EPISODE 241

[INTRODUCTION]

[0:00:01] ANNOUNCER: Welcome to the BetterHealthGuy Podcast, where we take a deep dive into complex chronic conditions and explore ways to build resilience, improve vitality, and achieve better health. To stay updated on Scott's work, you can sign up for his newsletter in the show notes, where you'll also find ways to support the show and help make more episodes like this one possible. If you find the podcast valuable, please subscribe, rate, or leave a review, as it helps the show reach additional listeners exploring similar questions.

The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing discussed on this podcast should be considered medical advice. As always, please discuss any health-related decisions with your own personal medical authority. And now, here's Scott, your BetterHealthGuy.

[0:00:57] SCOTT: Welcome to Episode 241 of the BetterHealthGuy Podcast. If you are searching for answers on your path to better health, I might just be your guy. Today, we bite into Root Causes: Exploring the Hidden Links Between Your Mouth and Your Health with my guest, Dr. Corbin Popp.

Dr. Corbin Popp grew up in small town Nebraska around his father's dental office. He excelled in science and math and earned a biochemistry degree with honors from the University of Nebraska. A Fulbright scholarship took him to Germany where he put dentistry on hold for a decade-long career as a professional dancer on Broadway and international stages. Dance taught him to see the body as one interconnected system, and that view shapes his dentistry today. A tooth functions within a bite, a jaw, a skeleton, and ultimately a whole person.

He graduated top of his class from the Arizona School of Dentistry and Oral Health and was named Resident of the Year in his graduate practice residency at the University of Colorado Anschutz. His practice focuses on ceramic implant surgery, regenerative bone augmentation, and complex Bioesthetic full mouth rehabilitation and jaw stabilization. His surgical work also includes managing root canal treated teeth and poorly healed extraction sites. These sites have historically been called cavitations or FDOJ lesions and are now being studied through newer concepts such as covered socket residuum or CSR.

He has completed Level 3 training through the OBI Foundation for Bioesthetic Dentistry, as well as Level 1 dental technician training in dental morphology. That combination reflects his view that bone, implant position, jaw stability, and tooth morphology must all come together to create function, which is why he stabilizes the jaw before restoring the teeth. He was the first American dentist certified in the Swiss Biohealth Concept, trained under Dr. Ulrich Volz, and later studied Biological Bone Augmentation with Dr. Frank Zastrow. He is currently in advanced postgraduate training with Professor Sharham Ghanaati, whose work in wound healing, regenerative biology, and jawbone healing informs his surgical approach.

On the more controversial questions in biological dentistry, he's careful to separate clinical observation from established science. In his words, biological dentistry shouldn't mean less science. It should mean more biology and better science.

And now my interview with Dr. Corbin Popp.

[INTERVIEW]

[0:03:42] SCOTT: I am honored today to have my very own biological dentist on the podcast. People fly in from around the world to work with him. For those of us who struggle with complex chronic conditions, looking to the mouth is often a missing piece of healing. Thank you so much for being here, Dr. Popp.

[0:03:58] DR. POPP: Yeah, thank you. Thank you for having me.

[0:04:01] SCOTT: So let's start with your backstory. What first drew you into dentistry? And then what was that shift from dentistry into biological dentistry to the point that you're now working with so many patients that are facing complex, chronic, systemic health challenges?

[0:04:19] DR. POPP: Sure. That question, I think I go right to the mix of art and science, which has been something I think through my life I've enjoyed a little bit of both. My father was a dentist. That didn't hurt. Now, I was not interested so much in dentistry in my college years, more medicine. But as you know, I kind of took a detour from science and went really into art, into the performing arts. But coming around from that experience, I was really looking for that mix of art and science. And my dad, he had passed away by then, but he was always saying, "Dentistry is great. You avoid a lot of the insurance issues with medicine." And so, I just kind of looked at it again. And because I like to work with my hands as well, it really was a continuation of performing in the closest sense with melding together art and science.

And it's a great field. I think about it all the time of how challenging dentistry is because you are the main performer and you're always on. And so, there's a lot of challenges with it, but a lot of that was, I think, the same training I had in the performing arts. So long story short, I think it's a culmination of all my experience led me that pathway.

[0:05:40] SCOTT: So let's talk a little more then about the performing arts, about art. You spent a decade as a professional dancer working with some big names. So much of that world is built around flow and movement and body mechanics. So how does that background show up in the work that you do today as a biological dentist?

[0:06:01] DR. POPP: It shows up. I mean, it is a huge part of it, because if you think about dentistry, there is corporate dentistry. Maybe that's slightly different. But my experience is more cottage industry dentistry where you wear all the hats. And there's the front stage, on stage, and then there's backstage. And this is the same in everyday dentistry. You better get your presets. Because if you don't set your presets and the show's on, well, then you look kind of like you weren't ready.

In that, every day, I have the analogies from performing to dentistry. The movement, of course, you're dancing. Every single patient you're dancing with because they're trying not to swallow. They're moving here, moving there. So, you kind of got to learn to; some places, you're working in the back of a cave, basically. And so, to do that requires the ability to move around.

I think that that's a huge help that I feel like I gained, thankfully. But I see new dentists come in and training new assistants. You're working with them, too. And so, if you both have left feet and you just constantly you're stepping into; there's a lot more risk. And then there's the timing dentistry. Everything is timed and overhead is high. And so, you don't have time to waste, basically. I love that part of it. And I love the part about dance, my performing arts. I was a late start there, so I looked at it from a physics standpoint. So, you're constantly mixing that art and science.

[0:07:31] SCOTT: So how often are you seeing patients today who are dealing with systemic, chronic, complex health challenges like Lyme disease, or mold illness, or mast cell activation, maybe systemic toxicity or a toxic terrain. And how important is it then to look at the whole body in order to optimize the work that you're doing in the mouth? Are we talking about more isolated problems or more interconnected parts of a broader whole? And if someone has both oral issues and systemic issues, should one be supported before the other, or can they be done in parallel?

[0:08:07] DR. POPP: I would add EDS to that list. It's happening more. To answer your first question, is how often? More. A lot more. And those are often challenging cases. I think that there's a place that we have to land is where I can; this is where the dentistry fits. And then this is where we need to collaborate. And those cases are an absolute must to collaborate.

I have my lane. I've learned so much from you, from my patients that are chronically ill and what they've learned. So, I have a good understanding. So, I feel like a quarterback in some aspect, but I'm always looking for the systemic medical quarterback. And this is a challenge because a lot of people who have been sick, as you know, they might even bounce around. And it's expensive when you have these multiple providers. But I need the help from the systemic providers in dealing with cases like you suggested.

And you, listening to some of your previous podcasts, you understand the correlation. You start to have multiple problems and maybe it's mold. That's not for me so much to decide. But what I have to do is say, "Okay. Where do we have potential areas, maybe sources that are contributing to the whole system." And that's where the collaboration, in my mind, is just imperative, which makes treatment harder because you have to take the time and stop and document and then collaborate and share and receive. It's a dance.

I mean, now it's a production. Otherwise, it could be me and the patient. Very simple with maybe say when we do a filling for you, it's a little more general dentistry. When you start to get into that bigger realm of systemic issues, you have a bigger production. There's no doubt.

[0:09:59] SCOTT: We're going to talk more about EDS as well. Interesting that you brought that up already because it does seem to be an issue that really is increasing in terms of the people that are dealing with it.

