Welcome to another episode of the SIBO Doctor Podcast. I'm your host, Dr. Nirala Jacobi.

And with me today is Dr. Victoria Sampson, a dentist talking about the oral microbiome. And I'm pretty excited about our guest today because Dr. Sampson is a very accomplished dentist and has really been on the forefront of change in dentistry and publishing several studies about the oral microbiome and the relationship between the mouth and the body. She's a very accomplished dentist having won numerous awards, and yeah, just very excited to have somebody who is of that caliber and who really has a firm grasp of understanding of the connection between the oral microbiome, and not just gut issues, but really systemic health. So, I'm very grateful to have her on our show. The full bio, as well as any other links how to find Dr. Sampson is in the show notes. So, go to sibodoctor.com, and click on the podcast, and you have all the show notes there. Welcome to the podcast, Dr. Sampson. It's so wonderful to finally have a dentist on our show to enlighten us on the oral microbiome and how it relates to systemic health.

Victoria Sampson:

Thank you so much for having me. I love doing podcasts, and I love people learning more about the mouth. The oral microbiome doesn't get as much good marketing or credit as the rest of the microbiomes do.

Nirala Jacobi:

That's very, very true. Let's start with you just going or explaining what the difference is, how the mouth microbiome differs from microbiomes in other parts the body.

Victoria Sampson:

So, the oral microbiome was founded or discovered around 200 years ago by a man called van Leeuwenhoek. And he basically decided not to brush his teeth for three days, and to collect all of the film and bacteria that was collecting around his teeth and gums. And then he had his own self-made microscope and he looked underneath his microscope and he found five bacteria, and he drew them, and those happen to be kind of the pioneering bacteria in the oral microbiome. And that's really where it all started. I mean, we all know about the gut microbiome, the skin, but the oral microbiome is a very special one, because it's constantly under attack, it's one of the microbiomes that it's exposed all the time. Every time we breathe, we drink, we eat, we smoke, anything, the microbiome is under attack.

Victoria Sampson:

And what also is quite interesting is that the oral microbiome is one of the only ones where it's gotten on shedding surfaces. So, our teeth. And unlike anything else in our body, our teeth do not shed. And so, that means that whilst other my microbiomes or other areas, skin, or et cetera, can shed, and the bacteria can kind of change by itself with non-shedding surfaces like the teeth, there is no way of actually changing the microbiome. And if you have poor bacteria on your teeth and you're not going in and getting them cleaned regularly, it can have some really drastic effects on the rest of your body. The oral microbiome itself is the second most diverse microbiome, just following the gut. So, it's got around 700 different species of bacteria and they amount to about two billion bacteria in the mouth at all times.

Nirala Jacobi:

Wow, that was a very good summary of the oral microbiome. Obviously, it's an aerobic place, right? So we have a lot of exposure to air. So I suppose that most of the bacteria, if not all, are aerobes, or need air, or anaerobes. So can you just kind of talk about the differences between those types of environments. Deep in the gut, we mostly have anaerobic bacteria, those that can survive without air, and the mouth.

Victoria Sampson:

So the mouth interestingly there's quite a lot of anaerobic bacteria. And it's the anaerobic bacteria that causes a lot of oral disease and then therefore spreads and causes systemic disease. So, you're right in thinking that because it's your mouth and it's constantly exposed you'd assume that the bacteria would be aerobic, but if you have gum disease, for example, what happens is that pocketing starts to form around the tooth. So I compare gum disease to, for example, a gum's around a tooth, tight as a turtleneck. That's the idea, you want it to be super tight, you can't get in between the gum and the tooth. But if you do have gum disease, then the gum start to get a bit leaky, and a bit flappy, and food and bacteria can get stuck in between the gum and tooth.

Victoria Sampson:

And the more food and bacteria that gets stuck, the more of an anaerobic kind of environment you create. And the more anaerobic bacteria that accumulates they actually start to diversify by themselves. And so you see a lot of obligate anaerobes at the very kind of apex of a lot of gum pocketing. And it's very difficult to reach, but it's also the most destructive bacteria that occurs in the mouth. So we've got all... I mean, we've got aerobes, anaerobes, and then there's also Candida. It's not just bacteria that can grow in the mouth and it's really dependent on a lot of what you do as habits. So, for example, what you eat, what you drink, are you drinking enough water? Are you staying hydrated? Do you smoke? What medications do you take? Are you taking any recreational drugs?

