Dr. Sampson: Why bleeding gums quietly drive disease risk

Steven Bartlett 0:00 Is there a link between our oral health and our fertility?

Dr. Victoria Sampson 0:02 Yes. This is some of the newest research that's coming out. They found that over 90% of men who wasn't able to conceive with their partners had a oral disease. For those who got treated, there was a 70% improvement in pregnancy. Now, research has also found that if a woman has gum disease, it takes them two months longer to conceive. And I'm the only one who's talking about it.

Steven Bartlett 0:21 And who are you?

Dr. Victoria Sampson 0:22 I am the Saliva Queen. Dr. Victoria Sampson is the trailblazing dentist...

Steven Bartlett 0:26 Whose data-driven research has uncovered the shocking link between our mouths...

Dr. Victoria Sampson 0:30 And some of the world's most destructive conditions. More than 90% of diseases can be traced back to our microbiomes, and we now understand that having an imbalanced oral microbiome increases your risk of high blood pressure, heart disease, Alzheimer's, rheumatoid arthritis. And even men who have gum disease are 2.85 times more likely to have erectile dysfunction.

Steven Bartlett 0:48 Really?

Dr. Victoria Sampson 0:49 Yeah. And then another study also showed there's oral bacteria that can make cancer more aggressive and harder to treat as well.

Steven Bartlett 0:55 But what is it that causes all of this?

Dr. Victoria Sampson 0:57 Poor oral hygiene, sugar, stress, but also some of us genetically will have mutations which can cause disease. But there's ways to fix it. For example, I had a patient who had terrible arthritis and terrible gum disease, and when I treated the gum disease, her rheumatoid arthritis got better, to the point where she was actually able to walk again.

Steven Bartlett 1:14 Wow.

Dr. Victoria Sampson 1:15 Yeah.

Steven Bartlett 1:15 So let's talk about what we can do about it. Is there any time where I shouldn't brush my teeth? Do I spit or rinse after I brush my teeth? Chewing gum, coffee, mouthwash, good or bad for me?

Dr. Victoria Sampson 1:25 Let's go through all of that. So weirdly...

Steven Bartlett 1:29 This has always blown my mind a little bit. 53% of you that listen to this show regularly haven't yet subscribed to the show. So could I ask you for a favor before we start? If you like the show, and you like what we do here, and you wanna support us, the free simple way that you can do just that is by hitting the subscribe button. And my commitment to you is, if you do that, then I'll do everything in my power, me and my team, to make sure that this show is better for you every single week. We'll listen to your feedback. We'll find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much. Dr. Victoria

Steven Bartlett 2:02 Sampson, what is the mission that you're on?

Dr. Victoria Sampson 2:07 Um, my mission is to show people that the mouth is the gateway to the rest of the body. And if they really want to achieve full body health, it starts with the mouth first.

Steven Bartlett 2:16 I've never heard of the term oral microbiome, really, until I met y- you and s- went through all of your work and your research. And I think many people listening to this now also probably aren't familiar with that term, or, a- and also the importance of that term. So if you had to make a case to someone like me who's really unfamiliar with this subject as to why it's so important, from a very top line perspective, what would you say?

Dr. Victoria Sampson 2:40 I think everyone knows that their gut has a microbiome. And for the past 10 years, we've always talked about how you can change your diet, probiotics, prebiotics for the gut microbiome. But what a lot of people don't understand is that the oral microbiome is the second largest and most diverse microbiome after the gut. It's also a lot easier to change, and actually, it's been shown to have a massive impact on general health. So uh, having an imbalanced oral microbiome increases your risk of oral diseases, like gum disease and decay, but also can increase your risk of other systemic diseases, like high blood pressure, heart disease, infertility, Alzheimer's. Um, and it's something that is so easy to manage and balance.

Steven Bartlett 3:20 How many people does this impact?

Steven Bartlett 3:22 A- a- and how many people is it relevant to? So an understanding of my or- oral microbiome is gonna help me in a number of ways as it relates to my overall health, but how many people does it really, really have an impact on?

Dr. Victoria Sampson 3:33 I think it depends on what you're trying to get out of the oral microbiome testing. Um, I would argue that it benefits everyone. We all have teeth. We all have mouths. Um, and everything that we do, every time we breathe, we eat, we drink, we kiss, uh, we are impacting our oral microbiome every single time. And then every time we swallow or we breathe, that bacteria that is putting into our mouth will travel elsewhere to the rest of the body and cause problems elsewhere.

Steven Bartlett 4:00 You said it's the second-biggest

Steven Bartlett 4:01 microbiome in the body.

Dr. Victoria Sampson 4:02 Yeah.

Steven Bartlett 4:02 How many bacteria are in my oral microbiome?

Dr. Victoria Sampson 4:05 So you have 700, approximately, 700 different bacteria, which make up two billion bacteria overall. And what's also very weird about the oral microbiome compared to any of the other microbiomes is that you've got lots of different environments or niches within the same mouth. So if you think about the bacteria that would like to live under the gums or at the back of your throat or on your teeth, they're all very different environments. Some are hot, cold, you know, wet, and so you've got lots and lots of different parties of bacteria within the same microbiome in the mouth.

Steven Bartlett 4:37 Okay. And y- you mentioned a second ago that things like kissing, breathing, swallowing have an impact on my oral microbiome-

Dr. Victoria Sampson 4:45 Yes.

Steven Bartlett 4:45 ... in a significant way that I need to know about.

Dr. Victoria Sampson 4:48 Uh, yes. So it's more about how often you're doing those certain habits. So, you know, for example, with kissing, the research has shown that you need to kiss more than 11 times a day for you to be sharing the same bacteria or microbiome as your partner. Um, but also even the habits that we have, um, the air quality that we have, everything will dictate the environment that our mouths are living in, and therefore what bacteria will live in our mouths.

Steven Bartlett 5:12 And on the subject of

Steven Bartlett 5:14 oral diseases and things like tooth decay, how many people are impacted globally by oral diseases?

Dr. Victoria Sampson 5:21 So the World Health Organization has come out, um, saying that 3.5 billion people have some sort of oral disease. And they've also found that 10% of our world population are suffering from severe gum disease, which makes gum disease one of the most prevalent inflammatory conditions, um, in the whole body.

Steven Bartlett 5:39 This conversation around the oral microbiome, have you seen it developing over the, over recent years? Have you seen it become more sort of pertinent to people in society?

Dr. Victoria Sampson 5:49 Massively. I think, I've been doing this for, for years. It's been something that I've loved. Um, and no one really knew what I was talking about most of the time. They all thought I was a bit of a dreamer. Even dentists, patients, they all thought, "Okay, well..."... doesn't really matter, does it? But in the last year or two, I've had people traveling from all around the world just to get their oral microbiome tested, to understand more about what's going on in their body. And I think we're seeing a shift in the generations, in terms of this new generation want to understand their health a lot more. So we're all sitting there wearing, you know, trackables, wearables, we're, you know, calculating how much sleep we have, how much we're eating. And for, uh, now, we're actually also wanting to understand our oral health. So that trust between a dentist and the patient is not necessary anymore. We want to actually understand what's going on in our mouths and actually, you know, be able to track things, see what bacteria we have, how much inflammation we have, our risk of diseases, and what we can do to change that.

Steven Bartlett 6:45 Last question before I ask you a

Steven Bartlett 6:47 more sort of personal question about yourself. Um, what other diseases in my body, or sort of implications in my body, are linked and can be traced back to the oral microbiome?

Dr. Victoria Sampson 6:56 We now understand that more than 90% of diseases can be traced back to an imbalanced microbiome. Uh, if we zone into just the oral microbiome, it's got connections with infertility, heart disease, diabetes, Alzheimer's, rheumatoid arthritis, um, and the list goes on, erectile dysfunction. Um, and what's also very interesting, going back to your question about, you know, is there been a new interest in this, in the last few years, we've actually been able to show that there is a strong connection and causation between the oral microbiome and general diseases. Whereas prior to maybe five years ago, there was a lot of kind of, "Is this correlation? Is it just that, okay, there's the same risk factors with gum disease and with heart disease, for example, smoking?" And now we're actually seeing that no, it's not just correlation, there is strong c-causation between the two.

Steven Bartlett 7:47 And who are you?

Dr. Victoria Sampson 7:49 Um, I am Victoria Samson, I'm a dentist, um, I do a lot on the oral microbiome. Um, people call me the saliva queen, that's my name on the streets (laughs) .

Steven Bartlett 7:59 (laughs) and what's your sort of, what professional experiences and education have brought you here today, and how long have you been doing that? How many mouths and how much saliva have you seen? Give me a cl- a sort of a big view on the, uh, the wealth of experience you have on the subject.

Dr. Victoria Sampson 8:14 Um, so originally, I trained as a dentist, um, and that's six years of training. Um, I would say I was a pretty traditional, conventional dentist as I graduated. Um, I'd done some training, um, at the Karolinska Institutet during my university, and the, the Karolinska Institutet

Dr. Victoria Sampson 8:33 is the best dental school in the world. Um, but they're very focused on the mouth-body connection, on testing saliva. Um, and what they thought was that, you know, you go to your doctor and you have a blood test, why don't you go to your dentist and get a saliva test? So from even dental school, I had this in the back of my mind, but I still didn't have the training, and so I just became a dentist. Um, I was working half NHS, half private, and then as time evolved, I then, um, shifted to fully private. Um, and then when COVID happened, um, I started doing a lot of research, and all the dental practices were closed across the country. Um, and I thought that was crazy, because basically the government was saying dental practices, uh, or dentistry is not a necessity. So, uh, I thought that was insane, and so I decided to do a lot of research, and I wrote a paper which was connecting, um, oral health with poor, with COVID complications. So what we found was that patients who had poor oral health or gum disease were at a much higher risk of COVID complications. Um, and then that evolved into me doing some studies with universities and hospitals. But the issue was that we couldn't go into, um, hospitals and check people's teeth and gums because they had COVID. So instead what we did was we would collect their saliva, and we would take it to the lab, and we had this beautiful snapshot of what was going on in a patient's mouth at that moment in time just from their saliva. So we did a lot of research, and we found that, uh, COVID sufferers or patients who had gum disease were nine times more likely to have COVID complications. But also what I took from that was that, why aren't we using saliva, you know, more regularly? Why don't we use this in a more commercial aspect and for our patients? So after that, I devoted a lot of time into developing oral microbiome testing. We had gut microbiome testing, you've got urinary microbiome, you've got every single microbiome has a test, but the oral microbiome didn't really have one. So I built one of the first oral microbiome tests in Europe, um, and that was a couple of years ago, and then now have come out and, uh, kind of left and created my own one, um, about a couple of weeks ago.

