Your Oral Health’s Role In Memory

Howard Hindin, DDS

Thank you for having me here. It’s a pleasure.

Dale Bredesen, MD

Let me just start by asking about how you got interested in this to begin with.

Howard Hindin, DDS

Well, even though I was a dentist back in the 19th, early 19th, and late 1970s, I became interested in acupuncture as my first licensed or certified dentist in acupuncture in New York State. I started looking at things beyond what I was taught in dental school. There is a lot. Dentistry, mostly because of the way we’re taught to deal with repair problems. Why they’re caused so early on? I was always interested in nutrition, so I loved surgery so early on in my career. I took 25 patients, 10 of whom I had surgery on, and I just improved their nutrition after the surgery. The surgery patients looked far better. After six months, you couldn’t tell the difference after year one. All we did was fix nutrition. We’re doing better. That led me down a path where I got involved in other things beyond nutrition, looking at the airways, sleep, breathing, and things related to something called heart rate variability, where we measure physiology which ultimately led me to start this organization. Another dentist, Michael Gelman, and I were sitting and having breakfast, and we said we should never have to see the patients we see because the problems that we see existed decades before, which is the same thing you’ve been saying.

Dale Bredesen, MD

No. That’s very helpful. We’re very interested, of course, in actionable items. How can we get better outcomes for people who are either suffering from cognitive decline or at high risk for cognitive decline? Let’s just go through them because there are so many things related to oral and systemic health. The first issue, I guess, would be: let’s go back to the breathing issue. You know, CPAP is everywhere. A lot of people don’t like it. A lot of people won’t stick with it. I see this all the time. yet they end up living with sleep apnea, which is often something that is an important contributor to cognitive decline. From your standpoint, what is the best way to approach this as far as, the airway, as far as sleep apnea? What is the best way to deal with this? From all the wonderful studies you guys have looked at, what has emerged as the best way to deal with this?

Howard Hindin, DDS

Sleep apnea, by definition, is a lack of breathing. It’s measured by something called an AHI number of times in the night. We either stop breathing or we have a 50% increased effort in breathing through our divided over the night. That gives you a score.

Dale Bredesen, MD

Yes.

Howard Hindin, DDS

The effective ways to treat apnea are with CPAP, as you mentioned, oral appliances, weight loss, and surgery. Those are the only four ways in and out of surgery. I’m including something called Inspire, which is the hyperglycemia nerve stimulator, which is like a pacemaker for the muscle under the tongue that would pull the tongue forward out of the airway. Those are the only four ways. However, often, if somebody has a score, let’s say, of 30, and they get any treatment, it comes down to 15. What a great job we’ve done. We’ve reduced it by 50%. But they’ve shown that you do not see health benefits, whether it’s blood pressure or diabetes unless you get that number under five. One of the problems is, whether is it effective. A lot of people get the CPAP or get an oral appliance at the end of treatment, but it can’t be at the end of treatment. That patient has to be monitored. Things change over time. There’s a battle between the School of CPAP and the School of Appliances.

But there are instances where using both together may be the solution to the problem. When the person who invented it came up with the idea of AHI at the end of his life, he said what a disservice I did to the medical community by using that as a guide, because maybe a better indication is the ODI, which is the oxygen saturation index. How many times during the night do we have a 3% or 4% D saturation so that if you think that a normal, healthy oxygen level is 96, 97%, or 3%, a 4% reduction would be 94, 95%? If you have that many times a night with or without apnea, then there could be little micro insults to the brain, which over decades will be a precursor to any dementia or brain trauma, number one. 

The other thing is that every time that happens, it sends a message to the brain that we have a problem, and it alters it, keeping us in a sympathetic state, which is a state where we can heal. We have increased inflammation and all the wonderful things that happen at night while we’re sleeping. Our brain is cleansed. We balance our metabolism. We balance our immune system. We reduce our bacterial load. It doesn’t happen unless we can get into that restful, relaxing, parasympathetic state.

Dale Bredesen, MD

Very interesting. What about these devices that increase airway size? They are a little bit like a retainer, but not for your teeth. More for your airway. Have you used those devices, and what do you think about them?

Howard Hindin, DDS

Our tongue is the front wall of our airway. Anything in our mouth is too small, too narrow, or we’ve worn our teeth down or lost teeth. Then there’ll be less room for our tongues. then it only has one place to go, back.

Dale Bredesen, MD

Okay.