Victoria Sampson:

All of those types of things directly impact not only the quantity of bacteria, but the quality. And that's a new kind of thing that people have really started to understand, probably in the last 10 to 20 years, because prior to that, dentists and anyone really thought that it was about, okay, brush your teeth and you will get rid of gum disease and decay, and that's it. And they assumed that oral diseases were caused by the quantity of bacteria in the mouth. And what we've realized it's not the quantity, it's actually the quality. And when you start to get growths of anaerobic bacteria, and you get diversification of the microbiome, that's when you start getting disease and dysbiosis and problems.

Nirala Jacobi:

There's been some talk about oral dysbiosis causing SIBO. Can you talk more about that connection?

Victoria Sampson:

Yeah. I mean, I like to compare it on a more maybe general term in terms of just gastrointestinal dysbiosis and oral dysbiosis first, and how they're directly connected. I mean, firstly, in a more physical way, if anything, your mouth is literally an extension of your gut. So, any kind of dysbiosis that's happening in your gut, there's a very high chance of happening in your mouth as well and vice versa. Another problem is that if you do have any oral dysbiosis or you're having poor habits up here in the mouth, then your saliva is actually transferring all of that poor bacteria into your gut.

Victoria Sampson:

So, there's a great medium that is just transferring all of that bacteria back and forth. So I do a lot of microbiome testing of my patients, their oral microbiomes, and I can pick up when they have any kind of gastrointestinal dysbiosis, just because they have high levels of certain bacteria that are just abnormal in the mouth, and you shouldn't really have them, or it's really high levels of it. And you look at their mouth and it kind of looks okay, but it's because it's coming from the gut and vice versa.

Nirala Jacobi:

That's fascinating, because that's a whole new area of sort of testing for those biomarkers is looking at oral microbiome. So what would you say are patterns of healthy mouth in terms of direct species versus a dysbiotic mouth? What are you looking for?

Victoria Sampson:

So there's kind of the red complexes that we're mainly looking at. So, in low levels they're okay, but high levels of Prevotella intermedia, Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus mutans, and then the one that I never will be able to pronounce, so I call it Aa, but I will attempt for you all today. Let me find it, because I write it down because I cannot remember for the life me. Okay, Actinobacillus actinomycetemcomitans.

Nirala Jacobi:

Very well done.

Victoria Sampson:

So if you write Aa, and you google it, and you say, gum disease Aa bacteria, it will come up, for all of those who cannot pronounce it like me. But those are the main, I would say, the big ones. And then you've got your orange complexes and they're also not great in high levels, but if I see a patient who has high Fusobacterium, or high Prevotella, or Porphyromonas gingivalis, that's a really big warning sign for me. And Aa in particular is kind of the most aggressive form of gum disease. So, it's not even just having high levels of red complexes, it's which red complexes are high. And that will give an indication of what type of gum disease they have, how aggressive it is, what's going to work better. So, for example, if they have high levels of Aa, they should be taking antibiotics, because it's too strong for any kind of antiseptic treatment.

Victoria Sampson:

So, yeah, we've got our kind of ringleaders of bacteria which we are definitely aiming most of our treatment towards, and they are the ones that cause the most oral disease. But what's also quite interesting going back about the gut is that you can also see a lot of gastrointestinal diseases in the mouth. So, for example, things like celiacs, Crohn's disease, even inflammatory bowel disorder, ulceration. A lot of those things you can actually see in the mouth, and you can pick them up quicker and earlier in the mouth and in the gut. So, a lot of patients think I'm crazy because I can be like, "Oh, I think you might have Crohn's. You should go and check that out." And lo and behold, a lot of them do go back and find out that they have Crohn's.

Nirala Jacobi:

That's fascinating. So, what would give that away if you're looking in somebody's mouth? What are you seeing that maybe shows up in the mouth before it would actually really show up in the gut to a high degree?