Steven Bartlett 10:45 That research you

Steven Bartlett 10:46 mentioned, specifically the research paper which was titled, "Could there be a link between oral hygiene and severity of COVID infections?" was the first research paper to link gum disease with worse COVID complications, and I was reading that it was the most cited research paper by the, one of the sort of dentistry publications?

Dr. Victoria Sampson 11:06 Yeah. Yeah. So the British Dental Journal is one of the most cited and viewed articles. Um, and what it also helped do was, um, the World Health Organization and SAGE picked that up, and they said, "Oh, wait a second, I think that oral health is really important for general health, and also we should reopen dental practices." So this also paved the way for dental practices reopening later on.

Steven Bartlett 11:28 W- what's going on there? Can you explain that to me like a 10-year-old? So if I have a bad or a unhealthy oral microbiome, I'm nine times more likely to end up in ICU with COVID complications. What- what's the link?

Dr. Victoria Sampson 11:43 So there's a few. So the first one is inflammation. So COVID, we know, um, it releases a lot of inflammatory markers, so it's what we call the cytokine storm. So it's essentially the storm of lots and lots of inflammatory markers. And gum disease, separately, um, is essentially inflammation of the gums. And so, what gum disease does is it releases lots of inflammatory markers from the mouth elsewhere to the rest of the body. So then when you add those together, and you have your cytokine storm from COVID, and you've got your inflammatory markers from gum disease, it's just adding petrol to the fire, so you're just making that cytokine storm even worse.

Steven Bartlett 12:18 Mm-hmm.

Dr. Victoria Sampson 12:19 Um, but then on a separate side, it's also bacteria. So if you look at the, um, autopsies and the research of COVID, uh, patients, um, most of them didn't die from the virus itself. You... No one really died from COVID-19. They died from complications. So the number one complication was actually a bacterial infection. So imagine your body... You've got COVID. You are really unwell, and your immune system is on absolute overdrive. This is the primetime for bacteria to come into your body and to cause what we call a bacterial superinfection. And so actually, when you look to the autopsies of a lot of these patients, they had oral bacteria from their mouth traveling to their lungs and causing bacterial superinfections which would result in things like pneumonia, and that's actually the cause of death for most patients.

Steven Bartlett 13:05 You don't really

Steven Bartlett 13:06 think that your oral microbiome can be fatal, it can kill you?

Dr. Victoria Sampson 13:11 No, and even, I think as a dentist, we weren't really taught how important bacteria was or how important the mouth was for the rest of the body. Uh, the number... The only one that we ever learnt, um, and a lot of people would know this one, is that if you, um, have heart surgery, you can't actually have a hygiene for about six months after the heart surgery.

Steven Bartlett 13:34 A dental hygiene?

Dr. Victoria Sampson 13:35 Yes.

Steven Bartlett 13:36 Hmm.

Dr. Victoria Sampson 13:36 And the reason for that is because you're at a very high res- risk of something called infective endocarditis. So this is oral bacteria which travels down to a faulty heart valve, um, and can actually cause death. Um, so we know that, but we never really look at it for other diseases or other problems.

Steven Bartlett 13:53 I wanna, um, I wanna take a step back

Steven Bartlett 13:55 before we go through the links between our or- oral microbiome and all of these diseases, but also, I really wanna also talk about h- what we can do about it, 'cause I've got so many questions around it. I've got all of these products down below my chair, from mouthwashes to toothpaste to all these kinds of things which I wanna talk about as well. But just taking a step back to something that one of my guests previously was telling me about, I think it was James Nestor. He was telling me that the, the mouth itself and the jaw, because of processed foods, is an abnormal shape. And when I say abnormal, I mean, um, in relation to how it was supposed to develop, because we're eating so many processed foods which aren't, you know, which are designed to be easy to chew, the mouth itself and the jaw have changed. Is there any truth in that?

Dr. Victoria Sampson 14:36 Yeah, 100%. So there was a man called Weston Price, um, and he was a dentist, and he basically suspected that, and he was like, "This is strange. Why is it that, um, people who are more industrialized in westernized areas have higher levels of decay and they have loads of crowding?" So they had basically lots of crowding of the teeth, um, and smaller jaws. And so he basically traveled around the world, and he looked at lots and... different, um, tribes, villages, countries, and he compared the teeth of, uh, for example, twins. One twin would be in a very industrialized, westernized area, and the other one was not. And what he found was that in the twins who were in these non-industrialized areas, they were eating harder foods, uh, they were having less sugar, and actually their jaws developed a lot better. So they didn't have crowding. They had perfect teeth actually, and they had no decay compared to the children or the, the twins who were in more industrialized areas. And it is because our food now has become so processed. A lot of children are not having hard foods, um, and so we don't develop the jaws and the muscles at an early age. And so the teeth haven't changed size, the teeth are exactly the same size as they were previously, but what we're seeing is that those teeth, um, don't have any space to grow anymore, and that's when we're getting crowding.

Steven Bartlett 15:57 And can you see that in any of those models?

Dr. Victoria Sampson 15:59 So, uh, yeah, in this model, you can actually see at the very back, so a lot of people will have wisdom teeth, um, and, uh, one of the biggest issues at the moment is that a lot of people have impacted wisdom teeth. So this is basically, imagine your teeth are all upright. Your wisdom tooth is coming out at a completely horizontal angle, and it's pushing on the rest of the teeth.

Steven Bartlett 16:19 Mm-hmm.

Dr. Victoria Sampson 16:19 It's an absolute nightmare as a dentist to take out. It's even more of a nightmare for a patient to have to endure, but also we're seeing that there are a lot more impacted wisdom teeth, um, in the last 30, 40 years than there were previously.

Steven Bartlett 16:32 Ah, because the diets have changed.

Dr. Victoria Sampson 16:33 Because the diets have changed. A lot more children are needing orthodontic treatment now as well, just because they have crowded teeth, teeth are overlapping, um, and so they need braces to straighten those teeth out. If you think about cavemen, cavemen didn't have dentists, they didn't have braces, they didn't even use toothpaste, but they didn't die from gum disease or decay or crowded teeth. So it's been something in our industrialized or more, kind of, westernized diet that has changed that.

Steven Bartlett 17:02 My wisdom tooth

Steven Bartlett 17:03 is coming through on my left side at the moment, and I think actually also my right side at the same time, and I'm 32 years old now. So I'm like, "W- why the hell am I growing teeth at 32 years old?" I thought I was on my way out or something.

Dr. Victoria Sampson 17:13 (laughs)

Steven Bartlett 17:13 Um, so I got two questions just before we crack on, which is, what the hell is a wisdom tooth, why is it called a wisdom tooth, and why is it coming through at 32 years old?

Dr. Victoria Sampson 17:20 (laughs) Um, so we have teeth erupting at different s- kind of times of our lives. So usually you have your baby teeth. They will erupt up to the age of about six or seven years old, um, and then you have your adult teeth coming through, and usually they will stop erupting around 12 years old. Um, and then you have nothing, you're chilling, you have nothing, nothing, nothing, nothing until about maybe-... mm, 18, 19 years old, and that's where you start to get your wisdom teeth. The name behind wisdom teeth, from what I understand, is because it's, it erupts when you're older. It's when you have more wisdom and you're-

Steven Bartlett 17:56 Mm-hmm.

Dr. Victoria Sampson 17:56 ... more wise.

Steven Bartlett 17:57 Oh, so I'm wise now.

Dr. Victoria Sampson 17:57 So you're just very wise.

Steven Bartlett 17:58 Oh, that actually makes sense.

Dr. Victoria Sampson 17:59 (laughs) Um, and so some people will get it at 18. Some people don't have any wisdom teeth. Some people have wisdom teeth which erupt perfectly and are all completely fine, and others will have their wisdom tooth erupt at 32 years old and maybe be a little bit impacted or cause problems. So they're also very strange teeth. Um, they're very unpredictable the way that they are.

Steven Bartlett 18:21 Is there any

Steven Bartlett 18:22 evolutionary basis for why we need them? There must be some kind of evolutionary reason for them.

Dr. Victoria Sampson 18:27 Not that I understand. What th- ha- is also happening is that, um, apparently, and this is some research, is that less people are having wisdom teeth because more children or y- or adults are getting their wisdom teeth taken out. And as evolution goes, um, eventually some people are actually not having wisdom teeth at all, because their ancestors haven't had wisdom teeth, so why would they have wisdom teeth? Um, but overall, no, there's no real need for wisdom teeth. I never like to take them out unless needed, because I mean, more teeth-

Steven Bartlett 19:00 The better.

Dr. Victoria Sampson 19:00 ... the better. And you never know if you have to have something taken out, then we can use your wisdom tooth for something.

Steven Bartlett 19:06 If I were to look

Steven Bartlett 19:07 at my ancestors from 500 years ago, you said they don't have dentists, they don't have toothpaste and all those kinds of things, but you also said they don't have too- tooth decay.

Dr. Victoria Sampson 19:16 Yeah.

Steven Bartlett 19:16 Does that not therefore mean that I shouldn't need a dentist and I shouldn't need toothpaste or mouthwash or floss?

Dr. Victoria Sampson 19:23 If you had a caveman diet, then potentially you might not need toothpaste, floss, or even a toothbrush. Um, and there's a lot of argument as to, you know, there's a lot of people out there saying, "No, you don't need to use any toothpaste. You don't need floss, anything like that." And fine, go ahead, do that, but only if you are going to be eating, you know, meat, uh, raw meat sometimes, and you're only drinking water and you're not having anything in your diet which has any sugar or carbohydrates in it.

Steven Bartlett 19:53 I mean, doesn't that speak to what the perfect diet is supposed to be? Can't we tell what the perfect diet is supposed to be by looking at the mouth?

Dr. Victoria Sampson 19:59 Yeah. So, uh, another issue is that with a lot of the food that we eat now, um, they have a lot more sugar in them, and that will impact the acidity of your saliva. And essentially what decay is, is, uh, you have sugar or you have some sort of carbohydrates, and you've got this bacteria in your mouth, and they feed on that sugar. And as they feed on that sugar, they release acid. Um, and if that acid is left there, then it can cause demineralization of your teeth, and that demineralization will end up with decay.