Dr. Dietrich Klinghardt has been a mentor of mine for over 20 years now. He's collaborated with Dr. Volz at Swiss Biohealth for many years as well. So, talk to us a little bit about the European and Swiss, maybe German influence in your training and career, how that's become really a central part of your work. And what's different about dentistry in the U.S. compared to Europe, to Switzerland? What compelled you to study with Dr. Volz and other leaders outside of the U.S.? And beyond Dr. Volz, who are some of your other mentors? What are some of the techniques or philosophies that you've brought from each of them into your work? What drew you to pursue the Bioesthetic training, and how has that shaped your approach to full mouth rehabilitation?

[0:10:55] DR. POPP: The difference between, I think, the Swiss; we'll use the Swiss, for instance, because that's been a lot of my training. They seem to lead the way often in this whole-body health, especially in dentistry. And dentistry in the U.S., I think we still are dragging a little bit in the traditional. The ends justifies the means, and that's based on material and architecture plans versus response of the body. I feel there's just more tension played toward that.

And so, Dr. Klinghardt, for instance, when he founded the Swiss Biohealth Clinic with Dr. Volz, I mean, they were thinking that in mind. And he wrote much of that portion, even of the Swiss concept book, was a big portion with Dr. Klinghardt. And Dr. Volz, to take him a step back, I mean, he was working at Paracelsus. And you know, Paracelsus, I'm sure Dr. Rau and these wonderful leaders that were, again, taking a step back and maybe looking at overall toxicities and that relationship to the immune system, gut health, of course, that's a lot of that foundation that we follow still. Those would be some of my mentors as well.

But when I was just coming out of my residency, surgical residency, at CU. I, of course, moved to the mountains because I was here to be in the mountains from Nebraska. So, it was interesting because I was not busy. So, I was driving to Denver to work. And I did start working with a bio-dentist, which was under Dr. John Augspurger. And he was traveling to Paracelsus, believe it or not.

And so, I was absorbing all this. And, of course, I would say I'm probably a bit of the devil's advocate. Very evidence-based. I'm very open-minded. But I also would like to be able to have data rather than just be in the holistic world without that. I got to play the devil's advocate for so many years until I really went on my own.

And along the way, of course, I met Dr. Volz. And so how he would look at the whole patient and in some of their treatments where they were really cleaning out the mouth of anything inflammatory. And these patients, I started to do this too. And that really changed my view of like, "Wow, these patients are really feeling better."

Now, maybe that's somewhat anecdotal or case study. It's not a big study, but it was feeding my curiosity and informing my curiosity because I was seeing what was working. And this is different than what we learned in our general dentistry schools, which is pretty much just kind of drill and fill. And you learn root canals. And you have no idea about hidden bone infections. And the material really didn't matter so much because nobody's allergic to mercury or metal according to the way you're trained. And not that that's wrong. It's in per se of how those dentists learned or how I learned it. That has to do with tradition a bit and a lot of old arguments a bit. So, I'm not here to try to solve those old arguments, of course. But looking at it is every person's different. And we're seeing a population also that is a little more sensitive, I would assume. I'm making an assumption, but I do believe that. And we're seeing immune systems be affected.

And so, I think the Swiss and maybe even the German culture a little bit, they have a traditional side too. But maybe if rules are slightly different or they're just the Swiss and they think a little bit more open, this is being adopted clearly and has been for decades here. It's just a slower process that's coming. And people are definitely more open to it.

Again, there's a lot of really great responses. And we have a lot of research to do to see where and how and why this type of dentistry is helping these sick patients that you mentioned with these conditions that you mentioned. Because they're no doubt challenging, and there is definitely an important aspect, at least in the start of the gut where I work, that can affect the whole system, and it's tough to prove that with a blood test or something. That's not always the most black and white thing to show. So, I think there's still a lot of work that we have to do to show that a little bit clearer to the traditional dentist.

[0:15:25] SCOTT: While we're on the topic of Dr. Klinghardt, I'm sure you're familiar with his system of muscle testing. I think they use it at Swiss Biohealth as well, Autonomic Response Testing. Dr. Simon Yu; oh, there you go. Hey, I got a whole pile of those in my room downstairs.

[0:15:41] DR. POPP: Yes. Simon Yu. My really good friend, Dr. Kelly Blodgett, who has quite a maybe Instagram following of cases and information. He's really good. He works with Simon Yu quite a bit. That's Biomeridian system, if I remember right now. Dr. Elliott Smith is actually a friend of mine in the mountains here, and he is an expert with an Avatar, which seems to be a preliminary type of device, but it's all based on Volz and maybe parts of the meridian system.

I think every dentist, whether they like it or not, they're muscle testing. I think of that with myself as I don't always pull out. Dr. Klinghardt's ART, I know how to use it. I'm wanting to do more, but the operation that it is currently is very large. And I think for like a Biomeridian testing, according to Dr. Blodgett, you really have to have a staff member who's kind of the expert at that.

So, energy testing, I'm a yes. If you can keep it simple. Again, I believe, and I do that kind of myself. I use a little bit of Dr. Roger Billica's techniques of rubbing the thumbs. You have a gut, and there's energy there for sure. So, I'm a yes on all of it. And I feel like that's an area that I hope to learn more and be able to utilize it more.

[0:17:04] SCOTT: So besides the energetic testing, are there any physics-based devices that are used in biological dentistry, let's say, to measure the vitality of the tooth? Can you use a device to say, "Okay, this tooth is very vital, and this tooth is gone or going?" Is that something that you do?

[0:17:23] DR. POPP: Absolutely. So, I don't just go through and test every tooth. And a lot of dentists do. That's totally, I think, great. There's a lot to do when you bring a new patient in and you have to kind of ration what you do. Otherwise, you'll be five hours. So, you can cold test every tooth. And that's something that we would do always when we're questioning a tooth. It's usually your first easy indicator, aside from the X-ray, of course, where does a tooth respond to a cold stimulus? How fast does it respond? We have them put their hand up and then you take the cold away because they're like, "Oh my God, it's cold." And then how long does it linger?

Because you're looking for teeth that if they have inflicted or I guess stimulated, we should say pain, how long does that linger? And does it go away right away is the same question. Do you have spontaneous pain? Because that could be indication that that tooth is inflamed or starting to go south. So, you start to try to diagnose, is this a reversible pulpitis or an irreversible pulpitis?

Some people don't respond to cold. And then you're thinking, "Uh-oh, test the next tooth. Well, that didn't respond either. Oh, okay, test the next tooth. Well, that didn't respond either." Well, this patient just may not respond very well to cold. Maybe that's a neurological thing going on. Okay, that's a little deeper. But then you move to the next test. Okay, let's do an electric pulp test. And let's test each tooth. And you turn the electricity up until, "Oh, I feel that a little bit." Okay, then you go to the next tooth. You can get a sense of if a tooth is responding or not, either by a cold stimulus or an electric stimulus.

And of course, tapping on it. If it hurts to tap on and every other tooth is fine, you start to scratch your head. What's going on? Are you biting on it hard? Or is that tooth now swollen from underneath because it died? So, there's those tests that every general dentist should have and know.

I think the holistic dentists, a lot of times they might test every single tooth, and they could read into it a little bit more. And you can meridian test each tooth. And I think that that is a really cool area, but it is also a little bit dependent, I think, on the tester, you know. So, you don't also want to have too much information. You kind of want to be able to see the forest and not just the trees. And this is a challenge for dentists, no doubt. There's so much information. You cannot get sucked in and be overwhelmed because you have to make a determination of what to do.

[0:19:43] SCOTT: So let's go there and talk about meridians and a term that I first learned from Dr. Klinghardt many years ago, which was interference fields. So, some suggest that interference fields play a role in up to 70% of chronic diseases. Wondering, is that something that's been proven? How commonly do you find interference fields to be a clinical issue in your patients? What are they? What are some examples? How can an interference field in the mouth more broadly impact us systemically?