Victoria Sampson:

So, with celiacs and Crohn's, there's a lot of ulceration. So you've got these kind of large ulcers across the mouth. And then also for Crohn's, in particular, you can get orofacial granulomatosis. So that's basically very large lip swelling. It's mainly seen in children, but they have these kind of granulomas, essentially, which builds up in their lips. And then for Crohn's you can get cobblestone mucosa, is what we call it. And I think it's quite similar in the gut as well, where it becomes quite white and rigidy feel-looking.

Victoria Sampson:

So those are the big kind of signs. And then for nutritional deficiencies, which are also, I guess, kind of connected, because all of these patients are not digesting the right nutrients you can see a lot of nutritional deficiencies in the mouth. So, anemia, for example, they have a very pale mucosa, slightly got a bit of a bluey, whitish tinge to it. It they've also got a lot of ulcers often. And then, obviously, the classic symptoms of fatigue and et cetera, and you kind of add them all together. B12 deficiency, they get a red beefy tongue. It's very sore. Sometimes they feel like it's burning. Vitamin C deficiency, bleeding. There are so many.

Nirala Jacobi:

Yeah. I do specialize in functional digestive disorders in my clinic, and aphthous ulcer or mouth ulcers are really common in those that have digestive disorders. I mean, not to the degree that you've maybe just explained, but just random ulcers can happen also with just general dysbiosis, I find. So, going back to your talk about SIBO, well, the whole dysbiosis in the mouth and how that could potentially lead to SIBO, what we now know from research and small intestinal aspirates is that the leading bacteria in SIBO tend to be E. coli and Klebsiella. Do you see those organisms as well? When we're talking about mouth dysbiosis, the red group, as you call them, they're really different bacteria from what we typically associate SIBO with. Can you talk a little bit about that?

Victoria Sampson:

I mean, I've never seen E. coli or Klebsiella in any of my oral microbiome tests that I performed. But with that being said, I would also say that E. coli and Klebsiella are not often included in oral microbiome tests because people don't think that they could be seen in the mouth. So, [inaudible 00:14:58] answer to that question is, I don't know, because it's often not in the microbiome... I've had it in a few microbiome tests, but it's always been negative. So, I don't know is the answer to that.

Nirala Jacobi:

We know from nasal swabs that, for example, we do often see gut bacteria on nasal swabs when we check for mold. So, it's just a curiosity that I have and the gas dynamics of how SIBO can really get sort of entrenched in the gut if the mouth is involved. I had a question about stool testing. Every now and then you see bacteria that I would associate more with oral microbiomes on a stool test. How significant is that?

Victoria Sampson:

Well, I personally don't do stool testing, but I work with a lot of functional practitioners who refer their patients to me to do their oral microbiome testing and to modulate their microbiome, and get them back to symbiosis. So, I often do have a stool test kind of the results on the side for me to read through. And it's interesting you say that, because I actually started my whole microbiome journey during COVID. I mean, I always knew about bacteria and about the microbiome, but the average dentist is not really taught about kind of modulating and modifying the microbiome and trying to achieve symbiosis. We don't do that normally. All we do is just clean. If you have a gum disease, we say you should go and have a hygiene and brush your teeth better.

Victoria Sampson:

We don't sit there thinking, oh, maybe five years ago you had gum disease and you have pathogenic bacteria still in your mouth from five years ago because the surfaces are non-shedding, and therefore, we need to put you on two weeks of, I don't know, an antiseptic, or we need to give you some probiotics and prebiotics. So it was all very new for me over COVID. I did a lot of research into the connection between COVID-19 and poor oral health. And what I thought was that if you had poor oral health, you had an increased risk of COVID-19 complications. And there was a lot of research in it. And it literally started because I read a paper. I forgot... I mean, it was a paper from China, and what they found is they looked at the metagenome of the patient and all of their stool tests as well. And they found extremely high levels of bacteria which were associated with gum disease, but in their stool. And there, I was thinking, "Well, that's weird. Why would there be Prevotella and P. gingivalis in the stool?"

Victoria Sampson:

And that literally started my whole research into it. And we found that actually there is a very strong connection between poor oral health and complications from COVID-19, and that in patients who have worse complications from COVID-19 the oral microbiome is often very dysbiotic beforehand. So, that's kind of where it started. So there is, and answer your question, a very strong connection between stool tests and the results that come from them. And if you do get high levels of Prevotella or P. gingivalis where kind of the red complexes that I was explaining earlier, then you should definitely not be turning a blind eye to them and you need to be probably referring to a dental practitioner to see what's going on there.