Steven Bartlett 20:31 Okay. So let's talk

Steven Bartlett 20:33 about the personal m- oral microbiome. Um, is my oral microbiome different from, say, Jack's over there and from my girlfriend's?

Dr. Victoria Sampson 20:42 Yes. Massively.

Steven Bartlett 20:42 H- h- massively different?

Dr. Victoria Sampson 20:44 Yes. Uh, maybe, uh, massively, I would say. Um, so one of the issues that I used to have was I was doing lots of oral microbiome testing, um, and I would have, you know, let's say you and your girlfriend do an oral microbiome test, and both of you, I would see your results, and they would come out pretty much the same, because we're only looking at certain bacteria. We can't look at all 700. So we would look at the top 20 bacteria that cause problems. So I would look at both of them, and then I would look inside your mouths, and one of you, I don't know (laughs) who in this case, had raging gum disease and terrib- terrible oral health, and the other person would be completely fine. So then I realized that actually it's not just bacteria that causes disease or problems, it's how your body responds to that bacteria and the strains of bacteria that you have as well. So for every bacteria, um, there'll be multiple strains, and some of those strains can be really aggressive and really horrible for your mouth, and other strains are completely fine and are not gonna cause you any problems. So when I developed my test, what we did is we looked at strains. So we looked at the strains of certain bacteria, um, and we would be able to differentiate between patients who had the really bad strains and the really good strains. But then also we looked at the ratio of good and bad bacteria in someone's mouth, so their diversity, as well as their genetic mutations and also their inflammation. So when you put all of it together and you, it's like a puzzle piece, then you can actually have a better insight into someone's oral health. So I guess my answer is that everyone's oral microbiome is a little bit different, but it's also how your body responds to that microbiome and bacteria that really dictates whether or not you're going to have disease or problems.

Steven Bartlett 22:21 So you could

Steven Bartlett 22:22 be someone who takes care of their teeth really, really well, but still have a bad oral microbiome relationship with the rest of your body, effectively?

Dr. Victoria Sampson 22:30 Yeah.

Steven Bartlett 22:30 Okay.

Dr. Victoria Sampson 22:30 And I see it every day, and we have a lot of patients who suffer from terrible gum disease, and they come to me and they brush three times a day. They've never touched a cigarette. They have immaculate oral hygiene. They eat very well. But they have terrible gum disease. And for those patients, they might have genetic mutations that predispose them to gum disease and to inflammation. So even the smallest amount of bacteria, their body responds in a very aggressive and inflammatory, destructive way, which can cause disease.

Steven Bartlett 22:58 When I was speaking to, I think it was Tim Spector about the gut microbiome, he was telling me that the gut microbiome turns over, i.e. the bacteria d- dies every couple of days or weeks or something. How often does the oral microbiome die, turn over, and why does that matter?

Dr. Victoria Sampson 23:16 So what's interesting or different between the oral and gut microbiome, the oral microbiome, if someone doesn't go in there and mechanically disrupt the bacteria and the plaque in your mouth, then that bacteria can stay forever. So the gut, what happens is you've got something called peristalsis, you've got movement, so the bacteria moves, it, it changes, it regenerates, there's turnover. In the mouth, so the teeth are the only non-shedding surfaces in the whole body, so that means-

Steven Bartlett 23:43 Non-shedding surfaces?

Dr. Victoria Sampson 23:44 So imagine if you, if you never had a shower-... uh, in your life. Uh, you would still self-wash because the skin cells would shed.

Steven Bartlett 23:52 Mm-hmm.

Dr. Victoria Sampson 23:53 But if you never brushed your teeth, then your teeth are not shedding. They're gonna stay like that. So that bacteria will just keep on growing and growing and growing and growing, and you'll get this really thick plaque. So that's why actually the oral microbiome, you need to mechanically remove that bacteria, and that's why brushing your teeth is super important or, um, using the correct toothpaste, or et cetera, going and seeing your hygienist because you need to mechanically remove that bacteria quite regularly.

Steven Bartlett 24:21 Okay.

Steven Bartlett 24:22 And the, the two ways ... I was reading in your work, it said that the two ways that oral health impacts overall health are by the spreading of bacteria, and the other sort of central issue is it causes inflammation. So on this point of spreading bacteria, I'm always concerned, this is a bit of a superstitious thing, but ev- any time that I'm sick, I'm always like, "Don't s-" ... uh, part of me is like, "Don't swallow."

Dr. Victoria Sampson 24:41 (laughs)

Steven Bartlett 24:42 Because in my head, I think if I'm sick in my mouth or if I've got, um, like a sore throat or something, I'm like, "If I swallow it, the rest of my body's gonna get sick." It's super, super s- superstitious, but is there any truth to any of this?

Dr. Victoria Sampson 24:54 Um, so not from just being sick like a common cold. And it's actually really interesting, I had a patient yesterday, and bless him, he's very young, seven years old, um, and he had exactly that same mindset. He just randomly woke up one day and he said, "This is kind of gross. Why am I swallowing my saliva? There's all these bad bugs and gross things in my saliva, and I'm swallowing it every day, and it's traveling to the rest of my body," at seven. And so what he ended up doing was refusing to swallow his own saliva, and so he would basically just dribble, and he would just wipe his, uh, the saliva off with a sleeve or he'd carry a towel with him and just wipe it. So bless him, he had a big rash around his, his, um, his face. Um, and it, it was a bit of a weird moment for me because I was like, "S- you're kinda right." Like, I mean, it is a bit weird, especially as a child to sit there and think like, yeah, you've got 700 dif- different bacteria, two billion bacteria overall, and then you're swallowing it, and it can travel elsewhere to the rest of the body. So yes, in, in short, yes, bacteria from your mouth when you swallow it, it can travel elsewhere to the rest of the body. However, a lot of the bacteria, um, dies, so the acid in the stomach can kill a lot of the bacteria. So it's only the really, really bad bacteria that are able to survive and cause problems, and that's why it's so important that you have a good oral microbiome and you balance it well.

Steven Bartlett 26:14 And the other central way that

Steven Bartlett 26:16 it can cause negative impacts to your overall health is by inflammation. What is the link between inflammation and my, my oral microbiome?

Dr. Victoria Sampson 26:26 So it's, uh, something that we call low-grade chronic inflammation. And imagine, so you've got this delicate balance of bacteria in your mouth, which is your microbiome, and we all have bad bacteria in our mouths, but most of us hopefully have better levels or higher levels of the good bacteria. So there's always that balance, and what happens in an imbalanced oral microbiome is that shift changes, so you get higher levels of bad bacteria, and you don't have enough good bacteria. These bad bacteria, firstly, yes, they can travel elsewhere to the rest of your body, as you discussed. The second is that they can release inflammatory markers. So they basically release inflammation, and this inflammation can travel from your mouth to the rest of your body and contribute to inflammation elsewhere. So for example, if you had rheumatoid arthritis and then you had inflammation from your gums, that inflammation from your gums is making your arthritis in your wrists worse. So it's contributing to it. Now, what's also interesting, and that's why it's called low-grade chronic inflammation, is often you wouldn't even know that you have it. I have so many patients who say, "Oh, you know, my gums bleed," but that's normal. If your eye bled or if your foot was bleeding every day, you would be worried and you would think, "Actually, there's inflammation here. There's a problem here." But so many people have bleeding gums, and they don't understand that bleeding gums is a sign. It's your gums screaming to you saying that, "I have inflammation," and that inflammation can travel. And then the third mechanism as well, so there's one more, is, um, it's damage to your blood vessels. So again, the same bad bacteria in your mouth, it releases these enzymes, these toxic enzymes, and they can travel through the rest of your body through your blood vessels, and they can actually damage your blood vessels. So these blood vessels are not able to dilate and constrict as well as they used to.

Steven Bartlett 28:13 On that point of arthritis, I read a stat which, um, I believe is true. I think it actually came

Steven Bartlett 28:18 from some of your research that said people with rheumatoid arthritis are eight times more likely to develop gum disease than patients without rheumatoid arthritis.

Dr. Victoria Sampson 28:26 Yes.

Steven Bartlett 28:27 Which is shocking.

Dr. Victoria Sampson 28:28 Yeah. So there's a really strong, um, bidirectional relationship between rheumatoid arthritis and gum disease. So that means that if you have really bad rheumatoid arthritis, you will have pretty bad gum disease, and if you treat your rheumatoid arthritis, your gum disease will get better, and vice versa. If you have, if you treat the gum disease, your rheumatoid arthritis will get better. And that was actually one of the, um, first patients that really got me on my journey of the mouth-body connection. So like, yeah, I was doing the saliva testing, I got it. You know, I was like, "Okay, cool. We are quantifying oral health. We're tracking things." But even me, I wasn't really fully sold on this whole mouth-body connection, how our mouth is connected to the rest of the body. So I had a patient who was sent to me by, um, her functional medicine practitioner, and she had been seen by, uh, four or five different practitioners. She had terrible rheumatoid arthritis, and she, um, went to this final guy, and he was the first guy to ever ask her, "Have you ever had your teeth checked? What's happened?" And she said, "Oh, I've had a few teeth taken out in the last year or two, about six teeth, but, you know, it's just, it, it is what it is." And he was like, "I, I don't think that's normal." So he sent her to me, and he was like, "Can you do your saliva stuff that you do and see if there's anything up, uh, d- going on there?" And we did do a saliva test. We saw that she had super high levels of inflammation, of collagen breakdown, um, high levels of bad bacteria, and what was the most important was that when I treated her gum disease, she had terrible gum disease, and that's why she was losing her teeth. When I treated the gum disease properly and aggressively, um, yes, her gums healed, but more importantly, her rheumatoid arthritis got better to the point where she was actually able to get off steroids and medication and be able to walk again.

Steven Bartlett 30:14 Wow.

Dr. Victoria Sampson 30:14 Yeah. (laughs)

Steven Bartlett 30:16 By treating her gum disease?

Dr. Victoria Sampson 30:17 Yeah. And I think that, you know, sometimes as a dentist, we treat a lot of gum disease, and we treat a lot of things, and we don't necessarily see the systemic consequences, because the patient doesn't come back or, you know... Um, or it's such a small impact that you don't necessarily see it. But this was the one time where I was like, "Wow, like, what we do is actually really, really insightful and really important."