Howard Hindin, DDS

When and when that happens, it’ll make our airways smaller. Any of these devices, what they can do is they can give you more height and they can bring your jaw forward. They can’t make your jaw wider, so if your deficiency is in one of those two dimensions, it will be more beneficial than if your deficit is a narrow arch. That’s why a CPAP works by blowing air at an increasing amount of velocity down this airway to prevent the soft tissue of the airway from collapsing while an oral appliance will bring it forward and keep it open. Sometimes the two of them work well together because the upper appliance will keep the tongue forward, and you can reduce the amount of velocity you need for a CPAP because a lot of people don’t wear it. They feel like they’re drowning in the air so the two together are often the best solution.

Dale Bredesen, MD

Excellent. All right, let’s move over to the microbiome for a moment of so much coming out. Of course, there’s been a lot in the last decade-plus on the gut microbiome, but of course, it’s turning out that the oral microbiome and the sinus microbiome as well as other skin microbiomes, etc. are turning out to be important players, especially the oral microbiome. With all the attention given to P.gingivalis in the brain, you find it in the brain; you find it’s gingipain. Of course, one biotech company has put a lot of time and effort into inhibiting that one specific Syrian protease in the gingipain in patients with Alzheimer’s. although, though the initial trial failed, there were some good takeaways. As I understand it, they’re now going to do another trial focused on people who had P.gingivalis. Tell me a little bit about what’s your favorite test for evaluating the oral microbiome.

Howard Hindin, DDS

There’s salivary testing that’s done by a different company. There’s Oral Diagnostics? But there’s a new company that’s just come out called Biome. I’m familiar with that company, but they use  RNA testing as opposed to DNA testing, and they get a lot more detail. I just had a call with them, and one of the things that they can tell is whether a certain bacteria is present and active. Just because something is there doesn’t mean it’s causing a problem. As you know, as a result of a conference, we’ve created this group of 24 dentists who are going through your protocol together. One of the things I’m looking at is having everybody do that testing with Biome to see if there’s precedent for active pathogens and see where they’re doing something else, like just improving the sleep or diet, will change active pathogens to non-active pathogens because, in dentistry, the traditional method of dealing with this is to scrape them away and get rid of them. If that doesn’t work, you give antibiotics and sometimes anti-spirochete medications like Flagyl to do that, but they found that after you finish treatment, bacteria will grow back in the same proportion that it was before. Now they were looking at probiotics. However, in periodontal disease, having no disease is considered an autoimmune disease.

What often happens is that it’s as much the response of the patient as it is the bacteria that are present, and being able to calm down the inflammatory process through an anti-inflammatory diet or better sleep, which reduces inflammation, or being dressed into control because college students around exam time would always come in with rampant gingivitis. Then, once the exam season was over without any other treatment, it got better. Stress can have an effect. The question is, we talked about these risk factors, but you can’t separate them. You have to look at what else is happening, and about what you said before, p.gingivalis is one of the bacteria that’s been identified as a component of heart disease and dementia. But when there’s a predator on the condition, this bacteria can also get into the gut, and then it will alter the gut microbiome and allow species that don’t belong there to grow. Even though we think of these gut dry skin microbiomes, the oral microbiome and the gut microbiome being separate, it’s not that they can, it’s the opposite of Las Vegas. We see what happens in Vegas stays there. What happens is that the mouth doesn’t stay there very well. What we try to do is try to look at what else is going on in the body that could be a factor. Certain bacteria PH of the saliva. We do salivary testing. We would like to get somebody to be slightly alkaline, yet people in alkaline mouths can’t get decay because the bacteria that cause tooth decay, streptomycin mutants, cannot live in that environment. Yes, oral pathogens are important, but you need to take a broad-spectrum approach to the problem.

Dale Bredesen, MD

How do you then accomplish this to keep things slightly alkaline? Does it have any negative impact on enamel?

Howard Hindin, DDS

No, it doesn’t have any negative action. But the way we try to get people to change their diets, vegetables are alkaline; everything else is acidic. You want to have a diet higher in vegetables, which, when you think about it, is the diet that’s recommended in your protocol. We want to have a diet. There’s a way of alkalizing drops. You can take half a teaspoon of baking soda in water, which will also help neutralize it. People can get PH paper and test themselves at home and test themselves in the morning. Now, if you find that you’re doing well, but in the morning, you tend to be more acidic, that could be related to a sleep problem because you’re not sleeping well and are more in an acidic, sympathetically upregulated state.

Dale Bredesen, MD

Interesting.

Howard Hindin, DDS

Okay. By helping people with their diet, you are giving them control over their health. Yes. You know, most of the traditional drop treatments—scraping, removing the plaque, and doing surgery—take away control of the patient’s health,  which I think is a big disservice that we’ve done over the years as we become more specialized.