And then talk to us a little bit about that dental systemic interplay in terms of the connection between the teeth, the meridians, the organs or systems. Is that one direction? Is that bidirectional? And how often do you see that tooth meridian organ system kind of play out in your practice?

[0:20:33] DR. POPP: That's interesting, the number. And is it possible? Perhaps it's different than proven, I believe, as far as I understand. And so, again, I'm not politically trying to get in there. And would I support that 70%? I don't think so, because I don't know how you prove that. But I do think there's a solid relationship. I think we all should agree that there is an electrical connection through a meridian system. How often do we see that directly? You do, and you want to document it right when it happens because it's so cool when it does. Back pain that goes away when you take out a metal implant, that definitely happens. And among my colleagues, I think those are the stories that get told the most.

I would still say in my own practice, it's not a real high percentage that you recognize those, that they're directly connected. But then there's the part that I think I'm more inclined to be aware of is that you're connected by fluid too. So I don't necessarily need that energetic relationship to to line up right away. And I'm not the expert at that. That's where the bio meridian testing. I know that Dr. Kelly Blodgett, when I talked to him about what he's learned over the last couple years doing it, is fascinating. And I think we'll see more relationships. But again, you have to be testing. You can't manage what you don't measure. And so, I think the more we measure that, we will see that. So, stay tuned.

But there's the connection of the blood. So, if you have an infected tooth, every time you're biting down, I mean, that's in the bloodstream. And we know, I mean, clearly. We totally have all agreed, all dentists across all fields have agreed that periodontal disease, bacteria in the gums, when it gets in the bloodstream, not good for prosthetic heart valves, for instance. Very clear. And that's a focal theory of infection, which it's still highly debated.

I think when we start to transition and look at other things like dead bone infections or root canal treated teeth, it's not as well accepted and maybe it's even disputed, but it's the same idea is if you have a bacterial infection. Now, I don't think bacteria necessarily means now you have a clinical disease. It would definitely want me to investigate further because I think the bacteria testing that's done is interesting, but it's always there.

And so, I feel like we might be getting a little bit into the weeds with some testing of just bacteria. But there has to be, in my mind, a pretty strong connection through the vascular system, in addition to the electrical system, for instance. Again, more research needed, without a doubt.

So, interference fields; and I loved that term when I was going through the education with the Swiss Biohealth. Basically, I say this to patients, they're inflammatory sources. And the main ones, according to the Swiss, are metal, which I think you could certainly even look at recent publications under the FDA to see about biocorrosion is very; it is a thing. Does that mean everybody suffers from that? We're not there yet, but it is a place to really look at. So metal, okay. Makes sense maybe because of all the other EMF waves that are being part of the deal right now. And that is actually an interference field according to the Swiss. So, metal, EMF waves.

Then we have root canal treated teeth, so dead teeth. And then FDOJs, CSRs, these are cavitations historically called or just unhealed bone. We would call it a residuum now, a covered socket residuum. This is a little bit more in recent information that we're learning from Dr. Shahram Ghanaati. Those four interference fields is what the Swiss Biohealth were looking at these patients and saying, "If we remove all those, then this patient can have a parasympathetic reset and start to heal."

And believe it or not, we see this. It's kind of hard to define it, black and white. But anecdotally or case study wise, this is why many of us do biological dentistry. Because it is incredible when patients sometimes who have felt so poorly all of a sudden are able to start to thrive again.

[0:25:04] SCOTT: Let's get into the practicalities of everyday oral health care. What kind of toothbrush should people be using? We hear now that bristles have microplastics. So, is that a concern? What kind of toothpaste should we consider? Where do you land on the mouthwashes being beneficial versus potentially damaging the oral microbiome and thus impacting our nitric oxide and potentially cardiovascular system? How important is flossing? Maybe tongue scraping? Do you like oil pulling? So ultimately, what does the “Optimized Daily Dental Care According to Popp” look like?

[0:25:44] DR. POPP: Well, I'm definitely not a toothbrush or product policeman. I'm not. Probably bias, really. Cocofloss is currently, for instance, what we use at the office. And we've cycled through many different products and definitely don't want to ever instill fear into the patients for something that we don't know if it's there, of course. Now, according to microplastics, Cocofloss does address that. And as far as we know, at this current time, that's not a concern for us.

Now, that could change. We think about plastics in dentistry a lot these days because I foresee that it might be the future mercury filling. Now it's plastic. And for a lot of reasons. And that's just we're seeing a lot more plastics in the brain, for instance, and maybe the relationship with neurological disease. Again, I'm not the police on it. We kind of pick one. And my scope is definitely more large surgical than it is more of hygiene.

But I think tongue scrapers. I mean, yes. I like Dominic Nischwitz's tongue scraper. It's made of copper, so it's kind of self-antibacterial. I think that's cool. It's not plastic. There you go. I often will recommend different products, like toothpaste-wise. Good question. Gerry Curatola has a pretty cool Revitin. I do every now and then like to get that. I like Biocidin, Dentalcidin every now and then. I probably am the one to cycle through things. Maybe that's just my nature to try it, but I don't feel like that is going to change. I think that the real deal comes from within. And that is a very big key, especially when we're talking about bigger surgeries. I don't build your bone. You do. I just make the scaffolding. So, we try to set the environment. But they're nice questions. And I think that it's not hard to find a product that you like that seems to follow in line with newer trends, reducing plastics, things like that.

Oil pulling, I love it. I would say from patient perspective, I think you got to pick the oil that is best. You don't want to have bad oil or rancid oil. I think that would be bad. But a lot of patients do respond and have less discomfort or pain in some situations. Now, you don't want to be swishing if you had surgery. That would be a time that you don't want to do it. but overall, I'm not opposed to it.

I usually tell patients to kind of back off of everything if they are going into surgery because I just don't know always if it's going to affect some of the grafting or regenerative material or eat it up faster or things like that. Because a lot of patients, they will try whatever from whatever. And I feel like sometimes backup and let's work on the gut health. That's where the collaboration works. That's probably more important to me than the product.

[0:28:32] SCOTT: Mouthwashes, yes or no?

[0:28:33] DR. POPP: Oh, I think great, if you like it. Now, we have Tooth and Gum Tonic. StellaLife is a rinse that we use. It's homeopathic that we really like because it does seem to help with postoperative pain and healing. I mean, yes. And if you ask about electric toothbrushes, I say I don't use it. I don't like using a battery. Something you have to change. But if it helps you and it helps you keep things clean, then I am more in support of that.

[0:29:01] SCOTT: So a patient comes in to you for their first appointment. What does that evaluation look like? You mentioned a little bit about bacteria. We know that some bacteria have potentially been found to be at least correlated, maybe partially causing things like Alzheimer's. So, talk to us a little bit about the oral microbiome testing. What do you commonly see? How important is that when you find significant findings there? Do you look under the microscope for the presence of spirochetes? Are there certain antimicrobials or interventions then based on those findings that you find can help mitigate those observations or those test results?

And is there value in something like an oral probiotic? Are X-rays or CBCT part of that initial evaluation for every patient? What do they reveal? How much today do we need to worry about radiation exposure when you're doing that type of imaging? And then what are you looking for on physical exam with a first-time patient?

[0:30:06] DR. POPP: Number one for me is finding out what's the motivation. How can I contribute? That's really the biggest thing that I'm going to be trying to figure out. We have a pretty standard intake trying to look at everything. And that means a full set of imaging. I like a panoramic because it's a canvas and it's a shot in time. I like a three-dimensional CBCT so we can layer through everything. That's underneath the surface.