Steven Bartlett 30:42 And you mentioned alongside

Steven Bartlett 30:43 that, um, inflammation also has an impact on cardiovascular functioning and health. Uh, I believe it's the case that cardiovascular disease is the biggest killer in the world, from what I understand. Um, so I was wondering if, if you knew any of the stats that show the impact or the l- the increased likelihood of me having a heart attack or a stroke or something, based on my oral microbiome?

Dr. Victoria Sampson 31:06 So, um, the research has shown that if you have gum disease, you are at a 20% higher chance of high blood pressure. Um, but also, they are now saying that up to 30 to 40% of cardiac, um, issues in hospital can be traced back to an oral bacteria, um, causing problems in the heart valve. Um, so the reason for this connection, so yes, inflammation, but also going back to that third mechanism I told you, which was about the vasoconstriction, so the blood vessels constricting and dilating. So, these toxic enzymes which are being released by the bacteria, they travel through the blood, um, and they basically stop the blood vessels from being able to widen and lots of blood to travel to the heart, and also to constrict, and that also is, um, one of the biggest connections with, uh, heart disease.

Steven Bartlett 31:57 I found this stat, which might well be from your work or someone else's. It's from the study called The Association Between Periodontitis and Blood Pressure Highlighted in Systemic- Systemically Healthy Individuals.

Dr. Victoria Sampson 32:08 Not mine, but... (laughs)

Steven Bartlett 32:09 Okay. And it found that people with gum disease were twice as likely to have a heart attack and three times as likely to have a stroke than those without inflammatory gum disease, which is absolutely staggering.

Dr. Victoria Sampson 32:21 Yeah, and then another study also showed that when you treated someone's gum disease, their levels of CRP... And CRP is an inflammatory marker that you can check in your blood. The levels of CRP significantly reduced, and for a lot of patients who suffer from heart conditions, they will get their CRP quite regularly checked through blood testing.

Steven Bartlett 32:40 Mm-hmm.

Dr. Victoria Sampson 32:40 And so this is a way of reducing their inflammation, is just by having a, a simple hygiene. And I've even seen, um, particularly in America, there's a lot of, um, uh, cardiac surgeons and, um, doctors related to, to heart health, um, who are now actually working with dentists, because they understand that if they work together, then they're going to have far better results for their patients.

Steven Bartlett 33:03 And this is, this is that swallowing thing we were talking about. This is because you're swallowing that bad bacteria.

Dr. Victoria Sampson 33:08 Yeah, and your heart valve, um, imagine if it's be- it's faulty, imagine you just had surgery. I always think of it like it's sticky. It's like Velcro, so it's really prone to infection and problems. It's just like if you fell over and you had a scab, and you were rolling around in mud all the time, you would get bacteria going into that scab and causing problems. This is the same thing with your heart valves.

Steven Bartlett 33:29 Doesn't the bacteria just

Steven Bartlett 33:30 travel on its own anyway? 'Cause I feel like it's in my mouth, so I feel like it... I don't know, these are living organisms. Don't they just, like, find their way down, even if I don't swallow?

Dr. Victoria Sampson 33:38 Yeah. Even through your blood, um, and also through your gums as well. So you can swallow your bacteria, breathe it, or it can go through your blood.

Steven Bartlett 33:47 At the start of this conversation,

Steven Bartlett 33:48 we were talking, you mentioned the sort of implications for your cardiovascular system, and one of the things you said was erectile dysfunction, and that was slightly alarming to me-

Dr. Victoria Sampson 33:56 (laughs)

Steven Bartlett 33:56 ... as a man-

Dr. Victoria Sampson 33:57 Yep. (laughs)

Steven Bartlett 33:58 ... um, who's trying to stay away from erectile dysfunction.

Dr. Victoria Sampson 34:00 (laughs)

Steven Bartlett 34:00 What is, what is the research that supports this idea that my oral microbiome can have an impact on my erectile functioning?

Dr. Victoria Sampson 34:08 So, men who have periodontal disease are 2.85 times more likely to suffer from erectile dysfunction.

Steven Bartlett 34:14 2.8 times?

Dr. Victoria Sampson 34:15 Yeah.

Steven Bartlett 34:16 Is... I'm pretty sure that's 280%, isn't it?

Dr. Victoria Sampson 34:18 Yeah.

Steven Bartlett 34:19 Okay, so what is this periodontal disease?

Dr. Victoria Sampson 34:21 Gum disease.

Steven Bartlett 34:22 Okay.

Dr. Victoria Sampson 34:22 So, uh, it's kind of, I would say it's a bit of a spectrum. So, the early stages of periodontal disease, or gum disease, is just gum inflammation. So that's that patient who is brushing their teeth, spits in the basin and sees blood. So that's the origin- you know, the early inflammation. If they don't get that checked out and sorted, that will just continue and continue and continue to what we call gum disease. Um, and that's where, yes, you've got inflammation, but actually, you have really high levels of bad bacteria now, and this bacteria is essentially eating away at the gums and also your bone. And, uh, it's, it's now become irreversible.

Steven Bartlett 34:58 I'm just gonna have a swig of this.

Dr. Victoria Sampson 35:00 (laughs)

Steven Bartlett 35:01 (laughs)

Dr. Victoria Sampson 35:01 For your erectile dysfunction? (laughs)

Steven Bartlett 35:02 Yeah. (laughs) Fucking hell. Okay.

Dr. Victoria Sampson 35:05 Um... (laughs) And then at the very end of the spectrum is people who are losing their teeth, having really terrible gum infections, and all of these kind of mouth-body connections that we're talking about.

Steven Bartlett 35:16 Okay, and then, uh, can you just explain, as, again, as, as if I'm 10, the, how my, how that gum disease, that periodontitis, is it called?

Dr. Victoria Sampson 35:24 Mm-hmm.

Steven Bartlett 35:25 ... has an impact on my penis? I don't understand.

Dr. Victoria Sampson 35:27 (laughs)

Steven Bartlett 35:27 Like, I don't understand the link. It makes all of my blood vessels-

Dr. Victoria Sampson 35:30 Exactly.

Steven Bartlett 35:30 ... dot... li- Uh, okay.

Dr. Victoria Sampson 35:31 Yes, so it essentially stops your blood vessels from dilating-

Steven Bartlett 35:35 Mm-hmm.

Dr. Victoria Sampson 35:35 ... and so you've got reduced blood flow to your penis.

Steven Bartlett 35:38 Okay.

Dr. Victoria Sampson 35:38 And therefore, doesn't work.

Steven Bartlett 35:41 Okay, so this is an emergency, this stuff. This is really something important. Um... (laughs)

Dr. Victoria Sampson 35:44 (laughs) That's the one statistic-

Steven Bartlett 35:46 (laughs)

Dr. Victoria Sampson 35:46 ... whenever I have a man in the chair, and he's like, "Oh, I don't want to brush my teeth," I'm like, "2.85 times more likely to have erectile dysfunction," they usually will go straight to the bathroom to brush their teeth. (laughs)

Steven Bartlett 35:54 The other thing, uh, no, but it's j- it's

Steven Bartlett 35:56 true, but also, the other thing that I, I read in your research which I found really, really, um, shocking is the link between my oral health, my oral microbiome, and cancer.

Dr. Victoria Sampson 36:07 Yeah.

Steven Bartlett 36:08 I was reading specifically about female breast cancer-

Dr. Victoria Sampson 36:11 Mm-hmm.

Steven Bartlett 36:11 ... um, which I know is, affects a lot of women. Um, what is the link there between breast cancer, cancer generally, and our oral microbiome?

Dr. Victoria Sampson 36:19 So this is, um, I would say some of the newest emerging research that's coming out. So with breast cancer, um, I didn't know this before this research came out, but your breast has, uh, its own microbiome. So that tissue within the breast, um, different bacteria are able to grow. And what they found was that in women who had breast cancer, they had high levels of certain oral bacteria in their breast microbiome. So the oral bacteria is called fusobacterium nucleatum, and they compared the breast microbiomes of patients who didn't have breast cancer versus those who had breast cancer.

Steven Bartlett 36:54 Sorry, what's an oral, uh, what's a breast microbiome?

Dr. Victoria Sampson 36:57 Just the collection of bacteria in your breast.

Steven Bartlett 36:59 Okay.

Dr. Victoria Sampson 36:59 Yeah. Um, I didn't even know there was a microbiome in your breast either, but (laughs) apparently so.

Steven Bartlett 37:04 Okay.

Dr. Victoria Sampson 37:04 And, um, so when they compared a healthy, um, woman, uh, her breasts to a woman who had breast cancer, the woman who had breast cancer had very high levels of the specific oral bacteria called fusobacterium nucleatum in their breast. Um, there's also been research on colorectal cancer. Um, and actually Apple News came out with something couple of months ago, which was nice to see them kind of just spreading the word. But what they found was that in patients who had colorectal cancer, um, more than 50% of them had the, the exact same oral bacteria from the breast cancer study, that fusobacterium nucleatum, in the colons. And what they found was that oral bacteria, uh, made the cancer more aggressive and harder to treat as well.

Steven Bartlett 37:53 I was reading about a study in mice, um, that linked that oral bacteria to tumor growth.

Dr. Victoria Sampson 37:59 Mm-hmm.

Steven Bartlett 37:59 Are you familiar with that study?

Dr. Victoria Sampson 38:01 Yes. And it's that specific oral bacteria, so the fusobacterium nucleatum, which has been shown to accelerate tumor growth, um, within mice, but also, um, for colorectal cancer and breast cancer as well.

Steven Bartlett 38:14 And what's your belief there? I know this research is fairly new, but do you think there is a, a causal relationship, a significant causal relationship between the health of our oral microbiome and our probability of developing some form of cancer?

Dr. Victoria Sampson 38:26 I wouldn't yet say causal. I think that for most cancers, it is multifactorial and there are a lot of things that can impact whether or not you get the cancer and how aggressive the cancer is. Um, I do think that oral health and some specific oral bacteria, um, are risk factors and can definitely increase the, um, aggression of those cancers or even the initiation of them. Um, there's also been research, and I think I'm waiting for the research to be published, on what they're doing is they've created a antibiotic which only kills that oral bacteria that I was talking about, so fusobacterium nucleatum. And they are going to be issuing that, uh, antibiotic to those patients who have the colorectal cancer which has the oral bacteria to see whether or not it slows down their progression or improves their, their prognosis. So if I see those results and it shows it, then there's for sure a strong causative link between the two. But for now, I would say that it's multifactorial and it's definitely a risk factor.