Nirala Jacobi:

I think that a lot of stool testing companies also don't report, like P. Gingivalis I've never seen. Prevotella, for sure, I've seen. Streptococcus mutans I've seen. Other streptococcal species, but that tends to be also normal. Streptococcus is not an unusual group of bacteria, same as [inaudible 00:18:50] and all that. So, there still is a lot to learn in terms of what you can really glean from a microbiome test or stool test. Let's move on to what should people look out for? I mean, they may think, "I'm brushing my teeth. Yes, I have got symptoms. How can I know whether or not the oral microbiome is causing some of my symptoms?"

Victoria Sampson:

I mean, I think first you definitely need to be going regularly to see your dentist and your hygienist. That's the number one ports of call. But also if you are working with a practitioner who's looking at your gut and trying to alleviate any symptoms or any problems, I think those practitioners should also be open to looking at the mouth. And I think that's one of the things that I'm very passionate about, is trying to get other practitioners to understand that actually a lot of problems they're not necessarily caused by the mouth, but they definitely exacerbate problems, and you will never fully get rid of a problem unless you get rid of the whole problem. And the mouth is a very important player in that. So, I think as a patient, it's about... I mean, the most you can do is going to your dentist and your hygienist regularly, making sure that you have immaculate oral hygiene, but then also making sure that your practitioner is looking at everything and all of the different microbiomes, and understanding the connection between the gut and the mouth.

Nirala Jacobi:

That's always the task, is getting practitioners up to date with their training as possible. And that's really why I'm so grateful that you're on the show, because I think we just, in recent years, have appreciated the contributions of the oral microbiome. And many of us may not have that training, because the science really didn't exist up until a few years ago to be able to offer oral microbiome testing. When I first started my career 25 years ago or so, we already knew about the connection between not just oral microbiome, but more in terms of root canals and often times people having long-term health effects from hidden infections below root canals. And there's a few books written about that. I don't know if you subscribed to that point of view about root canals can actually be sort of like a foci of infection that can be contributing to systemic illness. What are your thoughts on that?

Victoria Sampson:

Well, I'm in two minds. I was raised and taught that root canals are fined, but then when I graduated I learned a lot from other people about different things. And I think what was the most profound was when you had patients who had real experiences, and they were telling me, "Oh, yeah. Since I've had that tooth taken out and I had a root canal on it I'd feel so much better." I personally don't think that the science is there yet, and if a patient needs a root canal I will refer them to get a root canal done. There are many times where what I don't agree with is that some dentists who disagree with root canals and are vehemently against it will then take the tooth out and do something quite destructive and place like an implant.

Victoria Sampson:

Imagine if you're a 21-year-old adult, and yeah, you got decay and the tooth has crumbled, it's quite a big treatment to take the tooth out, and then six months’ worth of surgery, and placing an implant, and doing a bone graft. It's a lot. And I think that people forget that the alternative to a root canal is also quite aggressive and can cause problems as well. And the best treatment of all is to not have a problem in the first place, which is obviously going to your dentist and your hygienist regularly, but that doesn't always happen. So like I said, I still refer for root canals, and I make sure that I refer to a root canal specialist. I don't let general dentists do it. It has to be a specialist who does it all day, every day, under a microscope and extremely aseptic kind of way.

Victoria Sampson:

And that's all done and under a rubber dam as well, so that's the plastic isolation. So you isolate the tooth from the rest of the mouth, you use pretty strong antiseptics. We're talking like bleach, essentially. You're killing out all the bacteria and you're doing it under 25 microscopes. And if you do it really well, then there's no problem. And actually, patients will have their infections resolved and they will be fine. If it's done poorly, I agree, it can cause a lot of problems systemically and infection can spread. So, that's my opinion. Like I said, I still do them, and I also think that people forget how destructive the alternatives can be.

Nirala Jacobi:

Yeah, I agree. I always think you have to kind of look at the whole picture. I see a lot of people with chronic fatigue, and besides their digestive symptoms they have a lot of other systemic issues, and I always ask about that. And more often than not, people do have multiple root canals. And the way I always explain it to my patients is, "Look, if your immune system is fine and you're healthy, there's probably not an issue, but the more ill you get or the more immune dysfunction you have, then even tiny infections that may have been walled off by the immune system below a tooth can start to create problems." And that might be unbeknownst to you. You might not have a pain or you might not have really that many dental symptoms.