On the top surface of the general dentistry, you're looking at bitewings, some periapical X-rays. Overall, yeah, I mean, I think in some people if they've bounced around and are getting second opinions, we start to try to avoid excess radiography. There's the ALARA principle, which is trying to keep it as minimal as possible. But from a diagnosis standpoint, having that at some point in time particularly at the beginning of our relationship is key. Because if you can't measure it, you can't manage it. And so, you need to see that.

If you're worried about radiation, most patients I say, well, then you probably shouldn't live in Colorado. There's a lot more radiation. So, you have to look at it as like I'm trying to help. So, we do have patients concerned with that. And in some cases, we make amends. But in most cases, patients aren't so worried about the radiation.

Bacterial testing. Yes, we test every patient with a saliva test. And I would say we're learning. Very interesting. And trying to put in adjunct therapies such as probiotics. Yes, we try. Yes, mouth rinses. Yes, we do that. Yes, we add in ozone. Yes, we add in lasers. And I think we're just starting to get; we're about a year and a half in from doing that regularly. I can't say I have a specific algorithm or a trend that we're still learning. Yes, I do think everything works, Scott, until it doesn't. And I do think that there's a lot of research to be had in that department.

Again, I'm not as involved in the hygiene. I would bring in my care specialist and my hygienist to really probably chat with you better on that. But I do think testing it and looking at it over time now, something's off the charts. The real question is, is when do you resort to doing an antibiotic while you're getting your cleaning? And this is when you start to think of, "Okay, what's that going to do to the gut health?" So now we're into that. Okay, I need to collaborate with the integrative doctors and see what else is going on? I can treat this, of course. But if I don't have the support of this, am I really going to get good data or just be confused?

I have learned to use microscopy. Love that. Dr. Wall is a big fan of that. It's very easy. The setup's not real expensive. I think every general dentist should do it. Do we do it? No. Again, it's a hygienist that's going to do that. And we were looking at it and investing in that because you will definitely see this spirochetes and things like that. And I think it's a really great education for the patient. They start to see that well. We don't generally have a lot of problem getting patients to understand. And the saliva test is a big help for that because it gives you a rundown of it. But I would say room for us to improve and move into that is, I mean, yes, in due time.

[0:33:28] SCOTT: So, let's talk a little bit about cavities. Let's drill into that conversation a little bit. So how do you know when there's a cavity present? What does it mean if a child suddenly develops a dozen cavities all at once and they're not eating a lot of sugar? What are some potential explanations? Are there options that are emerging today for reversing early stage cavities or do we still need to move directly to a filling? Can we use lasers to address cavities or maybe instead of a dental drill to remove the cavity before potentially placing a filling? How are you approaching the cavity conversation today?

[0:34:06] DR. POPP: Much of my population is a bit older, so I don't always see this in my practice, early lesions. But in that respect, remineralization is definitely a topic and using a couple different modalities for that. I think that that also needs a little bit more evidence. There is evidence it works, but how well in humans rather than a test tube. That's been a little bit of my knowledge in the past that it's questionable. I still think it's worth trying to remineralize. So, if it's not quite a lesion big enough. Lasers, we do that all the time. It's very conservative. I use it on every single patient. So yes, I think that's great.

How do we see cavities? We see this between the X-ray and clinical. I'm a little concerned with AI because AI sees cavities. I think that that is more of a green light for practices to treat unnecessarily. I am a little more on the conservative side of treatment planning smaller lesions because I think you see if you have; I bought a practice that has years of X-rays. And so, if I, for instance, did have a new great new young dentist that might say, "Hey, that's a lesion there," I'm usually reluctant to treat smaller ones. Because then I look back five years, I'm like, "Well, it's still there."

Every dentist has a different threshold of what they treat. And I probably spend more time in the larger surgical augmentations and less time in the small bread and butter dentistry. I don't want to overtreat. And so, if I'm able to watch that, then that's when I would suggest try remineralization with whichever product you feel okay with. I think hydroxyapatite is kind of a newer one on the scene and does show promise, but only time will tell. Again, the terrain is probably the most important. And that's a collaborative effort of a nutritionist and integrative doctor.

Why would a child get caries a whole bunch of it? Well, I would first say, is this a male or a female? How old are they? Because there is definitely a time period when there's a hormone change. Pregnant woman, for instance, I have seen that. And it just means that the whole biome is flipped. This is where you need the integrative doctor. That's who you've got to look at first because I can do all this work, but that's just general dentistry. If it's not needing it right away, of course, that's when the lasers and remineralization comes in. But when it becomes everywhere, you've got to treat it all. And get the bacteria load down or it's a continual problem. And fix the internal issue.

So, the kid that doesn't have a lot of sugar, well, then you just say, "Well, do you ever get like a lemonade or something?" "I get a lemonade." And so it's not about that lemonade. It's did you sip it for five hours or did you drink it in five minutes? And a lot of times, "Oh, I sip it in the morning." Well, it's because the duration, it's the exposure time versus how much, if that makes some sense.

And there are cases like that, you just have to talk it through and see, well, what could be the culprit? But one way or another, it's not just the terrain, it's both. It's what are you putting in there? What bacteria is there? And is the terrain set up to kind of go bonkers or not?

[0:37:22] SCOTT: Let's talk a little bit about enamel. So, what are the most common causes of enamel erosion? What can we do to strengthen enamel? Maybe minerals again, maybe vitamin D3 and K2. When the enamel is already eroded, what are the kinds of treatments we have available today? You talked about nanohydroxyapatite as a potentially helpful tool here, one that we're watching. When do you consider fluoride as a necessity versus another potential toxin?

And I'm seeing more and more; in fact, even this morning, I saw something pop up on social media about getting closer to the point that we can regrow enamel. So, I'm wondering how close you think those tools are in the future?

[0:38:08] DR. POPP: Erosion can be multifactorial. A lot of times we're looking at, I think perimolysis might be a term. It's a combination of acid erosion, which many sources, GERD, ERD, bulimia, too much sugar duration, those kinds of things, increasing the acidity level above the critical point where enamel starts to melt away. And there's a point of that. It's measurable. That would be part of it. But then there's the occlusion, which is probably the most under-treated and under-diagnosed part of dentistry. Some of the hardest dentistry to do with a jaw that's hanging and moves around, it's challenging. Those little teeth and how they're shaped, that matters. Morphology, tooth shape matters. And if things are out of whack, whether it's neck, back, cranial strain, jaw, teeth, things can just continually wear. There's a big combination part of that.

Can we regrow enamel? I would say we're a ways away from that. However, in the world of AI, maybe we're close. There's been talk of this and regrowing teeth a long time. It's forever since I've been a dentist. Maybe that's not that long, but it's long enough that I can remember. So, I think there's wishes for that, but then there's also remineralizing whether you use a fluoride base or hydroxyapatite.

I think it's promising in a test tube. The real question again is, is this working in humans? I'm not an expert, so I would have to probably do a review on that to see, but that's where I would question it. But I don't want to give patients false hope on that either. I don't think it hurts to do.

Now, fluoride is an old argument. That's an argument forever, probably. But the concern for neurotoxicity, I don't think fluoride is a necessary adjunct for kids to prevent them from having decay. I think the diet should be looked at far more than adding or whether or not you didn't add fluoride. And that's the argument. So, I'm like, this is such an old argument. It's not for me. Let's look at the stuff that does look like it's more important.

Of course, the diet matters in the system. Now, there are cases that are gross rampant decay everywhere, and there's silver diamine fluorides. They probably arrest decay. And impressively, I think there are cases for those. They're not my cases. I don't see those cases. So, I probably have little to say on them. But at what point? Again, what is the goal? And what are the limitations? And every case is different. And that is a little bit of a decision maybe from the patient. Less doctors, which are generally like throwing fluoride sealants everywhere. I don't think that that's needed. And I don't think we need to fluoridate everything. Just let it be natural. We don't need to add it. That's my personal opinion. But I'm not here to have that argument really about it.