Steven Bartlett 39:31 That oral bacteria that you're describing, that you called it fusobacterium?

Dr. Victoria Sampson 39:35 Yeah.

Steven Bartlett 39:36 What is it that causes that? Is it something that I'm eating? Is it a lifestyle choice I'm making?

Dr. Victoria Sampson 39:41 Uh, multiple things. Poor oral hygiene. Um, some of us genetically will have higher levels of it. Um, it's what we eat, it's who we're kissing, it's what we're breathing in.

Steven Bartlett 39:51 Does my girlfriend have it?

Dr. Victoria Sampson 39:52 (laughs)

Dr. Victoria Sampson 39:54 So we would have to see.

Steven Bartlett 39:55 Okay.

Dr. Victoria Sampson 39:56 But it's, uh... And that's the thing, that's the beauty of being able to test these things now is that you can actually see, and also what's is strange is that green tea, um, you know, something so simple is extremely effective at killing fusobacterium nucleatum. So it's just knowing those types of things, being able to do the test, knowing the right treatment plans and recommendations based from that. We know green tea is good for us, and now we can really understand why.

Steven Bartlett 40:20 Okay, that's interesting. You, you have actually tested Jack over there, right? And you said to me before we started recording that he's got a ton of that fusobacterium.

Dr. Victoria Sampson 40:28 Uh, yes, he does. Yeah.

Steven Bartlett 40:30 And it's really getting out of control, that's what you said.

Dr. Victoria Sampson 40:31 It's really badly out of control, yeah.

Steven Bartlett 40:33 Thanks, Sylvester.

Dr. Victoria Sampson 40:33 So I've, um... (laughs)

Steven Bartlett 40:36 (laughs)

Dr. Victoria Sampson 40:36 I've given him a, a big vat of green tea as a gift.

Steven Bartlett 40:39 Green tea?

Dr. Victoria Sampson 40:40 Yes.

Steven Bartlett 40:41 Green tea. (laughs) This guy's gonna edit that out, this is the problem. (laughs)

Dr. Victoria Sampson 40:45 (laughs) Definitely. Cut it out.

Steven Bartlett 40:50 Green tea?

Dr. Victoria Sampson 40:51 Yeah.

Steven Bartlett 40:52 That's good for my oral microbiome?

Dr. Victoria Sampson 40:53 Yeah, really good.

Steven Bartlett 40:54 How?

Dr. Victoria Sampson 40:54 Stains, but really good. Um, it's anti-inflammatory, um, it helps with what we call oxidative stress. So this is, um, basically stress for the body. Um, and it's antibacterial, so it actually is very effective at killing fusobacterium nucleatum.

Steven Bartlett 41:10 What is your opinion of

Steven Bartlett 41:12 the impact that coffee has on my oral microbiome?

Dr. Victoria Sampson 41:15 I'm slightly biased because I love coffee.

Steven Bartlett 41:17 Okay.

Dr. Victoria Sampson 41:17 (laughs) Um, but there is no negative impact of coffee on the oral microbiome directly. Um, coffee does dry your mouth out, um, and so you have reduced saliva, and that can actually cause problems for the oral microbiome. So the saliva is super important in your mouth. It provides all of the food, the proteins, everything for the bacteria in your mouth. So it's kind of like this delivery service, your delivery, it's traveling around providing all the food and bacteria, um, sorry, food to the bacteria, and that's what keeps the good bacteria alive and happy. So when you have a dry mouth, let's say you're drinking lots of coffee or you're very nervous or you are on antidepressants, for example, um, which are a big one, then you just don't have as much saliva. So you, those bacteria don't have as much food, and those bacteria die, and then you get bad bacteria growing in replacement.

Steven Bartlett 42:13 What about tea? We're a nation

Steven Bartlett 42:14 of tea drinkers in the UK.

Dr. Victoria Sampson 42:16 Um, similar. So it also does dry your mouth, not as bad as coffee, but otherwise no problems other than staining.

Steven Bartlett 42:22 What about if I put loads of sugar in it? 'Cause a lot of people put a lot of sugar in it.

Dr. Victoria Sampson 42:24 Ah, okay, yeah. No, no, no. You never... No, no. So actually, sugar in your tea is even worse than you having a biscuit, for example. Um, so because the sugar dissolves in your hot tea, and the tea is hot when you drink it, um, it can actually cause more problems. Uh, another thing with sugar is, um, I have a sweet tooth, I love sugar, but it's about how you eat your sugar. So let's say if you have your hot tea with five lumps of sugar in there, and you're sipping it over an hour or two, that's where you start to see a lot of problems. So actually, you need to be having a sugar attack, so just all the sugar in one go. And that way, your mouth has all the sugar in one go, and it's able to neutralize the saliva and get back to a good state as quickly as possible. Every time you sip your, your tea with sugar, what happens is that the saliva has to go from acidic, back to neutral, acidic, back to neutral, acidic, and then it starts to just not work properly, and the saliva just stays acidic. And that's where you start to see decay.

Steven Bartlett 43:23 So you wanna just down the tea.

Dr. Victoria Sampson 43:25 Down the tea, or, I don't know if you're a M&M guy, have all your M&Ms in one go. Don't snack on M&Ms every 10 minutes.

Steven Bartlett 43:32 What about other drinks, like, I don't know, you know, Coca-Colas and these other sort of fizzy drinks that might have artificial sweeteners in, things like that?

Dr. Victoria Sampson 43:40 So they're not as bad as your natural sugars, um, but for example, something like your Coke or, or Fanta or whatever, it's also, um, very acidic, um, and it can actually cause erosion as well. So this is essentially where the outer layer of your tooth, so the enamel, is just worn away from having lots and lots of these fizzy drinks.

Steven Bartlett 44:00 Ah, okay. So it, it's not gonna

Steven Bartlett 44:02 cause decay in the same way, but it might change the acidic balance, which then decays my tooth, which makes me more susceptible to when I eat sugar-

Dr. Victoria Sampson 44:10 Exactly.

Steven Bartlett 44:10 ... to having a problem. Okay, got you.

Dr. Victoria Sampson 44:12 Exactly.

Steven Bartlett 44:12 So going back to what we were talking about, the, uh, the implications of an oral microbiome in the rest of my body, brain health is one thing that I was really curious about. Um, we've had lots of conversations on this show about Alzheimer's and dementia, and just general sort of optimal cognitive performance as I age. It's something I'm thinking a lot about. I wanna have a sharp brain. It's quite important because of what I do. Um, so is there a link between my oral microbiome and my cognitive and brain health?

Dr. Victoria Sampson 44:35 Yes. Um, so if we look at actually just the, the occurrence of Alzheimer's, um, and gum disease or, or oral health, a lot of research has shown that, um, if you have gum disease for more than 10 years, you have a 70% increased chance of developing Alzheimer's. So that was a study that was done on over 20,000 people, and they followed them for 20 years, and they saw, okay, if you had gum disease, um, at baseline, whether or not you get Alzheimer's at 10 years or 20 years. So a 70% increased chance of it. Um, they've also done a lot of research where, uh, they've been looking at oral bacteria, and what they found was that there are certain oral bacteria, so, uh, one called P. gingivalis, and that's one of the worst oral bacteria, I would say, out of all of them. So this P. gingivalis is able to travel from your mouth to your brain, I mean, it's only quite close by anyway, and what's unique about this bacteria is it's able to cross the barrier between, uh, in your brain, so the blood-brain barrier, um, and it releases these toxic enzymes. So these enzymes are called gingipains, and they're imagined as these, like, horrible firefighter things, and they can break down neurons, they can break down, um, a lot of brain tissue. And so when they looked at the cerebrospinal fluid and the brain fluid or tissue of Alzheimer's sufferers, they found that 97% of them had these toxic enzymes, these gingipains, in their brains, compared to zero for the patients who did not have Alzheimer's. So this is, you know, the first study shows, yes, there's some sort of correlation, but there's a lot of other risk factors. The second one, which was looking at your gingipains, is showing that there's definitely a strong causative factor, um, between the two. And then, another study which was very interesting was, um, looking at cognitive, cognitive decline. So okay, fine, you have Alzheimer's, unfortunately. Um, is it, is it too late? Should you stop brushing your teeth, or what's the point? And so what they did was they had, uh, patients, um, who had Alzheimer's, and they checked their cognitive function, and they also checked their oral health. And then, uh, six months later, they reviewed them, and they found that the patients who had gum disease had a much more rapid cognitive decline than those patients who didn't have gum disease. So again, it is still important if you do get Alzheimer's that you maintain your oral health, that you have someone help you brush your teeth, because your cognitive decline, um, will be faster.

Steven Bartlett 47:07 How do they unpick that from other causal factors that might be going on, like bad food choices? Because in my head I was thinking, well, if someone's drinking sugary fizzy drinks every day, they're more likely to have gum disease, but maybe also that the chemicals within that fizzy drink are impacting their chances of dementia. Maybe they're also someone that has an unhealthy lifestyle. Maybe they're more sedentary. If they're eating bad things, maybe they're more sedentary, and maybe it's that that's causing the rapid cognitive decline versus the gum disease itself. Is it possible to untangle all of this?

Dr. Victoria Sampson 47:41 I mean, it is very difficult. I think that for those types of things, you either... You're right, diet, lifestyle is super important. And we know that Alzheimer's is, again, multifactorial. Um, I think it's really about the quantity of patients that they check. So they need to be looking at a huge number of patients, and they did, um, to check whether or not there is a strong correlation between them. Um, also, going back to the gingipain study, so the one about the bacteria, that shows it doesn't, it's not diet or lifestyle or, or nutrition. It is a specific oral bacteria that has traveled to the brain and released these enzymes, which are then breaking down neurons. So there, there's definitely a strong causative, um, effect.

Steven Bartlett 48:24 That is, um, fascinating. It's really, really fascinating because dementia and Alzheimer's still seem to be a bit of a mystery.

Dr. Victoria Sampson 48:30 It is. And, and I work, um, with a, a team for Alzheimer's, and what they've done, similar to what you were saying, is that they've kind of separated all of the, the causes of Alzheimer's that we know, um, or the risk factors. And thankfully, they've put oral health as one of them as well. And I think from all of the other risk factors, so, uh, you know, for example, if you have, uh, the genetic mutations, you got the APOE4, or any of those mutations, that's, you can't change that unfortunately. Some of us have mutations which means that we are at a much higher risk of suff- of getting Alzheimer's in the future. But something like that oral bacteria, P. gingivalis, and those gingi pains, you can get rid of P. gingivalis really easily, again, if you tested it. You can even test for gingi pains, um, and then you can get rid of the bacteria before it starts causing problems.

