the treatment that's rendered is very good and allows the tooth to truly heal. So I hope that gives just some background on where we're starting from today.

MARTIN: Yeah. Well, in my circles, things are not nearly as rosy because I have had people tell me that they have an immune system challenge, let's call it that. And some of them have cancers, some of them chronic inflammatory diseases or whatever, and they will in the end ascribed it to an infection that was settled somewhere in the jaw and would not let go. And once they actually removed the tooth and cleaned up the area, the immune system improved dramatically. So what to say about that, right? Could we say, well, that was not a well done procedure. Or is it that the procedure itself is putting a challenge to the body. The way the explanation was put was, well, the tooth has many, many microtubules, which are essentially openings that allow for microbes to dwell in and leaving a dead tooth or dead tissue in the jaw is an invitation for trouble.

DR BRETT GILBERT: And let's start there, because I think there are a lot of situations where when this information comes across, it's come across and brought across in a very emotionally based, fear-provoking way. And one of those is example is the movie Root Cause, which came out of Australia, and it was so sensationalized and it was really quite upsetting to those who truly have the education and knowledge about what actually is happening, both biologically, physiologically, and then ultimately starting off with the fact that not every root canal treated tooth is the same. There are instances where even a root canal that is done well over time, the tooth has a lot of insults to it. The mouth is a very hostile environment to the tooth in the gums. Our diets, the way that we take care of our teeth with oral hygiene, there are a lot of challenges to the actual integrity of the tooth and its supporting tissues. So the first thing that's important is that we have to separate the idea that there is no dentist that's out there that's saying: "Hey, you had a root canal in your tooth, it wasn't done very well. It's likely infected. But you should keep that tooth or you shouldn't do anything about it." And I think that that's the part where the misconception is because any dentist, myself included, I can save teeth doing root canals. But there are some that are simply not savable, not salvageable. Cracks. Fractures. Decay. Periodontal bone loss.

So yes, you absolutely could be walking around with an infection in your jaw that needs to be removed. So that's one facet or bucket, Martin, that I think is something that we can absolutely agree on. Where we start to disagree a little bit is where you have a tooth that has presently an infection, and through the course of root canal treatment or endodontic therapy, which the best way I can describe it for anyone who's wondering is, if you think of the root of the tooth like a Twinkie cake. Right. So you have the cake on the outside and the cream filling in the middle. The root canal procedure allows us to go down inside the tooth and essentially remove the cream filling. And it used to just be on a very basic level, essentially trying to flow some solution down there to fight off bacteria, to kill microbes, to dissolve biofilm, to dissolve live vital tissue of an irritated nerve. But nowadays it's a completely different animal in terms of the solutions that we use, the power of them being able to penetrate into those dental tubules that you mentioned, Martin, the ability to drive solutions using laser technology, using sound energy to really disrupt all of the debris that sits in the walls.

And then ultimately once it's clean, be able to use more bio ceramic, biocompatible, hydrophilic type sealing materials that the body really accommodates and accepts very well. The other thing about it is,

MARTIN: Yeah. Let me jump in here with this, about 20 years ago my daughter had a terrible accident and broke several teeth right in the front here. And interestingly, one of the teeth was done root canal with Gutta-percha. Or is it pronounced that way?

DR BRETT GILBERT: Yes.

MARTIN: And the other one was done with something called endocal, which was or still is a material that seems to be able to change the pH with the changing seasons or days with the tooth. And sometimes it's more pliable, sometimes it's harder, and it just is more natural than that. Is that what you're referring to? When you're talking about biocompatible materials.

DR BRETT GILBERT: No. So, the way that we seal it is, the gutta percha that you're speaking of is sort of an inert vehicle that allows us to deliver the sealing agent against the walls. So the sealer is what I'm speaking of. And we use a bio-ceramic type material nowadays, it's a calcium silicate based material that hardens very quickly. It actually forms a layer of hydroxyapatite on its surface upon hardening. As we know, hydroxyapatite is a material that the body produces and also recognizes as self. And so we're seeing a lot better healing and a lot better sealing ability. It also is dimensionally very stable. As you mentioned, there have been materials in the past that either would shrink upon setting or not be able to maintain stability. So we are in an age of biomaterials that have helped in that regard a lot.