I don't think there's a magic topical. I think the magic truly does need to come from within and trying to find homeostasis there. Yes, vitamin D, K2, I think that that is part of that systemic part. Omega-3s, magnesium, vitamin C, these are all really important in either bone building or health of enamel and health of the system and the acidity level. And this is why it's hard. Because how's the dentist supposed to know that when this is a very much a systemic thing that the dentist isn't going to necessarily test for.

[0:41:36] SCOTT: So, let's talk about another challenging issue in dentistry, which is gum recession. And some people get to the point that they need a surgical procedure to correct it, maybe grafting. I know there's these newer pinhole techniques as well. There's a number of toothpastes out there that suggest that they can help reverse gum recession but very few of them seem to consistently work. So, what do you see as the drivers of gum recession? Can it be something that's more systemic like nutrient deficiency? Is it inflammation? Is it potentially from clenching and grinding? How do we minimize its progression? And then what are the approaches you might use to mitigate someone that's dealing with more significant gum recession?

[0:42:19] DR. POPP: Okay, so the case matters. We talk about a biotype in dentistry often, which is there's the thicker biotypes, the thinner biotypes. How much attached tissue you have around each tooth? This is called the gingiva or the keratinized tissue. It's attached to the bone. It's thick. We like to have a seal around every tooth. Implant, even more important, I'd say really important around metal implants, but zirconia seems to do a little bit better if we have to talk about that a little bit. But the gingiva really does matter.

Now, over time, there seems to be a physiologic loss of tissue and bone. The tissue follows the bone. In some people, they're more prone to periodontal disease, which is bone loss. Or if you had an extraction, some people lose it quickly. Other people don't. Again, we go back to the system probably has a big effect on that. And genetics probably does too. What kind of biotype you are?

When we look at surgical cases, we really want to identify that because some people we know that don't have a lot of that tissue, they're going to be more prone to losing more of it. So I'd say the better angle is best how to prevent loss versus how to treat it, which is always a little bit challenging. Now, there is definitely grafting procedures. Pinhole is a very non-invasive way. Free gingival grafts. You have a lot of tissue on your palate to do grafting that can put that tissue back. It's really challenging to build it all back up because the tissue sits basically above the bone. If you've lost the bone, you have to build the bone back up. And building bone vertically is the hardest thing in dentistry in my opinion.

I think it's more of is each tooth and implant, does it have that good seal of tissue around it is most important for stability. And on top of that, you are exactly right. The bite. If you're pounding on your shoulder because this tooth hits heavy every time you're hitting on that tooth, it is not uncommon to see that tooth take a hit. And then it starts to abfract or tissue get a notch out of the base of the neck of the tooth and the gums start to recede.

When we see recession and we think, "Okay, hey, we need to do a graft there," you have to back up and say, "What's going on with the bite?" Because if you don't treat the bite, then the following graft is going to have a problem, too, or it fails. So this is the challenge for every dentist is you have to see the forest in the trees and all these parts play a role. And I think that is precisely what biological dentistry is.

[0:44:58] SCOTT: How much of plaque is tied into the biofilm conversation? How important is considering dental biofilms in terms of overall health? And then where do you stand on the xylitol debate?

[0:45:10] DR. POPP: Biofilm is the hot topic, of course, in breaking up biofilms. I mean, the profile of what the oral biome is matters, I think, of what bacteria is there. And that bacteria, its prevalence is going to be very often based on biofilms. How well it can retain being there? And everybody, of course, because of their system, is going create biofilms differently, how well do they clean it, et cetera, et cetera. There's a whole lot here to talk about.

Breaking biofilms, we deal with this in surgery quite a bit, in addition to the whole periodontal field. Ozone. Ozone gas is great at that. It does well to disinfect and break up biofilms. Now, xylitol, five-carbon sugar, also very great at biofilm, preventing formation or attachment, I believe. I think xylitol, I'm not opposed to it. I think it has a really nice use maybe in mouth rinses and things like that. Again, I don't think that there's a magic bullet for everything. If it's in that category, it's okay. I think it's fine to use.

Now, I do know when they did do some testing with xylitol in younger kids, they probably had too much and they ended up having too much GI gas. And they stopped doing that for kids because that was not a good part of the study. So there can be discomfort, I think, in some people. And I have patients, believe it or not, that can't do xylitol. I have patients, I think, some of them, they can't do one thing or the other about for everything. And so I'm not here to try to figure out why always in those cases. Everybody's a little bit different.

[0:46:50] SCOTT: Let's talk a little bit about the mercury amalgam filling conversation. Why do we generally want metal out of the mouth? Are we still using mercury amalgams today? For patients who have them, what's the optimal way to remove them? And I know I've talked to many people over the years with complex chronic conditions where their trigger was the improper removal of dental amalgams. So are you using something like the SMART protocol? And what impact can having mercury amalgams have on our systemic health? Do we need to be looking at heavy metal toxicity, for example? Do you do before and after testing for someone's heavy metal burden? And what's used in a biological dentistry practice in place of mercury today?

[0:47:39] DR. POPP: In some ways, an older argument of the metal mercury filling. So, an amalgam filling, it's pretty much 50-50 mercury-silver. So, we call them mercury fillings. And mercury, as you know, maybe it's very toxic especially as a vapor. And we do believe that there is off gassing and absorption into the body. And it is a pretty strong source of mercury toxicity is the mercury fillings.

Do I do testing? Again, this is out in my realm. But yes, we do testing mainly in collaboration with integrative doctors. And so, yeah, somebody that does have high levels of heavy metals. This is when we start to look at, okay, how do we remove the source and then begin detoxing? And I think that there's still debate of if you should detox while you're still with metal mercury fillings, for instance.

Hal Huggins would always say why are you drying off if you're still in the shower? And that's an interesting concept. I support removal of mercury fillings. I've definitely have seen patients with some improvement with, say, fatigue or hormone control. But these are maybe anecdotal. It's, again, a tough one to pin down black and white of what that does. But patients can have improvement.

Now there's a risk just like you said. You start to remove these but you don't do it safely, and you're drilling on them, and the vapor, and then you just absorbed a whole bunch. And some people, yeah, they're going to have kind of like a Herx. They're going to really over-toxicify and have a problem. And that does happen. I have seen it. So, you try to use these safeguards either through the International Academy of Medicine and Toxicology, the IAOMT, or the IABDM is another organization that trains.

And you take a case, you take a course, and you present and you become accredited to be able to do a safe mercury removal. We call it smart in our particular one. And it does involve multiple suction areas in the mouth, outside, high speed, big volume barriers. Barriers for us mainly is the dentists and the assistants because we deal with it more. So, it's very much for the staff, but the patient as well. And they're on supplemental air. And so everybody has masked up to remove these and chunk them out in a specific way to try to reduce the exposure.

And then some binding. This is, again, I think where the integrative doctors are very helpful to aid in that. Maybe IV vitamin C. There's some things that can help those specific patients prevent a poor toxic outcome.

Yes, I think the mercury fillings, if you want to come from a general perspective as well, is they do; everything expands and contracts. Mercury or silver fillings, amalgams, they're not good for this because they do expand. They crack teeth. And so very often you remove a large mercury filling, you got a horizontal crack right under that cusp. And now you're going to switch to probably doing more of a crown to give that tooth the support that it's going to need.