Steven Bartlett 49:21 The test that you offer, does it test for gingi pains?

Dr. Victoria Sampson 49:23 It does, yeah. So we're the only ones, um, on the market who do, because that was something that I thought was super important. What's the point in us telling you that you have a bacteria if we can't tell you that that bacteria is being really bad in your mouth and causing a lot of problems?

Steven Bartlett 49:39 And people think I'm joking, but you have actually tested several members of my team, including myself, so w- I am actually gonna find out the results today.

Dr. Victoria Sampson 49:44 (laughs)

Steven Bartlett 49:45 Um, on the subject matter of the brain, uh, is there a link between my mental health, depression, anxiety, and my oral microbiome?

Dr. Victoria Sampson 49:54 So again, there's been a lot of research. Um, I think it's difficult for something like mental health and, um, and gum disease, which, you know, the chicken and the egg, which one came first. Um, because-

Steven Bartlett 50:08 Oh.

Dr. Victoria Sampson 50:08 ... one of the issues is, if you have a decline in your mental health, you are less likely to take care of your oral health-

Steven Bartlett 50:14 Mm-hmm.

Dr. Victoria Sampson 50:14 ... um, and therefore, that can exacerbate issues. So, there has been a lot of research to show that, you know, uh, there's a correlation between-

Steven Bartlett 50:22 Mm-hmm.

Dr. Victoria Sampson 50:22 ... poor mental health and poor oral health, but in my personal opinion, that causative connection is not there yet. Um, there's also been some research with things like schizophrenia, but again, it's the jury's still out, in my opinion.

Steven Bartlett 50:37 Are you able to tell the state

Steven Bartlett 50:39 of someone's mental health by looking at their oral microbiome, in your view?

Dr. Victoria Sampson 50:43 Um, you can know if something's up. Like for example, I, I had a patient relatively recently, I've been treating her for five, six years now, and I know that she takes good care of her, her teeth, she, she takes good care of herself. And a few weeks ago, she came in, and she was not taking care of her gums or her teeth at all. Everything was an absolute mess in there. And, um, so I did pull her aside, and I was like, "What's wrong? Like, something's happened here." And I think it is quite a big, um, sign for a lot of people, it's the first thing that they kind of let go of is their oral health.

Steven Bartlett 51:17 And is that because of, you know, they start certain self-soothing behaviors because they're stressed in other parts of their life? So if they're having a bad time in their relationship or work, and they're stressed, they might start eating sugar more or-

Dr. Victoria Sampson 51:29 Or just not brushing their teeth.

Steven Bartlett 51:29 ... smoking or drinking more?

Dr. Victoria Sampson 51:31 Yeah, yeah.

Steven Bartlett 51:31 Okay.

Dr. Victoria Sampson 51:31 Or just not brushing. Like with this woman, she just wasn't brushing her teeth anymore. Another thing that we can also see, I mean, it's kind of a bit on a tangent, but

Dr. Victoria Sampson 51:40 also, um, eating disorders as well. So things like bulimia, um, or even sometimes anorexia, you can see in the mouth. So there's a lot of times where we'll see young teenagers, um, and I'll know that they are bulimic because they have certain issues in their mouth which they shouldn't have. And that, again, is a telltale sign.

Steven Bartlett 51:58 Is that because the stomach acid is coming through their mouth?

Dr. Victoria Sampson 52:00 Yeah. So they get a lot of erosion on the, on their teeth, and then in some cases, you can also get these marks on the roof of your mouth. So if they're trying to force themselves to-

Steven Bartlett 52:09 Ah.

Dr. Victoria Sampson 52:09 ... to vomit, then you can see that. Um, and that's something that, you know, you have to pull the patient aside or tell their mother and explain that to them as well.

Steven Bartlett 52:17 And is there a

Steven Bartlett 52:18 relationship between stress and my oral health? So if I'm more stressed, and my cortisol levels are higher, is that gonna make everything in my mouth worse?

Dr. Victoria Sampson 52:25 Yes, it will.

Steven Bartlett 52:26 E- even outside of the lifestyle choi- choices I might make in such a state?

Dr. Victoria Sampson 52:29 Yes. Um, just that stress will increase your inflammatory markers, your inflammation. Um, it also will dry your mouth out. And all of those things will be linked. Um, uh, we do a lot of testing at my clinic, and so one of the tests that we look at is collagen breakdown. So, um, we have lots of different types of collagen all over our bodies, and our gums are made up of a certain collagen. So we look at an enzyme called AMMP8, and this enzyme is responsible for breaking down that specific collagen. Um, so we test the colli- that enzyme all the time with our patients. It's a really nice way of knowing, like, um, whether or not someone's about to have gum disease, um, how much collagen breakdown is happening from a biomolecular level. So I had a woman, very healthy, always been fine, um, and then she had her collagen breakdown tested, and her levels were through the roof. Her gums looked fine. She didn't look like she had any problems, but I've never seen such a high level in my life. And so, you know, I'm trying to think of what could be causing it, all of that. And she had lost her baby a couple of days before. And that type of intense stress on someone's body can have so many res- effects and impacts on the rest of your body. Um, and that was one of them. When we retested her six months later, she was back to normal again. But you can see even your mouth c- you know, stress can really impact you.

Steven Bartlett 53:52 On this subje- uh, I was thinking about,

Steven Bartlett 53:54 I just mentioned Jame- James Nestor earlier, who was telling me about the research of, um, how the, the mouth has changed shape because of the foods we're eating and how that, that's caused a bunch of downstream implications for us. One of the also, uh, o- one of the other things he also mentioned was about mouth breathing and nose breathing.

Dr. Victoria Sampson 54:11 Yes.

Steven Bartlett 54:12 And there's a lot of people that have become incredibly interested in whether we should be breathing through our mouths or our nose, and I was wondering if you had a perspective on that. Um, and also the other thing that he mentioned to me was that there's a link between mouth breathing and things like ADHD.... what is your point of view?

Dr. Victoria Sampson 54:30 I completely agree with all of that. So, actually, my sister, she is an orthodontist. Um, so she works at our clinic, a- and, um, you know, we run it together with our mother. And, um, she is very, very hot on, um, mouth breathing. And what she, um, mainly does is she basically tries to stop children in particular from breathing with their mouths open. And what she has found is that most of her patients, uh, who come to her, um, are mouth breathers. They often have some sort of, um, ADHD. They have, or some sort of attention deficit. Um, they are, uh, bed wetters. They grind their teeth a lot of the time, um, and they have a whole cascade of other problems, and, uh, she can treat it then, and it's relatively easy. She would argue that it's very difficult, but to me, I think it's easy. (laughs) I'm like, "Yeah, there we go, you can do what you do." Um, and because the, the jaws of a child are very malleable, so they haven't fully solidified, so you can still move things, you can, um, get the teeth to meet. So if you get the teeth to meet correctly, then, uh, the child won't want to breathe with their mouth open. The annoying thing is, is that, uh, a lot of adults are mouth breathers because their teeth do not meet correctly, or their jaws are in the incorrect position, and, uh, at that point, it is quite difficult to move the jaws into the correct position, or to get the teeth to close in a way so that the lips are at rest and you breathe with your nose instead of your mouth. But again, I see those types of patients because they all come to me with a lot of other problems, so again, same thing. A lot of them have, uh, a lot of them have suffered from long COVID. A lot of them have inflammatory conditions, um, h- are always tired, they, a lot of them, chronic fatigue. It, you know, there's a lot of connections now, uh, between mouth breathing and those types of issues as well.

Steven Bartlett 56:19 Is there a, a link between the health of my oral microbiome and whether I breathe through my nose or mouth?

Dr. Victoria Sampson 56:23 Yes.

Steven Bartlett 56:23 'Cause James was explaining to me that the nose is effectively like a, a filter system.

Dr. Victoria Sampson 56:28 Yeah.

Steven Bartlett 56:29 There's a certain temperature in there.

Dr. Victoria Sampson 56:30 Yeah.

Steven Bartlett 56:31 Um, there's, like, sinuses and stuff which are, have some kind of mucus which helps to catch bacteria. So if I'm breathing through my mouth, am I more likely to have a, a unhealthy oral microbiome?

Dr. Victoria Sampson 56:41 100%. So exactly the same thing. You're, you're, you've got a filter in your nose, and so it will stop a lot of bad things from coming through. But the mouth, uh, there is no filter. I mean, you breathe it in, it goes straight into your lungs, so there's no way of stopping anything. A lot of people now are starting to mouth tape, um, and that's become kind of trendy and cool. Um, it's not the easiest thing to do. It, it seems a bit weird to tape your mouth a- at nighttime. Um, but for anyone who's worried that they breathe with their mouth open, mouth taping, in my opinion, is a really nice way of just, like, testing it out and seeing whether or not you do breathe with your mouth open. Because you'll do some mouth taping, and you can see whether or not you sleep better, so if you have a wearable, you can see, "Oh, wow, my oxygen levels are so much better. I had such a deep sleep." And if that's the case, you might be more inclined to straighten your teeth or sort out the reason that you're breathing with your mouth open.

Steven Bartlett 57:35 And I,

Steven Bartlett 57:36 I, uh, took notes of a study which kind of is interconnected to the point we're making about mouth breathe- breathing, which said, "In a six-year study of 11,000 children, it was found that children who suffered from sleep-disordered breathing were 50% to 90% more likely to develop ADHD-like symptoms than were normal breathers who breathe through their nose correctly," which is absolutely staggering. 50% to 90% more likely to suffer from ADHD-like symptoms just because they breathe through their mouth at night-

Dr. Victoria Sampson 58:05 Yeah.

Steven Bartlett 58:05 ... and have disordered breathing.

Dr. Victoria Sampson 58:07 And it's, and it's mainly to do with also oxygen being delivered to your brain.

Steven Bartlett 58:11 Right, yeah.

Dr. Victoria Sampson 58:11 So there's not as much good oxygen, um, like, real, rich oxygen, filtered oxygen, traveling to the brain, and so that's basically not allowing your brain to function as well.

Steven Bartlett 58:22 You mentioned kissing earlier on.

Dr. Victoria Sampson 58:24 Yes.