MARTIN: Yeah, I like the word hydroxyapatite because indeed that's what the tooth itself is made of or built from. Right?

DR BRETT GILBERT: Yeah. And as is bone. And so, I think what's important again is to recognize that we have microscopes that we use nowadays to be able to see the anatomy. So look, if a tooth has four canals, Martin, and you do a great job on three of them, the tooth is going to retain infected material. Okay. So it is important to discern. I can't say that every root canal done in the world is equal. There probably are more apples than oranges. But as a dental specialist, as a root canal specialist utilizing 3-D imaging, utilizing microscopes, utilizing much more advanced and stable irrigation solutions that have surfactants in them, the surfactants allow the solutions to spread into the anatomy better. We have rotary instruments that allow us to clean in certain anatomies. The anatomies of an individual tooth vary tremendously. Some can be straight, some can be curved, long, short, tight, big.

And so we have the armamentarium to facilitate truly cleaning with mechanical works and then chemo cleansing or chemo activation of solutions. To really, again, biofilm is our big enemy, being able to dissolve tissue, being able to truly clean that space and then again, sealing it well. The other part of it is restoring the tooth well, so it's stable. But what we're seeing and what you're speaking of and a lot of your audience is familiar with is called the focal infection theory, meaning that there is a nidus of infection in the tooth that starts to impact the jaw, and then through the electrical or energy systems, the meridians of the body. They're claiming and I say claiming because there is no evidence to really support this.

MARTIN: I will take you to the anecdotal evidence people, if you want to meet them, I'll bring them to you. To the person, this anecdotal evidence is N of 100% because it's them and they suffer and they have it handled and they get better. So let's not go to the “there’s no evidence”, because I can promise you that there is for the individual.

DR BRETT GILBERT: Well, again, I think what would be important and fair is to look at the overall situation. If that was a hopeless tooth that either was unable to be treated again in an appropriate way or was not able to be treated at all. I think it's important to know that. Because the millions of teeth that are treated with root canals yearly. And so I use my Instagram as a platform to show what I call the Focal Healing Theory, which is to say you see a massive abscess at the end of a root, we treat it. We follow it and you see healthy bone completely fill that space.

MARTIN: Right on.

Then we have to also look at the fact that, yes, maybe an infected tooth can cause disease. And there's a de-evolution of the body. But what about when we resolve the disease? And now there's an evolution back to health. And I think it's important to note both.

MARTIN: Yeah. So let me ask you this. So people who have an existing root canal, which they could theoretically question. Is the modern technology able to overhaul it, give it a better chance?

DR BRETT GILBERT: Absolutely. We call Endodonic re-treatment. And it's a big part of my clinical practice. So again, with 3D imaging, we're able to essentially just visually dissect that tooth. Is there anatomy that wasn't treated? Is there an area under the restoration like a crown or filling that's leaking and decay is allowing bacteria to get in there, is there a periodontal condition? So yes, there are many cases in my practice which probably, I would say Martin, 35 to 40% of the cases I treat are teeth that have already had root canals that we are redoing. And there is also something that we do that is surgical, called apical microsurgery. So we recognize and just for those listening and again, I recognize everyone has different beliefs. And our belief system is based on the evidence that we've been exposed to that resonates with us.

But anatomically, something that we can all agree to is that the last three millimeters of a root of a tooth has an incredible variation and incredible, almost like a myriad of anatomies. So we like to think of the canal that runs through the route as a straight line. But as you get to the last three millimeters of that route, it's almost like arborization, like a tree. There's all these little micro channels, little portals of exit. And on occasion, when we simply can't get that clean with root canal treatment, we can actually go in surgically and take the last three millimeters of the tooth off. So after three millimeters, that incredible sort of blossoming of anatomy stops. And now you typically have one main channel. So aside from regular root canal, aside from redoing a root canal, we also have an option surgically to clean up that problematic part of the tooth. But again, so that the patient can retain their natural tooth in health and comfort. And that's what we do. And so I just want to be clear that I don't advocate that every tooth is savable. But I also don't advocate that every tooth that either has had or needs a root canal should be extracted.