Nirala Jacobi:

So, I think it's important for people to know about it rather than just everybody go pull out their root canals. It's more about understanding that this could be another addition to your problem if you're looking for answers why you're continuing to be ill even though you're addressing all your symptoms. So it's just another rock to look under in terms of what is contributing to overall health. And I've had a personal experience with a colleague who was really, really ill. And so, I also have had that experience, not personally, but more from my colleagues and from some of my patients who were quite ill with it. So I do think it's an important topic. But getting back to what people can do, and how oral symptoms contribute to systemic symptoms in terms of, what else are you seeing? I mean, we know that there's a big connection between gum disease and heart disease, right? So can you talk to us about that connection?

Victoria Sampson:

Yeah. So, it's mainly to do with low grade chronic inflammation. So, if you have gum disease in your mouth, then that means that you have kind of the incorrect quality of bacteria in your mouth, you've got dysbiosis, and that dysbiosis is causing an increase in inflammatory markers. So they're namely, interleukin 2, 6, 8, and 10. You usually have higher numbers of tumor necrosis factors, CRP, lipopolysaccharides. So, you're just having kind of like this constant emission of low grade, but chronic inflammation. And I always compare it to, if you had like an infection on your toenail and you didn't really think about, it didn't really cause you many problems, but it was constantly there for years, that would obviously impact the rest of your body, and how the rest of your body would be able to fight other diseases or infections and your immunity. And it's exactly the same thing. And unfortunately, people kind of disregard their mouth and they go, "Oh, my gums are bleeding. It's okay." Or, "My dentist always tells me I have gum disease." And you're like, "No, but actually is quite important because of that low grade chronic inflammation."

Victoria Sampson:

And so, what research has found is that actually that low grade chronic inflammation can spread elsewhere to the rest of the body, and it can impact blood vessels, it can spread bacteria to other parts of the body as well. So, one of the main systemic diseases, as you said, is heart disease. And the way that works is that you have all of these emission of this chronic inflammation and it spreads to the rest of your body, and it will actually impact the lumen of your arteries. And so will make the arteries and veins more stiff, so they won't be able to have as much blood. So the circulation goes down. And that's all because of the inflammatory markers spreading from your gums and from your mouth. So, that's the kind of strong connection between heart disease and gum disease. Then you have the same for diabetes. So diabetes is the biggest one for gum disease, and there's been a ton of research on that. So you're three times more likely to have diabetes if you have gum disease, and they're bi-directional.

Victoria Sampson:

So, if you have gum disease you're more likely to have diabetes and vice versa. And the way that that works is, again, it's that low grade chronic inflammation, It's the traveling of bacteria elsewhere to your body, and your body not being able to actually monitor your glucose levels, because it's got something else that it's doing at the same time. So, that is one of the biggest problems that dentists and hygienists have, is that they find it very difficult to handle diabetic patients. And what they've found is that if the diabetes is under control and you have a good glycemic level, then your gum disease improves, and you have much better control of your gum disease. And the same the other way, if you go and see your hygienist regularly, and you're improving your gum health, lo and behold, your glycemic control will also improve. So, there's that kind of link as well. I mean, I can go on, there's so many different connections for systemic disease. Do you want me to go on?

Nirala Jacobi:

Yes. Please, give us a few more examples.

Victoria Sampson:

So obesity, there's three times more likely risk of obesity, and that was a paper that came out in 2004. And then the one that is quite hot, it's a very hot topic at the moment is Alzheimer's. So a 70% increased risk of Alzheimer's disease if you have gum disease. And what they found was that, particularly, Porphyromonas gingivalis in the mouth. When you have high levels of that bacteria, it releases a toxic enzyme called gingipains. And gingipains when they were looking at patients who were suffering from Alzheimer's, they found this gingipains actually in the cerebral spinal fluid of Alzheimer's patients, and essentially, in their brains. And there were really high levels of gingipains in the brains. And they found that gingipains actually can cleave certain parts of the neurons in your brain, and that will basically increase your risk of Alzheimer's disease. So, it's all about essentially creating these fatty plaques in Alzheimer's disease. And so, these gingipains enable that to happen by cleaving proteins and allowing for these fatty plaques to be created.