Steven Bartlett 58:24 Um, I'm still supposed to kiss my partner, right?

Dr. Victoria Sampson 58:27 Yes. I hope you do, many times.

Steven Bartlett 58:29 You s- you said if I kiss her

Steven Bartlett 58:31 more than 11 times a day or something, then our oral microbiomes synchronize in some way?

Dr. Victoria Sampson 58:36 Yeah, so there is, um, passage of bacteria from you to her and her to you. Um, they have also shown that, uh, for example, they did a study where one, uh, partner chewed lots and lots of probiotics, so like good bacteria, and then had a super long smooch with their partner, and actually was able to transfer nearly 60% or 70% of that good bacteria into their partner. So it's not necessarily long-lasting. I wouldn't say that, um, you know, if you kiss someone once on a night out that you are going to terribly impact your microbiome. It's fine, you can go and kiss, but it's more for long-term partners. If you're kissing regularly and for a long time, then yes, your microbiomes will start to, um, be quite similar. Um, another factor as well is that obviously your lifestyles are probably pretty similar. You're probably using the same toothpaste, eating the same food, so it's difficult to fully put it on just kissing, but yeah.

Steven Bartlett 59:30 What about oral sex

Steven Bartlett 59:32 and the implications that will have? So if we're, if me and my partner are doing oral sex with each other, is that gonna impact our oral microbiome?

Dr. Victoria Sampson 59:40 Yes. So actually, there's been a few case reports which have shown, um, uh, there's one in particular, and, uh, I had a patient as well (laughs) who had this. A woman who, um, had a new partner, and she liked to perform oral sex on him, and then she came to me because she was complaining of very inflamed gums and she was getting gingivitis-

Steven Bartlett 1:00:00 Ugh.

Dr. Victoria Sampson 1:00:01 ... and, you know, it's not something I really ask. Like, I'm not gonna be like, "How's your, how's your sex life going these days?" Like, so I didn't ask it, but she kept on coming back to me, "No, my gums are still inflamed. No, my gums are still inflamed." And then she asked, she was like, "Is it maybe because I have a new partner?" And I was like, "Okay, maybe you guys are kissing a lot." And she was like, "No, no, no, no," and, and then she explained to me. Um, and then I was like, "Okay, fine, why don't you go and test and, uh, ask him, eh, whether or not he has any issues?" Um, and it turns out that he was having recurrent urinary infections, and so actually, they were transferring bacteria, and she was having inflammation in her gums because she was...... yeah, performing her oral sex. So yeah, there is transfer. Again, I wouldn't be scared and say never do it. Um, I once made an ex-boyfriend do an oral microbiome test, uh, (laughs) just to check and just to make sure everything was okay. (laughs)

Steven Bartlett 1:00:49 You made him do it?

Dr. Victoria Sampson 1:00:50 Yeah. (laughs) I don't, it's not a, it's not a, um, a prerequisite anymore, but it was at the time. I was like, "Uh, let me see, let me just make sure."

Steven Bartlett 1:00:58 Of course it is, of course it is. You must, you must think that when you meet people. You must think, "God, I wonder what their oral microbiome is saying," like, in a romantic context, 'cause you know the significance of it.

Dr. Victoria Sampson 1:01:05 Yeah, I think it's a... You know, I spend a lot of time and energy making sure my oral microbiome is very nice and balanced, so I wouldn't want anyone messing that up for me.

Steven Bartlett 1:01:14 Hmm.

Dr. Victoria Sampson 1:01:14 It's important.

Steven Bartlett 1:01:15 Are you in a relationship now?

Dr. Victoria Sampson 1:01:16 Yes, I am.

Steven Bartlett 1:01:16 Have you tested their oral m- microbiome?

Dr. Victoria Sampson 1:01:18 I've been trying to, but he won't let me. (laughs)

Steven Bartlett 1:01:21 (laughs) You- you've asked him?

Dr. Victoria Sampson 1:01:22 Yeah, of course I have.

Steven Bartlett 1:01:23 And what did he say?

Dr. Victoria Sampson 1:01:24 Um-

Steven Bartlett 1:01:24 Mind your own business?

Dr. Victoria Sampson 1:01:24 But I did give him an oral microbiome test, so hopefully he will just use it. I said, "You can even use a fake name, I don't care. I don't, I'm not going to test it. I'm not gonna check it."

Steven Bartlett 1:01:32 Ah, okay.

Dr. Victoria Sampson 1:01:32 "I just want you to do the test for me." (laughs)

Steven Bartlett 1:01:35 For- for you?

Dr. Victoria Sampson 1:01:36 For me, yeah. (laughs)

Steven Bartlett 1:01:38 And what's his, what's his rebuttal? He's like, "I don't..."

Dr. Victoria Sampson 1:01:40 He was like, "What happens if you break up with me if I have a really imbalanced oral microbiome?" And I was like, "I hope that our relationship is stronger than just your oral microbiome, but there's ways to fix it." And that's the beauty of the oral microbiome is that it's actually pretty easy to, to fix and to change.

Steven Bartlett 1:01:54 If his results

Steven Bartlett 1:01:55 came back and he had a terrible oral microbiome, one of the worst you've ever seen-

Dr. Victoria Sampson 1:01:58 Yeah.

Steven Bartlett 1:01:59 ... are you less likely to kiss him that day?

Dr. Victoria Sampson 1:02:02 That day, yes. (laughs)

Steven Bartlett 1:02:03 There you go. Don't do the test, my friend.

Dr. Victoria Sampson 1:02:05 No, no, no, that day-

Steven Bartlett 1:02:06 Don't do the test.

Dr. Victoria Sampson 1:02:07 That day, yes, and then-

Steven Bartlett 1:02:08 There's no upside to him doing this test. I completely understand.

Dr. Victoria Sampson 1:02:10 And then I would go and creep into his bathroom and change all of his oral products and-

Steven Bartlett 1:02:14 This is what he's scared about.

Dr. Victoria Sampson 1:02:15 ... personalize everything for him, and then-

Steven Bartlett 1:02:17 You've done that already?

Dr. Victoria Sampson 1:02:18 (laughs) I already have, yes.

Steven Bartlett 1:02:20 Yeah. (laughs)

Dr. Victoria Sampson 1:02:20 He tests everything out for me as well, 'cause I get a lot of products sent to me, so I'm always getting him to s- to try things out for me as well.

Steven Bartlett 1:02:26 Okay, so no blow jobs if they've got, um, issues down there?

Dr. Victoria Sampson 1:02:30 Yeah, yeah.

Steven Bartlett 1:02:32 Okay. And we don't really know if they've got issues down there unless they admit it or do

Steven Bartlett 1:02:35 some kinda test?

Dr. Victoria Sampson 1:02:36 Yeah, yeah.

Steven Bartlett 1:02:37 Okay. What about fertility? Is there a link between our oral health and our fertility?

Dr. Victoria Sampson 1:02:41 Yes. Um, so if we look at men to start with, um, there was a study done, and they found ... So they looked at a group of subfertile men, so men who, um, weren't able to conceive with their partners, and they checked all of their mouths, and they found that over 90% of these men had some sort of oral infection or dental disease of some sort going on. They split the group into two. Half the group had the, uh, treatment that was needed, so I don't know if they had gum disease or decay, they- they got it fixed, and the other half were left to their own devices. Um, after eight months, there was a 70% improvement, um, in their success for pregnancy, the men who'd had their oral infections sorted, um, and they had a much better improvement in their sperm quality and motility as well.

Steven Bartlett 1:03:33 And what did they do to those men in that group where they saw the significant improvement?

Dr. Victoria Sampson 1:03:37 So y- for example, if the man had, um, gum disease, they would treat it with, uh, hygiene, or if they had an infected tooth, maybe they would take it out or do a root canal or et cetera. They would just have to treat that infection. So, I speak a lot about gum disease all the time, but actually, there are so many other oral diseases, like decay, um, or toothache, or all those types of things, that can also contribute inflammation and problems.

Steven Bartlett 1:04:02 In that study, six months after, th- their sperm had improved by 20%, and after eight months, 50% of their wives were pregnant.

Dr. Victoria Sampson 1:04:09 Yes.

Steven Bartlett 1:04:10 That is staggering.

Dr. Victoria Sampson 1:04:11 Yeah.

Steven Bartlett 1:04:12 What about women, though? Is- is there a- a similar sort of result as it relates to women's fertility?

Dr. Victoria Sampson 1:04:17 Yes. So, um, research has also found that if a woman has gum disease, um, she is less likely to ovulate, um, and also she's going to have, uh, issues with conception. So, they've found that women with gum disease, it takes them two months longer to conceive versus a woman who doesn't have gum disease. Um, but once the woman has conceived, um, the issue is still not over. She still has to maintain her gums. So firstly, a lot of women will have, um, pregnancy gingivitis. So this is basically super inflamed, puffy gums because of all the hormones, um, and so they should be going very regularly to see their hygienist. Um, but also what the research has found is that women who are pregnant and have gum disease are at a much higher risk of preterm birth, so premature, uh, babies, low birth weight, um, and also preeclampsia as well. So, they did a study in Malawi. Um, it was on 10,000 women. So Malawi has the highest rate of preterm birth in the world, at just about, I think it's n- just under 20%. Um, and preterm birth is, uh, a big issue for- for governments, for hospitals. It's really expensive. You need to keep the woman and the child in the hospital for a lot longer, but also that child will have a whole myriad of problems afterwards as well. So weirdly, Wrigley's, um, the sugar- the chewing gum company, sponsored this, uh, study. They went to Malawi. They had these 10,000 women. They split them up into two. 5,000 of those women, uh, were given sugar-free chewing gum, toothbrush, and some toothpaste, and the other half were left alone. And they found that there was a 20% improvement, um, or 20%, sorry, reduction in preterm birth in the woman who'd had the sugar-free chewing gum compared to the woman who hadn't had it. So something so cheap and so easy like chewing gum was able to actually reduce the risk of preterm birth for these women.

Steven Bartlett 1:06:10 How and why?

Dr. Victoria Sampson 1:06:11 So, if you look into the research a little bit more ... Um, you going to get your chewing gum now? (laughs)

Steven Bartlett 1:06:17 Yes.