MARTIN: As we should. Yeah, we should definitely go down to the granularity of the person. As I was saying, the N of one, the person who either has a problem or not. How did we get to the problem? And I hear you saying the right things, as far as I can tell, is that you need to identify A) is this situation solvable and savable or B) are we past the point of no return? This has to come out.

DR BRETT GILBERT: Yeah. And Martin, we've we internally as specialists and colleagues have discussed that in order to really show, let's say that we're in a situation over 120 years of this argument. It would be so helpful if as a dental and medical community, we could collaborate to get more data on a patient who, as you mentioned, an N of one who has a problem with the tooth. They've developed some type of cancer or other inflammatory disease, as you've mentioned. Getting more history of like, what's that patient? What other conditions need to be considered? What's their mental state? What is their stress level? What in comparison is someone that's their age living in the same area? What's their incidence of cancer or what's their incidence of inflammatory bowel? Because there are 25 to 30 million root canals documented just in the US per year. There are a lot of teeth on either side of the mouth that are done. And just because someone develops a cancer or something, it's very hard to make that direct connection scientifically. It would be great if we could.

MARTIN: Well, I tell you, I have my own personal experience, which was not with root canal. My experience was with mercury amalgam filling, right? I had, I went into the dentist and he said, well, according to these X-rays and he showed me, he said: "You know, these are weak. You're gonna need 12." And then he said: "Well, you can have the white ones or the silver ones." And I asked, is there a difference? And he said: "Well, the white ones will cost you extra. But no, not really."

DR BRETT GILBERT: Hmm.

MARTIN: Well, there's a difference in me. I'm a very poor methylator, and I did not do well with the methylmercury that started arriving. And I have a long litany of things that went wrong with me post Mercury acquisition, call it that. Right. So I know that me, my own self had a… how do I best put it? Many people do just fine or do okay. I sure as anything did not.

DR BRETT GILBERT: Interesting. Yeah. The amalgam alloy type fillings, the advantage of them over the years is that there is a bit of corrosion that occurs between the tooth and the metal, which actually seals very well the gaps that can allow further decay. Well, the composite or white, the white fillings that are bonded have gotten much better over time. But yeah, listen, if Mercury is a concern then we don't have the need anymore to place mercury alloy. I'm not going to go out on a limb and say that I believe they're bad in comparison, because I don't know that we have, again, enough direct evidence, but there is definitely mercury involved in how it's cured. And therefore it's hard to deny that there could be a mercury release over some period of time. So I personally don't have any metal fillings anymore either. So.

MARTIN: That debate is clear to me. Once you see the clear gassing off of the mercury vapor that's been demonstrated and well, anyway, my own personal case was very clear to me.

DR BRETT GILBERT: Yeah. I'm glad you're doing better now, that's all that counts.

MARTIN: Yeah, I'm fine. And it was, if it weren't for that, I would probably not be talking to you today about health, because I'd be still merrily involved in computer science and whatever else.

DR BRETT GILBERT: Well, it's a blessing that you're here because I appreciate all the fine work you're doing and spreading awareness. And I've learned a lot from your podcast and learned a lot from our interview together as well. I've been thinking about it quite a bit since we did that. And that'll be coming out in a couple of weeks here Martin, too. Awesome.

MARTIN: All right. So let's let's dive in. I really think it's the rework. It's the repair. It's the re-endo that is of interest to people. Because if you're done with, I don't know, 30, 40 year old technique or by a person who was educated 57 years ago. Right?

DR BRETT GILBERT: Yeah.

MARTIN: It's a whole different thing compared to what we know today and the techniques we have and technologies we have and the details you're explaining. So.

DR BRETT GILBERT: Yeah, and I think listen, anytime you have bacteria that are harbored inside the tooth, it's also important to understand the anatomy. And the argument that really gets under my skin a little bit is the idea that it's a dead tooth. And the reason that I say that is because the nerve tissue inside the roots, its actual function, is to form the tooth. The tooth forms from the inside out. Meaning, if you look at a young person, say a five year old, the front tooth is going, the root end is going to be straight up and down like this. It'll take time for that root to continue to grow and close. And that process is actually the responsibility of the tissue inside the root. So my point is, is once a tooth is fully formed, that internal tissue doesn't really any longer have a direct function. It can continue to elaborate to structure. Sometimes the canals get quite thin over time as that tissue continues to work, but that tissue can be removed at that point without really a functional change to the tooth. But what's discounted is the fact that on the outside surface of the tooth, there is absolutely live living tissue that is cellular based, which is called cementum. And the cementum is a sticky type of material that allows a ligament fiber to attach into the cemental part of the tooth and then into the bone. So as your tooth sits in the socket, it's got a shock absorber of these millions of little ligament fibers. And so what's important to recognize is if those tissues are asymptomatic, healthy on imaging, functioning well. It's really difficult for me to accept that this is a dead tooth.