Dale Bredesen, MD

Yes. Then, in our first clinical trial, we published a year and a half ago, we used Dentalcidin, and for people, I know at your conference, one of the points made was that these probiotics seem to be even superior. My question is, number one: do you ever use, first Dentalcidin, to get rid of some of the pathogens and then come in with probiotics? Second, what are your favorite probiotics? Oral probiotics?

Howard Hindin, DDS

I think that’s a good approach. Because anyone is never going to have a sterile mouth, you always want to know that there’s always going to be bacteria. You want to reduce the bad bacteria and encourage the growth of the good bacteria. The different ones work better for different patients. Recently, I met a researcher who has a company called Phyto Dental Solutions that makes products based on cannabinoids. They’re taking out some of the trendy products. He claims, and he just sent me a sample to test, that his products can reduce the bad bacteria without reducing the good bacteria, which I think will be great because most of the products you use today kill everything. Then you try it with good probiotics. Then when they’re looking at that, the most favorable traditionally is the lactobacillus trying to put. The probiotics that contain that seem to be the most favorable ones that I’ve been showing the best benefit today.

Dale Bredesen, MD

Interesting. Okay. For the ones that you don’t want to see, of course, we tend to think of you as P. gingivalis, T, Denticola, F. Nucleatum, Prevotella Intermedia. Are there others that concern you?

Howard Hindin, DDS

Well, any of this spirochete would be a concern. They did a study where they showed that when somebody loses an implant and they do testing around that, there is always a spirochete that is interesting around that. In our practice, we’ve treated a lot of people with chronic Lyme disease. Lyme disease can mask a TMJ problem or something else because it seems that whenever there is an injury or problem somewhere, the dormant Lyme spirochete will go to that site. I think that’s a factor too.

Dale Bredesen, MD

Okay. In our trial, we also sent everyone to dentists and did a cone beam analysis because some people, of course, have these undiagnosed abscesses. What triggers you if you’ve got someone who’s got problems and typically, cognitive problems? What triggers you to want to get cone beam analysis?

Howard Hindin, DDS

We have a cone beam in our office. Every new patient we see gets a cone beam regardless because we don’t know what’s not that. Before that, there are things that we have uncovered with a cone beam that we would have never seen. We’ve observed calcification in the carotid arteries on their own. We’ve picked up cancer; we picked up other, other things. If it’s a new patient, we think that they may not have had as much of an in-depth exam before. I don’t want to go back two or three years later and find there was something there that I could have found before, especially if you take somebody’s health history, what chronic diseases they’re fighting, and what medications they’re on. You want that information, and what’s amazing about new patients is that we find that some patients are being treated by multiple physicians who don’t know everything that they’re taking. There’s no good communication.

Dale Bredesen, MD

Then let’s talk for a minute about root canals. Here’s another concern: People who’ve had root canals, do you have an algorithm or do you have a feeling about them? When should these come out? Are you concerned about them? Can they be sterilized? Are these a problem? What is your method of analyzing people who have root canals?

Howard Hindin, DDS

Well, that’s a very interesting question, or that there are people who have symptoms. They will say that I’ve never felt the same. I never felt it. It always feels funny. Yes. Ever since I’ve had the root canal. Then a normal, regular x-ray is taken, and everything looks fine. Then you do a cone beam, and it doesn’t look fine. That would be something like that. That would be considered if somebody says, What we like to do is do a medical history and I’m one column and a dental history and the other column. If there’s been a change in history when somebody has had a root canal, then that’s suspect. Then there were root canals. They just don’t look good. That could be a problem. 

If somebody is having major restorative dentistry done and one of those root canal teeth is going to be the foundation for a bridge or something, we may consider removing it and replacing it with an implant. On the other hand, some people believe no root canal is good and should be taken out. But then removing all those teeth can also present a problem for people. But if somebody has no health issues, then I will leave. The root canals look okay. They would be okay. I wouldn’t do it. I don’t have any root canals in my mouth. I’ve been fortunate. But if I had to lose a tooth or have a root canal done, I would probably think long and hard before I did. They take out the tooth instead of doing the work now.

Dale Bredesen, MD

Yes. Okay.

Howard Hindin, DDS

It is very young to be 83 without any root canals. So far, so good.

Dale Bredesen, MD

Yes, you’re doing great for 83. I’m impressed. This is a big issue for people because you’re talking about, losing a tooth, and at the same time, when you’re talking about someone with cognitive decline, you’ve got to identify what’s driving it or you’re going to lose the person. This becomes an important issue when you decide to leave it when I’m out.