Replacement fillings, we do use composites. And I am probably questioning this the most in recent times of doing direct composites. Is there plastic exposure? How do you minimize that? I wish, and I do think that there's more research coming on that for advisement. But you can also do things as an indirect, which is more like a crown or onlay. And these are using materials such as porcelain or zirconia, very Biocompatible. There's different kinds. And definitely some patients are not as Biocompatible with some materials. There are thousands. And you can do a test for that called a Biocomp test to see if you're reactive to the different materials.

But I would say that the ceramics are probably the most Biocompatible. However, they are going to be twice or more expensive than a direct filling. The direct filling is a mixture of a plastic with a ceramic filler. And the more filler you can put into the resin, I think the better. It wears better, it lasts longer, maybe less plastic exposure.

Nowadays, we can even print the material and the material I think is fully cured outside the mouth, reducing again the plastic exposure as well. But it's a balance. The ability to do everything is an indirect is a very high cost for the patient.

[0:52:18] SCOTT: So, I think that's an important thing to consider that when we're working with biological dentistry, the materials are hopefully better. They're maybe less toxic, but it doesn't necessarily mean that they're always non-toxic, that there are still some procedures and things that have to be done that we don't have completely biologic materials to use in those types of procedures.

[0:52:41] DR. POPP: Yeah. I mean, the most biologic is you try to keep what you have. And even then, there's autoimmunity, which is interesting, right? So, Biocompatibility and biomaterials is definitely something that the biological dentist is thinking of. I would say zirconia is really a fun material because the tissue just loves it. And so, versus, say, like a titanium implant, if you're looking at a zirconia type material, we see that in the tissue.

And I would say the same. There are restorative materials like zirconia that do well. And then there's other different types of zirconia that don't do so well. So there's definitely more that we have to figure out in certain susceptible patients.

[0:53:28] SCOTT: So, we're going to talk a little bit here about root canals, then we're going to get into some of the cavitation, some of the implant type conversation as well. So, let's talk a little first about root canals. Why are they needed? Once a tooth has had a root canal, is that essentially a dead body part that's still sitting in the mouth? Is that root canal then a source of toxins and infections over a long period of time? We know that that can act as an interference field from the earlier part of our conversation, also potentially impacting us systemically through that meridian system that we talked about.

So, should anyone that has a complex chronic health issue consider, not always absolutes, but consider removing any root canals? Are there ways now to do root canals that are more biologic? Meaning, ozone, lasers, and other things? So that over time it's not a source of toxicity and infections. If somebody comes to you and they have a root canal tooth, are you sometimes extracting the tooth and then replacing it with an implant. And when a tooth is extracted in biological dentistry, is it always the case that the dental ligament is also removed to minimize the chance of future cavitations?

[0:54:45] DR. POPP: First thing is prevention. I have patients come very often where they were told, okay, they need a root canal. And you could tell their tooth is really broken down. For instance, in this case, for an example, decay. You can see it on the x-ray. It's close to the pulp. But the tooth, because we cold tested, as I explained to you, it responds, and the cold goes away. So, the tooth is still alive. Okay. But that patient was said, "You need a root canal." And that's not necessarily wrong. It's, again, the training that the dentist had is they know when they go in to take out that decay, it's very possible they pulp it or they get into the pulp because the decay is so deep.

Once you pulp a tooth, the prognosis drops considerably. And there are things you can do, ozone, laser, sure, okay, and you can patch it up, say a prayer. If you can get in there gently using lasers and ozone, things like that, very often, you can clean that decay out and not kill the tooth. I would say hundreds of times that's happened. It doesn't happen every time. You might save a tooth for a while and then it dies down the road. There were things like that, of course. But the reason that they recommended the root canal is they're trying to just speed the process.

Believe it or not, insurance probably pays the most for root canal buildup crown, RCT buildup crown. So those are done quite often, and it's a high revenue for practices. So, I would believe that teeth are killed prematurely more often than we wish. And so, then you're faced with a tooth that if it does die, that can come with pain and swelling and abscess, things like drainage. That's infection. And so, you're faced with, "What do I do? Do I do a root canal?" where you basically clean out the inside, you clean out the rest of it and you reduce the infected areas. And so, the body can kind of wall it down if you will. But the tooth itself is like coral. It's porous everywhere.

And I believe if you look into the research, pretty much all root canals, whether they're done perfectly or not, they have a component of bacteria. Okay, that doesn't necessarily mean that the bacteria means disease, but I think that the potential is there. And so those are the areas that I would be very focused on, especially in a patient with chronic issues. The chronic patients are being more proactive and just saying, "Let's get them out. Let's not do a root canal because there is a potential source of bacteria."

Now, I share a patient with a friend, Dr. Carnahan, Jill Carnahan, and in talking to her recently about a patient who had a tooth that had died, and this patient was basically dealing with an autoimmunity for 10 years needing IVIG with low protein. Once removing that tooth easily; because in Dr. Carnahan's world, you can see trends a little more because there's probably more testing. But a specific trend that changes when you remove that nidus of infection. Now, is it only with a dead tooth and an abscess? Or is it also with a root canal treated tooth that we know can fill up with bacteria?

And I would say you have to keep an open mind, especially when you're dealing with chronic disease. In my mind, it could be. Maybe it's not proven in every case. But the evidence, I think, is growing that you need to be critical, I think, of anything dead. And so, there's no blood supply anymore in a root canal treated tooth. And if it fills with bacteria, they are also really prone to reinfect.

So, we pull root canals very often in our practice. I'm a big ceramic implantologist. I would say that's my primary place where I would recommend patients is remove it and replace it with a Biocompatible material. And yes, you mentioned removing the PDL ligament. I think cleaning the bone is probably one of the biggest principles of Dr. Shahram Ghanaati. He's the guy leading the way in how to prevent the CSR or the cavitation, how to prevent the ischemic bone from an extraction, how do we not let that happen? And it, believe it or not, starts internally. And you have to work collaboratively.

And there's a few things. One is cleaning the bone is vital. You have to do that. And this is what he's seen histologically, which you are already seeing his publications roll out. And you'll see many more. This is a PhD, plastic surgeon, oral surgeon from the University of Frankfurt, Dr. Shahram Ghanaati. We're lucky to have those people to be able to actually show hard evidence of why.

Now, I'm not here to say I'm anti root canal. I would say I'm anti unresolved infection or persistent infection. I think that that deserves more attention. And so again, I'm not trying to answer the argument of root canal bad or good. I would say in a teen, if a tooth dies, you're faced with a tough decision. Do you pull out the tooth and do a ceramic implant when a teen is still growing? And I think that you're playing with something that we just don't know if that's wise to do. And so maybe you look at the root canal as something that is a more of a short-term solution. That in the future, you consider removal, especially if you have chronic illness. But it does hold bone. And so, you're trying to balance a little bit of maybe risk with outcome.

[1:00:24] SCOTT: How often do the sinuses come into the dental conversation? So, what's the connection between the sinubiome, the oral biome? You already made that connection to the gut biome. Do you see things when you're doing imaging like fungal balls in the sinuses maybe connected to a failed root canal? Can dental materials migrate upward into the sinus cavity or the sinus cavity itself drop into the dental arena? And is there sometimes a need for a sinus lift maybe due to bone loss from the dental issues as part of the work that you do as a biological dentist?

[1:01:02] DR. POPP: Yeah. Yeah, I wish there was more collaboration with the ENT department and the oral surgeon department. Different biomes, and they're connected anatomically. Of course, you're right next to it. And all the time, we're doing some kind of a bump or a lift into the sinus, but preserving as best we can the membrane, the Schneiderian membrane that lines the sinus.