MARTIN: Yeah. So you're saying nerve or no nerve, the cementum carries on, yeah?

DR BRETT GILBERT: Yeah it does. And it's fed by our blood supply. The ligament is as well. And the best way to describe the ligament, think about if you ever get a popcorn kernel caught in between your teeth, and you just have that gnawing feeling of your tooth being out of position. Those are what we call the periodontal ligament fibers. That is a live structure that's attached right into the outer surface of the tooth. And so if that structure can heal, then it's impossible to say that you're not able to save a tooth, a natural tooth through root canal treatment.

However, the quality of treatment, the quality of the materials that are used, all of this counts. And so I think it's important for the audience to understand that I can't sit here and convince you that every single root canal that's done is going to be perfect and will solve the disease. But I also need you to know that there are root canals that will. And so to make a broad statement to patients out in the world that, hey, root canals are dangerous, they cause sickness. You need to have your tooth extracted. They claim an ozone preparation is critical and then they use what's called a zirconium implant versus some of the more acceptable implants that are used, which are titanium. So I think it's important to realize that there is probably no absolution, but we have to carve out some space in each other's argument so that I can accept that a tooth that's not well treated and is diseased is problematic for our body and our system. However, a tooth that is well treated and is healing is not. And that's really important for patients to know.

MARTIN: Yeah. Well, listen, I hear from the people who are at the margins, the worst of them. So for example, I have a vivid memory of a woman calling me saying that her titanium implant is getting rejected. The bone around it is coming apart somehow. I don't remember the exact words, but the visual I have of it is that the titanium rod is not holding and it's coming out.

DR BRETT GILBERT: Yeah, that does happen. There are a percentage of cases where it is rejected and it doesn't integrate. So we want full integration with the bone. There's a wonderful track record of implants but nothing's 100. And therefore there are patients that have that. But I believe that's likely true of a zirconium implant as well. So not that I have an objection, I just don't see as much literature and I don't see as many clinicians placing them. And listen, I have space in my heart and my mind to accept a lot of these concerns. But what I don't like is some of the figures that have been behind this movement of the Focal Infection Theory. If you watch the root cause movie, these are very marginal dentists and clinicians that have been in a lot of legal trouble that are making these very broad claims without really holding any evidence of whether it's a meta analysis, whether it's even just case studies. There's really no evidence. There's just speculation and fear.

And all I can ask of anyone who questions the safety of root canal treatment. I don't expect that I can turn your mind around instantly, but please hold space for the idea that we have volumes and volumes of evidence that show the effectiveness of healing, of teeth that have been treated with root canal therapy and retained in a healthy way in their mouth for decades. And ultimately, the beauty of advanced imaging, talking about what we call cone beam CT. So cone beam computed tomography is we can actually track the healing where you can literally see the healthy bone that PDL that I was mentioning, that ligament space, all of that actually reformed back to its original form and function. So you have to recognize that that means that the ability of root canal treatment to solve problems, it's there.

MARTIN: Right. Well, I hear you say. Right. If you can see it, evidence is evidence. Arguments are solved by presenting evidence and saying, well, the truth is this. Right.

DR BRETT GILBERT: True. True.

MARTIN: So be that. And I'm encouraged to hear that you're able to rework somebody's mouth. Probably not in a very inexpensive way. But.