Victoria Sampson:

So Alzheimer's is the biggest one at the moment. Everyone's very hot and excited about that one, because the research... I mean, it's always been thought, but the research has only really come out in 2020, and then COVID kind of eclipsed it, so no one really thought much about it, but it's having a comeback now. And I think that there's a lot of connections between oral disease and systemic disease, but the research is still not 100% there on a lot of them, and it takes a long time for any connections to be strongly kind of in concrete for people to believe it. So, the biggest ones which have been kind of established are the Alzheimer's, the heart disease and the diabetes. Those are the biggest ones at the moment. So I treat in particular patients who have chronic inflammatory diseases. So things like systemic lupus erythematosus, or rheumatoid arthritis, those are kind of my main patients. And it started because I was working with a couple of functional practitioners.

Victoria Sampson:

I'm an advisor for a microbiome testing company. So, these functional practitioners were using that microbiome testing company and said, "Hey, why don't I actually refer my patients to the advisor?" So, I started working with them and all of their patients had these chronic inflammatory diseases. And what we were finding was that when they were coming in to see me, and I was modulating their oral microbiome and trying to get rid of the bad bacteria and putting the good bacteria back in, their diseases of whatever sorts, so their arthritis, for example, would actually improve. And so, we actually we published a few case studies recently, which were showing that it's kind of like a two-pronged approach, because you obviously need to be treated by a practitioner in terms of your diet, your medication, et cetera, but you also need to make sure that your mouth is under control. And there's a strong connection again with gum disease and systemic inflammatory disorders.

Nirala Jacobi:

Wow, that is absolutely fascinating. So, is it just inflammatory conditions or would you say also certain myalgias like in fibromyalgia? Would you also potentially see that connection of having a dysbiotic mouth that can cause sort of pain and inflammation, not to the degree of rheumatoid arthritis, which we think more of as autoimmunity, but more in terms of general inflammation and myalgias. I'm going to start looking out for that a whole lot more now. I mean, that's so amazing, because practitioners that are listening, we probably all have a little filing cabinet of patients that may not have improved with all of our well indicated protocols, but that was maybe the missing link is that we really didn't maybe look close enough to the oral microbiome. So, what can practitioners do? Or maybe let me rephrase the question. You talked about you put the good bacteria back in, so how do you do that? How do you repopulate or restore an oral microbiome that may be dysbiotic?

Victoria Sampson:

You're asking for my secret recipe now. So what I do first is I do an oral microbiome test. I check which bacteria they have and which ones I want to kick out. And then based on which or what I call it... I mean, I probably should think of a better scientific terminology for this, but I call it the purge. And I basically want to kick out all of the bad bacteria before I start re-establishing the microbiome and putting any good stuff in. So what annoys me is when I have patients who clearly are very in tune with their body and they come, they're like, "Ooh, I take prebiotics and probiotics, and I really take care of my mouth." I'm like, "That's really great, but none of those probiotics are going anywhere." First of all, there's just no space. You've got a ton of bad bacteria and there's competition, and they'll never win. So, first is to find out what's the bad bacteria. Then I've got kind of an armamentarium of lots of different mouth washers and antiseptic rinses, and et cetera that I use.

Victoria Sampson:

So, for example, Fusobacterium nucleatum, it reacts, or it works very well with a mouthwash which has hydrogen peroxide in it, because the hydrogen peroxide it's got air, essentially, and it's aerobic and the F. nucleatum is anaerobic, and it kills it. So that's a really great way of doing it. So I might put a patient on maybe two weeks. Once or twice a day, they use that mouthwash at a different time to brushing. Sometimes like I said some patients need antibiotics. I try and avoid it, because I feel like it's a bit of a grenade in the microbiome in the mouth, but if it has to be done it has to be done. And then also I do something else which is called Guided Biofilm Therapy. So this is basically it's created by a company called EMS, and it's essentially a kind of a newer cooler way of cleaning your teeth.