Now, yes, I would say yes in a lot of those questions. Is there communication in some way? Yes. And when you lift a sinus, say, if you had an extraction and you lost volume. In order to place an implant, you may need to build that volume up either in the sinus or on the ridge. And that's very common. I would say probably 30-plus percent, you're going to get a perforation in that Schneiderian membrane.

And there's techniques we have to repair it and to keep that intact. But you're going to get some bone graft which has the oral biome bacteria in it as well. Certainly, we use PRF or platelet-rich fibrin, which is maybe antibacterial, but also supports tissue progenation and growth. Sinus is an interesting one. You can have a communication between the mouth and the sinus from an extraction that doesn't heal well and it'll retain a communication tract that has to be surgically separated and treated.

Fungal balls, I'm interested because I learned a little bit about this just recently. How those look in particular on X-rays? I haven't been looking for those in particular. So, I'm excited to kind of keep my eye open. Mucus retention cysts are something that I would probably see a lot more often, which is the cells that do release mucus. So, you see inflamed and reactive sinuses very often in dentistry. And I would say there's a relationship, of course, to root canal treated teeth, titanium implants, recently grafted sites, CSRs or cavitations. But it's a tough trend to really lock in.

And I wouldn't say it's an exact science of how to always treat it. I see reactive sinuses often, and I very often would like the ENT world to either drain and clean those sinuses. They're very reluctant to do that. So, I think there's a lot we need to learn on how to not only diagnose when it's a fungal thing. Because I think the systemic part; again, I got to go back to that. Of course, looking at what dental inflammatory or maybe interference field you have there, could it affect it? I'd say it does. But how much and in which cases? That's a tough one to nail down. I'm curious and I'm vigilant in trying to answer that question better.

[1:04:04] SCOTT: So let's get into the cavitation conversation. Some people call it NICO or Neuralgia-Inducing Cavitational Osteonecrosis. You mentioned FDOJ or Fatty Degenerative Osteonecrosis of the Jawbone. So, for people who are not familiar, what is a cavitation? What causes them? How prevalent are they? Is it common that people in the general public maybe have them, but it doesn't burden their system enough that they even know? And thus, the more chronically ill patients or maybe the ones that are exploring this. I've heard some people suggest that there may be 95% of people have some type of cavitation. I'm wondering if you see numbers that high in your practice, or is that maybe more of a selectivity bias?

[1:04:50] DR. POPP: Again, interesting, possible, different from proven. I know there's a lot of talk about 90% of cases have this cavitation. Cavitation actually has been – the terminology has been around a very long time. I think if you look back to Weston Price, there is in the literature and talk of it in the long bones and the hips, ischemic bone or dead bone areas. I think that that's important because if you have that or if it's a fatty type of substance.

Now, the most recent talk and research, again, is by Dr. Sharham Ghanaati. We've kind of broken it down into five categories, but those main ones are osteomyelitis, inflammatory, fibrous, and fatty. They're kind of the main four. The NICO was probably more from Johann Lechner doing research out of Munich, looking at these sites where people did have pain. And in some cases I would say I've seen that myself.

The FDOJ is a newer terminology, the Fatty Degenerative Osteolysis of the Jawbone. That's what the Swiss termed it, a little bit more Dr. Volz and Klinghardt. And I would say a lot of times we see fatty material there. And so, my concern is toxicities will attract into those fatty areas and could be a source. I think that is where I go.

Now, I'm wondering, how do we know that 90% of the people have cavitations? Now, I see low density on almost every X-ray. So for the longest time, we tell patients is like – and let me tell you this, this is very funny. Dr. Volz, by the way, rule number one, when you're going through the training, rule number one, the cavitation is there. Okay. And rule number two, if you're questioning it, the cavitation is there. And I don't disagree with that.

Every time we go to these previous wisdom teeth sites, the bone is soft and fatty, almost, I would say 95-plus percent of the time. So, I'm not going to just say, "Hey, they're always there." The real question is what is in it and what is that doing to you? That's the real question. If they're there or not, I would say they probably are.

And then the next real question I hope we always ask is how do you prevent them? Because we do believe they're pathologic in a lot of cases. And that's because the patient experience when they're cleaned out, they do a lot better. But now we're looking at the histologic of what's in it. And that's, I think, where we're really starting to learn rather than just be in the in the woo-woo world of, "Oh, they're there. And let's clean them out." We have to have a little bit more evidence because it's an interesting phenomenon, especially in a world of toxicity, which we live in even more every day. So if we have these areas that can accumulate them, I think that there's definitely room for pathology. But not just, "Hey, they're there on the X-ray, and that's your problem. And let's clean them out."

[1:07:48] SCOTT: So, what do we know about what is in them? Do you take some of the material from the cavitation surgery process and send that to, let's say, DNA ConneXions, for example? And do you see things like Borrelia, or Lyme, or co-infections like Bartonella or Babesia, or environmental toxicants, or mycotoxins? Have we been able to characterize what is in those cavitational sites?

[1:08:14] DR. POPP: Yes. And yes, I would say histologically is still the most important part, because it's your diagnosis, so we do a histological analysis. I use Dr. Jerry Bouquot. He's been around a very long time as an oral pathologist, but able to really look at the osteomyelitis, the inflammatory conditions, the fibrosis or fatty types of tissue. That kind of gives you a little bit more of diagnosis.

But if you take it a step further, DNA ConneXions is an example, or Microbiology DX, where it can look at, "Hey, What bacteria is here? Is it MARCoNS? Is there a fungal component?" I think that that's interesting. Now, DNA ConneXions, if you do run both the microbial part and the Lyme part, not a cheap test. So, this is partially why cavitation surgery is not inexpensive. It's a procedure.

I like to have that information. But I would say I don't know what trends I've learned specifically from it. You usually get a laundry list of anaerobic bacteria every time, all the time. And so I don't know. I think that it requires more research and that comes at a very high expense. I do send out for it sometimes. And I always am intrigued when I see it back, but I think it probably scares patients in some cases.

[1:09:39] SCOTT: Do you see Lyme and co-infections in cavitations?

[1:09:42] DR. POPP: In a high percentage. But also, it's a little bit; you don't know how much. And there's several that are there, but maybe closer to non-detectable.

[1:09:52] SCOTT: I'm also interested in over time here. I know DNA ConneXions recently came out with their RANTES test, or CCL5, which we've heard for many years can be produced in cavitations. So, do you look at RANTES at all in these cavitation sites?

[1:10:07] DR. POPP: Yeah, I have colleagues doing this test. I would say the feedback from them is it's not giving you a level. It's there or not. And I don't know because I am really following the Dr. Ghanaati ARENA-Protocol. And so, in our group of, I don't know, there's maybe 30 of us in this third year treating CSRs and studying them. It's not part of our protocol at the moment. And it may be due to cost. You have to kind of narrow it down. The histologic is huge.

I would say I'm more interested, to be honest with you, in doing a immune test like a Cyrex Lab to do a Lymphocyte Map and really see your Th1, Th2 ratios. I feel like that has a lot of merit. And if there was something I was going to recommend testing, even based on cost, that's where I gravitate to. But I would love to do DNA connections on everybody all the time. But without a before and after, I feel like the information is lost. This is, again, the challenge. You can test everything you want, but if you don't measure it, you can't manage it.

[1:11:18] SCOTT: So how do you explore the potential for a cavitation? You've mentioned Dr. Ghanaati a couple of times. It seems like a controversial area where two different dentists can look at the exact same scan and disagree about whether or not a cavitation is there. So is imaging alone enough to make that call? Is a biopsy necessary? Is a biopsy ever done before the cavitation procedure? Talk to us a little bit about how we know whether or not a cavitation might exist in a given patient that warrants moving into a surgical process?