DR BRETT GILBERT: There's definitely, what I'm describing is, certainly. And I'm, the tip of the arrow. I'm a specialist that's involved with all technological developments. I practice at an extremely high level. So I'm speaking from that place. And I'm not denying that there's variance in probably the quality of treatment. But we do have evidence over decades showing that the body is really quite responsive and really quite adaptive. Even if we did speculate that there was material left behind in the tooth, we still see healing. So I think it's important to recognize that this procedure is really effective. And we have the evidence to support that, not that every tooth can be saved. And so if someone did have an experience, as you said in N of one, they had an infected tooth. They came out and they felt better. I'm so grateful that they had that tooth removed. But at the same time, a lot of patients are feeling an incredible amount of fear about even approaching root canal treatment, and instead they're having their natural tooth gone. And the truth is, Martin, if a tooth is gone and not replaced and not accounted for, it starts to impact the other teeth. And then the bite and the ability to eat.

DR BRETT GILBERT: It's got repercussions.

MARTIN: So tell me this. Right. I'm in the middle of the country somewhere. How do I evaluate whether the endodontist that I can reach with reason within an hour's drive? How do I evaluate whether they do or don't know what they should know to meet your standard.

DR BRETT GILBERT: Yeah. So I would say that an Endodontics specialist would meet that standard. The training programs are very beautifully done, Endodontists tend to be very passionate. This is a very specific area of dentistry, working down inside the teeth. And those that select to go into it typically have a passion for it, as I do. A general dentist though, a general practitioner, that's where maybe you do want to inquire a little bit more. How many cases do you typically treat? How comfortable are you treating it? Is my case a little more challenging? Might it be better for me to visit a specialist? So I think it's important to know that the availability of a specialist is really just asking questions of your dentist. And some dentists might say, you know what? I treat cases every week. I do C.E. and continue to study. Or maybe the doctor doesn't feel really comfortable. I think we're seeing more and more that a lot of general dentists either don't do root canal treatment at all, because the specialty has become so advanced, or are really dedicated to treating teeth that are within their comfort zone of treatment. We call that case selection, and therefore the referral pattern is much more common now than it was 30 years ago, where the field was a little more even, Martin with the specialist and the general dentist. And now that playing field is much more uneven.

MARTIN: Right. Well it makes sense. We do specialize. Yes. Well, good. Good to hear. YSo, those of you out there with a crown on top of a root canal, wondering, is it safe? Is it not safe? Well, have it evaluated. By the way, this surgical procedure that you mentioned, this is what, cut through the gum, drill through the bone and go in there?

DR BRETT GILBERT: Yeah, yeah. So we're able to reflect the gum tissue and then approach the root end directly. And so we're able to use cone beam 3D imaging. So we have measurements, we know exactly where we're going. We use microscopes so when I'm looking down inside the little opening I can see everything. We use special ultrasonic tips to create. What we do is we create a little filling, a little preparation in the end of the root, and then again use a bio ceramic type material. I just had a beautiful case come back yesterday, a patient that had a very large abscess over two teeth in the front, and she had root canal treatment.

MARTIN: The face was like this and antibiotics.

DR BRETT GILBERT: Oh yeah, she had been back and forth many times with that. And we went ahead and did the surgical procedure I'm describing, removed the abscess, cleaned everything, did a little bit of bone grafting. The patient came back for a nine month follow up yesterday and the bone was beautiful. It was healed. She has no symptoms. The tissue is normal. And this was an opportunity to actually save this woman's two front teeth. So this is a powerful treatment that allows a patient to get back to health with their natural teeth. All I hope from this podcast episode, Martin, is to implore on the audience that this is possible. Is it always possible? No, but it is possible. And because people are walking around with usually 30 plus teeth in their mouth for the course of their life. It's important to know that in today's day and age it is absolutely possible to reverse disease and save a natural tooth to allow the patient to function. The health, the chewing, the speech, all the beautiful things that our teeth provide for us.

MARTIN: Yeah. Gratitude for the way we have been built and the temple we occupy. Right.

DR BRETT GILBERT: Absolutely.

MARTIN: Take care of it as best as we can.

DR BRETT GILBERT: Yeah. Yeah. So I know,

MARTIN: I hear you on that. No disagreement. It's just the understanding and true data. Not just hearsay, just proper data collected.

DR BRETT GILBERT: Yeah. And like I said, for us, we have the cases, we see the healing and it's important to share that. And I think Instagram and social media have become a very powerful place for colleagues to share. And I think what we've done is we've done a great job helping to educate each other, helping to share techniques and cases where I'm afraid we haven't done a very good job, is putting forward education to the patient, to the general public, to really give them an understanding of the fact that root canal treatment is actually a miracle, for saving teeth, for getting patients out of pain and disease. But we need to do a better job sharing that.