Victoria Sampson:

So what you do is, you coat the teeth in a vegetable dye, and then the vegetables dye will show up the areas of biofilm and essentially plaque formation in your mouth. And then you spray off the biofilm in any of the bacteria with an antiseptic spray, which has erythritol in it. So the erythritol basically removes all of the plaque. It's abrasive enough that it actually physically and mechanically cleans, but it's also got that chemical component where it modulates what bacteria will re-establish on the teeth or on the gums or in the mouth, and it will help in the future to actually modulate that microbiome as well. So, I replaced my classic average hygiene with Guided Biofilm Therapy, and it has the same or better results.

Victoria Sampson:

And then once the patient has a good microbiome when we've kicked out all the bad stuff, or at least we're on the way there, then I'll start recommending prebiotics and probiotics. So I have my favorite probiotic, it's a livestream, it's by a company called Nvivo, and I get them to use it once or twice a day. And then we go from there, and we keep on doing microbiome testing to make sure that things are improving. Sometimes I do blood tests or inflammatory marker tests to check as well for certain enzymes. And yeah, that's it. I mean, it's all tailored, so my idea is that it's personalized dentistry. Just like you have personalized medicine, why is it that we should all just be told to clean? There's different things that people need to do, tongue scraping. Not everyone should do it, but certain people should do it.

Nirala Jacobi:

And the probiotics that you using are they specific oral probiotics or are they general probiotics?

Victoria Sampson:

They're specific oral probiotics, but the oral probiotic that I use you can swallow it. So, it is thought to also help with the gut as well.

Nirala Jacobi:

Because there are a few dental probiotic strains coming out in terms of probiotic products from different companies, and I just wonder what your thoughts are about that. I guess, it's just like with any probiotic, you have to kind of do your research and see if that's appropriate. Wow, this is just-

Victoria Sampson:

I think the delivery is important. I think the problem with a lot of probiotics that I see, and a lot of companies will approach me and be like, "Hey, try out our new probiotic." Firstly, for me, they need to have enough clinical trials and studies that show that their probiotic, in particular, works, not just the streams that they're using, because it's all about the delivery and making sure that when the probiotic is ingested it's alive and it's actually working. So that, for me, is the absolute most important.

Nirala Jacobi:

I'm surprised that it's not a liquid or a microbiome, I mean, sorry, probiotic. I mean, these are capsules, so you swallow them or you actually-

Victoria Sampson:

Liquid.

Nirala Jacobi:

Liquid. Yeah, that makes a lot more sense, because there are capsules-

Victoria Sampson:

When you mix it it's like a powder.

Nirala Jacobi:

Right. Okay, because there are capsules, and I'm just wondering, "Well, why are you swallowing it? That's already bypassing that the target area." Totally fascinating. Oh, my God, I have so much more questions, but I know it's late for you. I think one of the big frustrations that people are going to feel when they listen to this podcast is like, "Well, where can I find someone like you? What can I do to, to find a good dentist that does these really extraordinary types of individualized therapies that really most dentists don't do?" So is there an association or is there a resource that people can access to find someone like you, or find you? Where are you?

Victoria Sampson:

So I'm based in London. I work in two practices. One it's in Harley Street and the other one is in St. James's Park. So, if you guys want, you can just search my name and find me. I also have an Instagram. So I do post very regularly things about the microbiome patients that I've treated and what I've done to get them to where they are, and pretty pictures of teeth as well once in a while. So, you can follow, that's at @drvictoriasampson. And then there is... I mean, it is a very new kind of niche part of dentistry, but there is a dentist, he goes by the name Ask the Dentist, and I know he's based in America. And he does have a directory on his website and you can find functional dentists who are on there. That doesn't mean that they necessarily do microbiome testing and modulating the bacteria, but they definitely understand the kind of systemic implications of oral care, and they are a little bit more holistic in their treatments.

Nirala Jacobi:

Dr. Sampson, it's been really wonderful, and you have such a great way of summarizing complicated topics. So I really appreciate your time with me today, and I will put all of that information about your website and your social media presence in the show notes. So, click through to that if you are listening and you want more information. Thank you so much for your time.

Victoria Sampson:

No worries. My absolute pleasure. Thank you for having me. I'm happy that we finally got this to work.

Nirala Jacobi:

Yes. It took a while, it took a while. I wasn't going to give up. So, thank you so much.