Howard Hindin, DDS

There, somebody is looking to find the root causes. It’s a pun for their dementia. I would look at the root canals very carefully. The ultimate decision is up to the patient and what they want to do. If they’ve improved their diet, they’re exercising more to manage their stress. then things are improving; their market scores are improving. You may say, well, let’s watch it. But, if it’s not, I would rather sacrifice the tooth if it was suspicious and protect the brain.

Dale Bredesen, MD

Yes, it’s a great point. If you’re going to sacrifice the brain to keep the tooth, that doesn’t make a lot of sense. That’s helpful. Let’s now move to toxicity. Of course, it has been striking for years that you can get what looks like identical Alzheimer’s pathology simply by giving someone mercury. Of all the metals, it’s the one that gives you more than anything else. True Alzheimer pathology. Well, of course, others can contribute things like lead, arsenic, cadmium, and things like that. Of course, a lot has been written about aluminum, but mercury is the one that gives you the pathology of Alzheimer’s, most strikingly. This comes up all the time. People say, Do I need to get my amalgams out? I guess the first question is, What is the current feeling about putting in amalgams?

Howard Hindin, DDS

We haven’t done it. I haven’t done a mercury filling since 1970. I was one of the first dentists to eliminate mercury from my practice, accused of being communist in all sorts of things. But I came to the belief that, from what I knew at the time, I couldn’t put it in a family member or somebody I liked. My partner at that time said, Well, can’t we just use up what we have? I said I hope so. We didn’t, and I don’t think there’s any place for it in practice. When I started in practice, over 95% of restorations were mercury fillings. Now it’s less than 20%.

Dale Bredesen, MD

Yes.

Howard Hindin, DDS

It’s usually the people in the underserved communities who are who they are and who have this done. There are so many equally or better materials today. The question is, if you have them, who should have them taken out?

Dale Bredesen, MD

How quickly. One or two at a time. All of them. This is one of the concerns. We had a case that we heard about, unfortunately, for a woman who was just taking wonderful care of her mother but took her to have many amalgams taken out all at once. The next day, she had a cardiac arrhythmia and passed away. Now, it’s not clear that that had anything to do with having all these things taken out, but it raised concern. Do you like to take out one or two at a time and then wait a few months? Or do you like to take out all of them at a time? If someone’s got it, let’s say they’ve got six or eight of them back.

Howard Hindin, DDS

Number one is that if you’re taking out all of them, that’s a traumatic procedure. Forget about that; it’s mercury. Somebody in the chair—how many injections of anesthetic are you going to give them? Someone like this patient may have had five or six copies. Was of anesthetic with epinephrine preserved in that, which might have been the cause of the problem we have. We move them a quadrant at a time or more without any problems like that. As long as you know the patient you’re treating, what is their condition now? Are they able to tolerate being in a dental chair for 2 hours? Are you using a rubber dam? Oxygen. We have them rinsed with chlorella. Even so, anything that gets around them, like a rubber dam can, will cause the chlorella to just act like a mop, picking up any leftover mercury, and then, if some, we also want to know whether they’re an APOE4 for those people they don’t detoxify well. You might need to do some preparatory work to prepare them for the removal.

The other thing that we found personally is that we had people that we and I’ve been doing this for many years, and we removed all the feelings. Some people notice remarkable changes in their health. I have miracle stories, and we tried out our miracle stories, and our people, whom I thought would do better, wouldn’t do better. These are the same people who remain patients. then we later treated their sleep. All of a sudden, they got even. They got better. We look at what their sleep is before we consider what we would consider removing their fillings; that’s part of the preparatory work, and we want them to be alkaline because people don’t detoxify well if they’re in an acid state. Removing them isn’t, and this is the big problem. The big problem, I believe, is that somebody says, Yes, you want your fillings removed, will remove them, and they don’t do a complete assessment of the patient. If somebody has a negative impact from mercury fillings, you have to treat it as an important problem, not just say, sure, we’ll take them out and replace them with because, after 10 or 15 years, there’s very little mercury leaking out of the fillings.

The biggest exposure is going to come when you drill them out and create this vapor that could be a problem. If you’re going to do that, you want to make sure that’s going to be okay. You do want to make sure that they can be replaced with other fillings, or are the teeth going to need crowns? Is that going to threaten the tooth? You might end up needing a root canal on one or more of those teeth. There’s a lot to be considered. Everything that we talked about—airways, periodontal pathogens, toxicity—they’re all related. You can’t separate them. There’s not a fence between them.