And I believe the voice of the expert is the right voice. And so I'm hoping that this will be an opportunity, this beautiful collaboration between us on the podcast to share that. And as we're moving forward in time, I'm hoping more and more my colleagues will heed the call to talk more to patients in front of the camera, because I think that those messages are really reassuring to patients that they understand that this is a legitimate science, it's a legitimate art. And ultimately the results that we get are results that they could get. But not every case is going to work. Not every case is even appropriate to try to retreat. And that's why extraction is sometimes the only option that's going to allow the patient to get healthy. I'm just afraid that on the other side of this argument that's not said, it's more a broad stroke and its root canals are bad. And that's what I'd like to dispel.

MARTIN: Yeah, I hear you clearly here that an infection is possible and infection is treatable, and we need to review every case individually and make a very thorough assessment and decide.

DR BRETT GILBERT: Yeah, I have a very close friend of mine who is, I'm going to say in quotation marks they call themselves "biological dentists."

MARTIN: All right.

DR BRETT GILBERT: So there really is no academic designation of a biological dentist. It's more become an acronym for more of a naturopath. Someone who certainly they're the dentists that are out there saying root canals are bad. They're all over Instagram and social media. What bothers me about their tactics is that they often speak in terms of fear and not evidence. And that's really the part that kind of bothers me that I really am motivated to speak on. It'd be great to have a more collegial type of conversation. But again, it's such a broad stroke. And so for all the biological dentists out there, let's get together. Let's talk a little bit more. Let's share each other's feelings, beliefs and biases so that ultimately we give messages to the general public. The general public knows that they should brush and floss their teeth. Beyond that, they're not experts in dentistry. And so I wish we could kind of come together more, Martin, and talk more and maybe refine the messaging so that a patient can make a decision based on education and evidence and not on being made to feel afraid.

MARTIN: Well, let me butt in here with this. Right. I was in the computer field for 20 something years, and in the sales we knew and sometimes used. I didn't, but I've seen it used and it's FUD, fear, uncertainty and doubt. And that is the most powerful selling method when you speak about your competition. So when you want to gain business or attract it to yourself, and if you can plant seeds of uncertainty and doubt and subsequent fear into the mind of the prospect, they will come to you. You're a dishonest seller, but you will get the business. And that's what you're describing to me.

I actually was a client of a "biological dentist" in the sense that when I had my mercury being removed from my teeth and replaced with composite, it was, which year was it? About 18 years ago, the treatment was such that it was treated as disposal of hazardous waste, which after all, mercury is. If you break a mercury vapor light, they have you evacuate the room and clean it out like it's dangerous, well, it is. So the funny part was right, like masks and oxygen and barriers and whatnot. And he was protecting himself from getting toxified by the mercury vapor that was coming off of the drill site.

DR BRETT GILBERT: And there are regulations on mercury separation too, from the debris that comes out. So fortunately, I think 25 years ago when I got out of dental school, there was still sort of this, a lot more dentists were placing amalgam. I think that, again, the materials have come so far that we do have really good. We even have bioactive materials, bonding materials that allow a fluoride exchange into the tooth. Again, utilizing some of these calcium ions to help remineralize the teeth. So we're in a situation now where there really is probably a better alternative to amalgam in terms of being able to restore teeth, being able to make sure that they last, making sure that the bonding is efficient over a long period of time, and certainly they're more esthetic. And so I think overall, from a restorative position, the materials have really created a situation where there is no patient that would really have to make a hard choice between a metal and a composite filling at this point in time. Composite is readily available and consistent in this day and age. So that's great. That part of the argument we can sort of probably let go to some degree, unless someone is, still has metal fillings. If they're concerned about that, they can be removed. It's not without consequence though, everyone should know. The more work that's done on a tooth, the more it can rattle the nerve inside. So I've known patients that have had metal fillings removed. Some of them were quite deep after the composites are placed. Now they develop a toothache and now you're going to have to decide do you want to get a root canal or have it extracted? I hope after today you might be a little more comfortable accepting that the root canal could be a great option.