Dr. Victoria Sampson 1:06:18 Um, so sugar-free (laughs) chewing gum, um, has been shown to, um, stimulate your saliva, so it helps with what we were talking about earlier. Saliva's super important, um, when it provides all the good food for, uh, your bacteria. Um, but then also if it's sugar-free, um, let's say it's using xylitol, that's naturally antibacterial, so it's killing a lot of the bacteria in the mouth. And what they found is that there are certain oral bacteria that can travel down to the placenta, um, and can also, uh, cause problems there and essentially, um, increase the chance of preterm birth.

Steven Bartlett 1:06:52 You sufficiently convinced me that saliva is an important thing, and I actually did one of your tests.

Dr. Victoria Sampson 1:06:57 Okay.

Steven Bartlett 1:06:57 Let me go grab the results.

Dr. Victoria Sampson 1:06:58 Okay.

Steven Bartlett 1:07:00 Every

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Steven Bartlett 1:08:00 And here are the results.

Dr. Victoria Sampson 1:08:03 Okay.

Steven Bartlett 1:08:04 I've not actually seen them yet.

Dr. Victoria Sampson 1:08:05 No.

Steven Bartlett 1:08:05 So this is exciting. Um, I'll give them to you so you can explain them to me.

Dr. Victoria Sampson 1:08:09 Okay.

Steven Bartlett 1:08:09 Is that okay? So this is the test that I did, right?

Dr. Victoria Sampson 1:08:12 Yes, you did. Yeah.

Steven Bartlett 1:08:15 Okay. Uh, um, the test I did contains this little kit that-

Dr. Victoria Sampson 1:08:22 Yes.

Steven Bartlett 1:08:23 ... basically in the middle of the office one day, someone came up to me and said-

Dr. Victoria Sampson 1:08:26 (laughs)

Steven Bartlett 1:08:26 ... "Steve, can you spit in this?"

Dr. Victoria Sampson 1:08:27 (laughs)

Steven Bartlett 1:08:27 And I said, "Sure."

Dr. Victoria Sampson 1:08:29 Yep.

Steven Bartlett 1:08:29 And then they took my spit away.

Dr. Victoria Sampson 1:08:31 Yes.

Steven Bartlett 1:08:31 Um, and it turns out it was upon request from you.

Dr. Victoria Sampson 1:08:35 Yes, exactly. I wanted your saliva.

Steven Bartlett 1:08:37 Yeah, which is-

Dr. Victoria Sampson 1:08:37 Just to check to make sure if I could do this interview as well, so. (laughs)

Steven Bartlett 1:08:39 Oh, right. Okay. So this is the test that I did. I spat in this little thing.

Dr. Victoria Sampson 1:08:44 Yes.

Steven Bartlett 1:08:44 Sent it off back to you, you ran the test, how long does it take to do this test?

Dr. Victoria Sampson 1:08:48 Uh, it would probably take you about two minutes to do sp- uh, yourself, and then you get the results three to four weeks later.

Steven Bartlett 1:08:55 What did you find out from doing my test?

Dr. Victoria Sampson 1:08:58 (clicks tongue) Well...

Steven Bartlett 1:08:58 Okay.

Dr. Victoria Sampson 1:08:59 Let's go through your results. So, um, we found that you have quite a diverse microbiome, so that means that you have a nice ratio of good bacteria versus bad bacteria. And this has been compared to healthy and diseased subjects, so you are really right on the top of the bell curve, so very good with that, so happy. Um, then we predict your-

Steven Bartlett 1:09:21 Diverse is better?

Dr. Victoria Sampson 1:09:22 Uh, arguably yes. Yeah.

Steven Bartlett 1:09:23 Okay.

Dr. Victoria Sampson 1:09:24 Um, then what we have is we've created this algorithm that predicts your risk of certain, um, issues or diseases in the mouth, so those are things like bad breath-

Steven Bartlett 1:09:33 Mm-hmm.

Dr. Victoria Sampson 1:09:33 ... gum disease, um, decay, and general inflammation. So your risk of bad breath was low. You didn't have a, a high risk for that. Gum disease was medium.

Steven Bartlett 1:09:44 Okay.

Dr. Victoria Sampson 1:09:44 So slight, maybe there's a bit of inflammation going on there. Your risk for, uh, decay was also medium, and your risk for general inflammation, so this is inflammation throughout the rest of your body, um, was quite low. Um, and then if we zoom in, we then look at your good bacteria. So we're also quite unique because we thought that it was unfair that a lot of tests don't look at the good stuff. So we look at all of the bacteria which has been shown to be the most beneficial in a microbiome. So for you, you had pretty much high to very high levels of, uh, good bacteria, which is great. Uh, no problems with that. And then we look at bad bacteria, so we actually, uh, look at about 500 different bacteria, but then we zoom into the top 20 bad ones which are really associated with things like gum disease, decay, bad breath. So for you, out of all the bacteria that we looked at, you only had quite high levels of one bacteria, which was bad for you. Um, and so this bacteria is very strongly associated with basically, uh, a lot of buildup of, um, plaque in your mouth. So having not looked in your mouth, I have no idea about your dental health or anything like that. I would assume that basically, um, you're a bit overdue on the hygiene maybe, maybe there's a lot of plaque buildup going on, um, from that result. But the rest of the bad bacteria, so all of these ones we're talking about, your-

Steven Bartlett 1:11:07 The erectile dysfunction one was-

Dr. Victoria Sampson 1:11:08 Your erectile dysfunction one's fine. Um, your P. gingivalis is fine, you know, F. nucleatum, those ones were actually, uh, very good. Um, then also on top of that, going back to the Alzheimer's, so we look at those virulence factors associated with P. gingivalis, and you had none of those virulence factors, which is also really good.

Steven Bartlett 1:11:28 Okay.

Dr. Victoria Sampson 1:11:29 Then we look at your genetic mutations. So, uh, we've identified about 10 different genetic mutations which increase your risk of decay and gum disease. So, uh, for the decay, out of the five genetic mutations we looked at, four out of five of them you had. So that means that you, and maybe you, you have stopped it, but you are at a higher chance of having a sweet tooth, of having more acidic saliva. On top of that, it might be that you, if you're stressed out or you're really unhappy, some people will run to the casino, others will run to the bottle, and for you, you might actually be someone who goes and has a chocolate bar and actually enjoys sugar.

Steven Bartlett 1:12:08 No comment.

Dr. Victoria Sampson 1:12:09 Um, on top of that-

Steven Bartlett 1:12:10 None of your business.

Dr. Victoria Sampson 1:12:10 (laughs) Let's say you had your sugar because you are stressed out or whatever, you also have been shown to have a genetic mutation which means that your taste perception is lower, so you need two bars of chocolate, not just one-

Steven Bartlett 1:12:24 No comment. No comment.

Dr. Victoria Sampson 1:12:25 (laughs) ... to make you feel-

Steven Bartlett 1:12:26 That's the end of this podcast.

Dr. Victoria Sampson 1:12:27 ... happier. (laughs)

Steven Bartlett 1:12:27 That's the end of this episode.

Dr. Victoria Sampson 1:12:28 I'll give you my card afterwards.

Steven Bartlett 1:12:29 Close the file. Yeah. (laughs)

Dr. Victoria Sampson 1:12:31 (laughs)

Steven Bartlett 1:12:32 Close your document. Have a day. (laughs)

Dr. Victoria Sampson 1:12:35 (laughs)

Steven Bartlett 1:12:35 No, I mean, it all, it all squares with reality, so please do keep going.

Dr. Victoria Sampson 1:12:39 Um, so that's your decay, uh, situation. In terms of gum disease, again, we look at, um, certain mutations. So there are some mutations that can triple your risk of gum disease. Um, they can increase the amount of inflammation that you release from your mouth. So imagine, um, you, there are some people who even the smallest amounts of bacteria, they might have great hygiene, if they have a few small bad bacteria in their mouths, they have mutations which means that they respond in a very hyperinflammatory and very aggressive way, and they will be at a very high chance of gum disease. So in your case, um, you had one mutation...And I would say, out of all of the mutations for gum disease, it was the best one. So it basically means that you have, um, genetically, you're more predisposed to bacteria collecting around your gums.

Steven Bartlett 1:13:28 Okay.

Dr. Victoria Sampson 1:13:28 So you might be someone who actually needs to go really regularly for a hygiene, and it's kind of a bit annoying because you keep on getting buildup, or they keep telling you to come back because actually, genetically, you have that in your saliva.

Steven Bartlett 1:13:40 Mm-hmm.

Dr. Victoria Sampson 1:13:41 Um, then afterwards, we give you personalized recommendations. So we tell you based on, um, everything that we've seen, the bacteria, your mutations, what, your input from the questionnaire, we tell you what toothbrush would be good for you, what supplements you should be taking, what, uh, toothpaste, floss, um, everything basically, even chew sugar-free gum, all of those types of things to, um, improve your oral health and rebalance your microbiome.

Steven Bartlett 1:14:07 And you can tell all of that just from me spitting in a tube once?

Dr. Victoria Sampson 1:14:10 Yes. And then at the very end, we have a list of all of the detected organisms. So like I said, we look at the top 20, which we know are really bad for you. But actually, sometimes, in some patients, we'll have like w- weird bacteria, really high levels of weird bacteria. So I had one patient, she had really bad breath, and her gums were kind of okay, her teeth were okay, there were no problems, but she was like, "I don't know what's going on." So she did the saliva test, and she had 40% of her oral microbiome was made out of one bacteria. So, uh, I was searching this bacterial, so I've never heard of this bacteria before. It is extremely prevalent in dogs. So then I get back to her, I'm like, "Do you have any dogs?" And she was like, "Yeah, yeah, four, four or five dogs at home." And I was like, "Do you kiss your dogs?" She was like, "Yeah, yeah, of course I do. Like, they're my, they're my babies." So she was kissing her dogs, and she was getting transfer of bacteria from her dogs into her mouth, and that was what was making up her whole microbiome. So what-

Steven Bartlett 1:15:02 And that was giving her bad breath?

Dr. Victoria Sampson 1:15:04 Yeah.

Steven Bartlett 1:15:04 Yeah.

Dr. Victoria Sampson 1:15:04 So what I did was I gave her, um, a, a treatment, so recommendation-

Steven Bartlett 1:15:10 A muzzle.

Dr. Victoria Sampson 1:15:10 (laughs) Eno, I gave all of her dogs, I said, "You need to take this specific..." um, it's not medication, it's like a supplement. So it basically stops, uh, like buildup of plaque in dogs' teeth. So I was like, "Your dogs have gum disease basically, so they need to be treated if