Dale Bredesen, MD

If you go back to your, you mentioned the big success stories and the miracle stories. Did those people have high blood levels of mercury, or is that not helpful to us to look at? Because I know people I hear from frequently will say, Look, I’ve got a bunch of amalgams, but look, my mercury level is normal. Do I have to have these out?

Howard Hindin, DDS

That if you’re exposed to mercury, it gets transported through the blood, and it’s dropped off somewhat? Once the mercury exposure has been done, you’ve had the exposure, and it’s been shipped and dropped off into tissue somewhere. The mercury isn’t going to show high levels. If you do red blood cell mercury, it might show a bit better level. They look at urine mercury also, and they do a provocative test where you give somebody a chelating agent like the DMCA or DMPS, and you look at the difference between a no and a no chelating agent. With that, that might show something. But then again, somebody might have been eliminating mercury through their stool more than the urine. There are a couple of labs that do that. Even if you do urine for mercury, the urine for mercury may not be high, and some other metals might be higher. Being curious, back in the early days when I was doing this, I took a couple of patients and had them do a urine test every week after we finished. It was amazing that one week the mercury would be high, the next week arsenic would be high, and something else would be high next week. Then another week, the mercury would be high again. What would happen is that whatever is most available to come out comes out, when we use things like chlorella or, sulfur-containing foods, eggs. I have people start on a diet before we even begin the process. Protect them.

Dale Bredesen, MD

Well, let’s talk a little bit about gingivitis. I know that people will get periodontitis, as you talked about earlier. But what about the person who says, Look, I don’t have any root canals; I don’t have any major problems, but when I brush my teeth each night, each day, or whatever, I see blood in the sink when I spit? What do you recommend for this person who has chronic, mild gingivitis?

Howard Hindin, DDS

First of all, I always ask people: Is there any other part of your body that would bleed when you touched it that you would accept?

Dale Bredesen, MD

Yes. 

Howard Hindin, DDS

Because bleeding gums are not normal. Again, what’s the root cause? Is it that their home care isn’t good? Is it that their mouth is alkaline? Maybe they’re a mouth-breather and at night can’t breathe through it. Mouth tissues dry out, which makes them more susceptible to bleeding.

Dale Bredesen, MD

Yes.

Howard Hindin, DDS

But If you have gingivitis and you don’t get the cause of it, it will become something else, and it won’t stay gingivitis. Gingivitis. It’s so wonderful that somebody has gingivitis because it gives you something easily treatable and reversible and an early warning sign. But yes, there’s so much medicine today. We ignored the early warning signs that it’s not a big deal.

Dale Bredesen, MD

What are your favorite treatments, or what is your favorite treatment for gingivitis in general?

Howard Hindin, DDS

In general, it’s improved home care, flossing, and brushing. Check your PH, and check if you are alkaline. Check your sleep whether you’re sleeping well, or maybe you’ve just become a habitual mouth breather. Try taping your mouth at night. In a very light silicone tape.

Dale Bredesen, MD

Do you have a favorite water flosser, and do you suggest that people should get water flossers? Yes, something like a water pick, that thing. Does that help?

Howard Hindin, DDS

If somebody has trouble manipulating the floss, they can become like a water picker. There are so many different companies. I think the only caveat I would say is that you never want to use it at full force, and you always want to direct it parallel to horizontal. Don’t push it into pockets because you don’t have any. It’s just going to be it’s going to be you’re going to cause more bleeding. Some use one of these devices, and they think that I get a lot of bleeding when I do it. That’s a good thing. It’s not a good thing.

Dale Bredesen, MD

I make a very good point. Is there anything else we should talk about concerning oral systemic care and cognitive decline?

Howard Hindin, DDS

I think one of the problems is that there aren’t enough practitioners doing it well, which is what we’re trying to teach. I don’t know who was going to be viewing this, but often changes occur because the public demands the changes. My message would be that if you think that this has any value, make sure that when you go to your dentist, you ask for all these things. You ask them to check these things. because I believe that dentists play a very important role, not only in looking at the risk factors for dementia but for all the other chronic diseases. More and more dentists are doing that. You were one of our keynote speakers last year, at our Collaboration Cures conference, it’s called Collaboration Cures because no one practitioner has the answers or health care. The medicine of the future is going to be personalized for the patient. You bring in the team members from different practice parameters that will deal with them ideally. 

Dale Bredesen, MD

Fantastic. Thank you very much, Dr. Hindin. I think it’s become very clear that better oral care means better cognitive outcomes. This is such a critical area. Thanks very much. It’s great to have you here at the Reverse Alzheimer’s Summit, and I look forward to talking to you next time.

Howard Hindin, DDS

Thank you, Dale.