MARTIN: Yeah, I appreciate that we are helping the listener to develop a set of questions that they should be asking about what's going on in their mouth and also what they should know talking to the dentist. Because when you're coming in from a place of better information, you're going to have a better outcome, no doubt.

DR BRETT GILBERT: Yeah. And I think one of the most important questions is to ask your dentist, are you able to take a 3D image for me? A cone beam. And if that doctor doesn't have one in their office, which many do not, you could always be referred to a different office just to even get that imaging. The imaging can also be sent to an oral radiologist if that dentist maybe isn't as comfortable reading it. So if you have a great relationship with your dentist, maybe they're not as up to date with some of this higher tech equipment. You can still allow them to facilitate getting the imaging, getting a report from a radiologist, and truly understanding the status of your tooth that has had a root canal or might need one. So that's a really great point, Martin, is what questions to ask and what might be the best evidence to support what you need? Well, 3D imaging is the best to the best because you can truly see, in just a dental X-ray. Unfortunately, you're only getting a two-dimensional view of a three dimensional object. And with the cone beam, we have such incredible resolution that I can actually see every single minute detail in that tooth. And so I think that could be a great bridge for us to allow a patient that's a bit skeptical to be able to either understand where they are now, or maybe track the progress one way or another of a tooth that they have a question mark about.

MARTIN: Right on. Yeah. Good. I think let's end on a positive note.

DR BRETT GILBERT: Okay. Fair enough.

MARTIN: It's possible,

DR BRETT GILBERT: Question for you, Martin, if you don't mind.

MARTIN: No.

DR BRETT GILBERT: We talked a lot about supplements and diet. For you, in terms of the oral cavity and the teeth, from a dietary standpoint or a supplemental standpoint, what do you typically recommend for retaining and maintaining?

MARTIN: That's an awesome question. So in a crisis, like you have an abscess or you have pain and whatever. We actually have a wonderful tincture made with magnesium chloride into which we have a soaked goldenseal. Goldenseal is an antiviral, antibacterial herb. And so with this magnesium, you get great penetration. And I've had a good number of people come back saying: "Oh my gosh, the abscess is resolved!" Because there's a calcification sac around it. Magnesium allows to open that up, penetrate it. And the herbal stuff is really well known and well documented to have an antiviral and antibacterial capacity. So that thing is like, save me now kind of supplement, if you will.

But the long term, of course, we need to worry about the internal pH balance. You don't want to be too acidic or too alkaline. And that is answered by Metabolic Typing. That's the, are you alkalized by fats and proteins or carbohydrates? So we need to get the person to understand how to best eat. And then there are, of course, the classic don'ts. There's the five things that nobody should eat, which is refined flour, refined sugar, refined salt, refined plant seed oils and pasteurized dairy. And it's been homogenized on top. Those five things don't belong into anybody's body.

DR BRETT GILBERT: Powerful.

MARTIN: Beyond that, we have mineralization supplementation and it should be targeted. Some people need more calcium. Some people need more Magnesium It depends on your inner workings. Some people need more sodium. Some need more Potassium. Again those are genetic predispositions that should be honored because if you work against your type, you'll have poor results.

DR BRETT GILBERT: And to that point, for those that are out there, many people are simply either afraid of the dentist or for whatever reason, try to avoid the dentist. But the oral cavity is a beautiful mirror for our overall health. And so having regular exams of your mouth can oftentimes, sometimes give early signs of other, more systemic problems. So, just encourage everyone to recognize the importance of their oral health, whether it's diet and supplements, as Martin is so well versed in and has a wonderful line, whether it's seeing a practitioner to be evaluated, just know that your mouth is really a gateway to your overall health. And so, if you are avoiding the dentist for any reason and we all have a million of them, please think about overcoming that so that your health can be put into a priority and you don't wind up getting sick from something that might have been preventable if it had been detected earlier.

MARTIN: Yeah. Good point. Really good point. I mean, I go in once a year and take a full exam, not just not just dental hygiene, full exam. Let's see. What do you see. Is it okay? And of course for me the message is well you're old, you have been chewing a lot. Your teeth are worn, but it's okay for the age you are.

DR BRETT GILBERT: Oh, goodness. Well, our teeth serve us well. But as I mentioned, the mouth is not a kind environment for our teeth and gums. So, taking good care and most importantly, the diet is such an important part. And obviously utilizing floss on a daily basis, brushing your teeth regularly, it's good for relationships and it's certainly good for your health.

MARTIN: That's true with relationships. We have one other thing that should be mentioned. It's called Amazing O. And the O stands for oxygen. And you can use that as a treatment. It has very high ORP, oxidation reduction potential. So when you put it in the mouth, all things viral, bacterial, fungal will get pushed past their ability to sustain. They are wiped out. And so if you happen to have halitosis or just a bad smelling mouth. It's time to do this. Pulling with the infection killers, so to speak. And it's not, I would not use the listerine. I would not use alcohol. That's the wrong way to go about it. I would say.

DR BRETT GILBERT: So, is it a tincture that's diluted? Or is it a rinse or?

MARTIN: It's a concentrate. We sell it in a bottle. I don't have one here. I could go get it, but it's just a bottle with an eyedropper. You put two drops into a spoonful of water and work it around and.

DR BRETT GILBERT: Interesting.

MARTIN: Done. Yeah. The other thing I would highly recommend is actually oil pulling, which is done with something like coconut oil, a teaspoon of coconut oil, it will melt in your mouth. And then you can work it around your mouth for like five minutes like this. And it will absorb things that are fat soluble and it will take out toxins. Don't swallow it. Spit it out. Brett, as you said, the mouth is a pretty hostile environment. We want to take the bad things out. And oil pulling with coconut oil or some other oil, you can choose any, olive oil will work, is a very smart thing to do because it really improves the oral environment.

DR BRETT GILBERT: I always laugh when I hear coconut. The coconut is such a miracle. The number of uses, the benefits, the way it is able to produce itself based on just a coconut falling to the ground and how it's, it's really just an amazing, amazing product of this Earth. So, grateful to hear all the different uses. And I appreciate that I hadn't really heard much about that, just sort of swishing coconut oil, but it makes perfect sense.

MARTIN: Yeah, yeah, because you can get it into nooks and crannies under the gum line if you put enough force on it, it'll start pulling the things that don't belong. Yep. It's very useful. You can really maintain your oral health for a long time. I wish I was taught these things at high school rather than much later when I was scrambling for solutions.

DR BRETT GILBERT: Yeah. And I wish, because everyone is on their phones and I wish there was more genuine health related maintenance content for people to really consume because there's so much to learn about, like you said, how to take care of ourselves. The knowledge is out there. And I just hope that over time we can use social media and a lot of this consumption of content for more of the micro learning, you know, whether it's about your mental health, your emotional health, your physical health. So I appreciate what you're doing, and I hope that along the way, we can continue to collaborate and make more content. That just puts that little seed of idea in someone's mind that they can actually take control of their health, but they have to first take control of the knowledge. And that's the hard part.

MARTIN: Yeah. All right, Brett, where will people find you?

DR BRETT GILBERT: Oh, yes, you could find me on Instagram. I'm Dr Brett Gilbert , just @DrBrettGilbert. I'm actually the same handle on YouTube, on Facebook, on LinkedIn. I'm available if anyone has any questions. I would really love to entertain this conversation. If someone has really strong feelings about root canal treatment and their safety to reach out, all I can ask is that if you do approach me, please do so with an open mind, because I can promise you I will approach you with an open mind as well. I think we can learn a lot from each other, but we have to come to the table a little more open minded and realize that there are extremes. And then there's a middle ground. And I think that most patients, unfortunately, aren't getting the information that's the middle ground. And I would love to support that and even collaborate with any of the biological dentists out there, as I mentioned, to sit down to talk, even to create some type of literature or publication that could at least bring us closer so that patients really understand that natural teeth can be saved very effectively, but not all of them. And so let's focus on where patients can be guided so that they have the proper information and they can make a health decision for themselves. Because as we mentioned, a loss of teeth is very detrimental to our health overall.

MARTIN: Indeed. All right, well spoken. You can find this on life-enthusiast.com. My name is Martin Pytela and this is the Life Enthusiast podcast. Thank you for spending your time with us today. And thank you, Dr Brett Gilbert DDS.