[1:11:55] DR. POPP: This is a huge question that comes up every single day in the practice. When I get patients that have come here and they said, "Dr. so-and-so said I have a cavitation." And you cannot diagnose a cavitation on an X-ray. You just can't. You see density. And then there's certain algorithms I think you can run on that density to really indicate if the site didn't heal well.

Now, this is what Dr. Ghanaati's visualization is doing. You can do thermography to see if that's an inflamed source. I think that's helpful. But the reality is your diagnosis is going to come from the biopsy. Could you biopsy it before you go in? There might be an ability. But the hard thing about it is the CSR very often will close over the top but the residuum is on the inside. And so, you can't always get a large bore needle easily through.

Now, there's X tips and things like that. But it's hard, I think, especially when we're in that stage of learning and research, we want to have a solid biopsy. So, when we do our cavitation or CSR surgery, we cut that top window out and it goes to the lab for histology. Anything else, we get out of there, it goes in there as well. And this is where we're going to learn that a little bit more.

And believe it or not, this is also part of Dr. Ghanaati's research is, can you treat it with ozone? Can you treat it with laser? At the moment, the only way that we're seeing histologically the improvements is to get in there and physically, using either rotating instruments, hand scalers, ultrasonics, remove it and get good bleeding. And believe it or not, a big component of it is to graft it. And this is also where a lot of new steps are being taken. When we're talking about instead of the CSR treatment, how do you prevent it from happening in the first place? That is what Ghanaati's, I think, goal really is. And it does involve grafting the sites in order to trick the body into thinking that that wound is healed somewhat. And then the tissue grows over and it turns over in the bone is what we are postulating and what we're starting to see histologically. And that's really where I think the rubber hits the road is when you see it histologically. Otherwise, I think it's a lot of conjecture and belief, which is not necessarily my department.

[1:14:27] SCOTT: So, given how invasive cavitation surgery can be, who's a good candidate for that? Who isn't a good candidate? Are there patients that maybe you turn away or push the pause button because they're not systemically stable enough because of their Lyme and mold and mast cell, and maybe the surgery is going to stress their system more than they can handle? I know Dr. Klinghardt talks about addressing retroviruses before doing these procedures. Dr. Yu likes to address parasites first. Is there a sequence that you tend to prioritize? And what do you look at to determine whether or not someone is truly ready? And then what do you do prior to the procedure to optimize the outcome of that cavitation surgery?

[1:15:09] DR. POPP: I think Swiss Biohealth and Dr. Klinghardt, they were really great about putting together the Swiss Biohealth Week. So in preparation, I do think there's merit to the parasites and the retroviruses. I wish we'd all come together and come to a little bit of determination of really the best checklist, if you will. But, again, it's really tough for the surgical biological dentist to take all those responsibilities. This is where the collaboration; and I have patients with Klinghardt and with Dr. Yu. So yes and yes, I think that that's all important. It's questions I have on exactly how, but that's where I have them. So, you definitely want to prepare the patient.

I think I tell patients, and this is from Dr. Frank Zastrow, I think it's really important, that patient, anybody could do it. But you have to believe; the patient really needs to believe in the treatment plan proposed. Me, as the treating physician, the staff to be able to also coordinate it and themselves. If those four things are not there, I'm a no. If I have a patient that's on the fence, I'm a no. Because the belief as well is so important that you; and this is why the collaborating team and the patient and the doctor, we come together and say, "Hey, This is the right choice," rather than jump into anything. You don't want to do that.

And the Swiss were so great to instill look at blood work. I ask blood work for everybody. I really refer it out. But minimum, there's some things you want – if you have a low vitamin D and we're going to place implants, 300% greater risk of implant failure with low vitamin D. And that's published. Could they use more research? Of course. But I think that that's talked about a little bit more and accepted more. I think to expand that is so important.

And you could go well beyond vitamin D or cholesterol and things like that. You have to boost these patients up. And when you get those patients that are mast cell, Lyme, mold, I mean, it's the classic, SIBO and EDS. You have all these inflammatory issues. They may not heal very well. And I think that that is something that's why we need their doctor. We need them. We need me. We need to talk about it. And if we'd still end up at the end of the day of, "Hey, this is the next step," we're going to have a good outcome.

And I'm always in the corner if for whatever reason it's a challenging journey. And it can be for those patients that don't heal very well. It's a regenerative capacity. And I think that there's a lot of tests, of course. Looking at the couple different markers in their blood work, for instance, I think more the better. Because I tell this to patients and my students a lot is it always works until it doesn't. And you just have to be prepared for that because it's becoming more challenging with patients that are experiencing more toxicity levels. They don't. It's fewer that you have the miracle cases. We still have them.

But I feel like in the past, it was more common. Just removing metal, patients would be like, "Wow, this is a miracle." Removing a root canal, "My ringing went away overnight." These are wonderful case studies. And they definitely fuel our interest and our curiosity, but that's not every case.

[1:18:49] SCOTT: One of the things that I like about your approach is that collaboration with their systemic doctor. I've always told people they want to have their surgeon and their doctor that's maybe treating their Lyme in conversation, because sometimes these surgical procedures also can be a stress on the system. And if they're not considering the possibility that maybe they need a little more support for their Lyme and co-infections and other things, then they can kind of have that whole process reactivate. So, I think that collaboration, that team approach is really critical.

So, talk to us a little bit more about what you actually as the surgeon do in a cavitation procedure. You talked about using PRF to help kind of with that healing process. You talked about IV vitamin C as a post-surgical recovery tool. But talk to us also about the potential complications, potential recurrence rates. And then how much of a needle mover have these cavitation procedures been in your patients and over what period of time?

[1:19:50] DR. POPP: Yeah, it's different. I definitely have had some that came in the next day. And these are large surgeries. So it's always wonderful to see patients that have a large surgery with the IV and the ozone. They come in and it's like, "You had a huge five-hour surgery yesterday," and they look totally normal. And they're smiling, and it's amazing. I think the modalities that we use help a lot, and probably circulation again with that.

For the cavitation treatments, sometimes again the next day, people feel like they've either slept better, have better energy. And some, I think, it goes weeks and even to months, and they have more improvement. Now we see a lot of Pompa program patients doing cellular healing, going through his protocols. And my sister, for instance, it was a few months ago. And, oh my goodness, her CSRs, it was gigantic. And so I was really interested to see how she did. And within weeks. So notably. And she had been going through Pompa's program maybe nine; or a year, I think, and was really wanting to do this procedure.

And look at it this way. I don't think I have one patient that hasn't had some improvement. And we will do a multiple questionnaire, symptom questionnaire. And I did this during COVID, looked at all my old patients, looking at what's improved, what hasn't, categorize it. And overall, everyone had some improvement reported, okay? Some more than others. For sure.

I think there's very few patients that had a poor outcome. There are some. Now, this is looking across all of my colleagues. Some patients, they come in later looking for revision or whatnot. Very few of them have a poor experience where the outcome is worse than where they started. There are some. And I think those are the ones that were needing to really do a better intake and see which type of patients are susceptible to that.

The EDS, having Lyme, mold untreated, no doctor to really measure what's going on, their regenerative capacity. I think that's when you might get into a little bit of trouble. Now, the Pompa patients have really built up their cellular ability to detox. And I would say they do really well, which is probably why that's a big part of that program is this is part of that whole experience.

I've had mine treated as well. My own experience, I increase energy, but I would say; I don't know. I feel good. I don't feel like I have had miracle experiences changing things always. But I think it's a safe procedure and there's some benefit for patients that is miraculous at times. less at other times. The real question though is do they come back? And I think this is where Dr. Ghanaati and his research is really showing that. So, some of the modalities, yes, laser, ozone, PRF, now grafting those sites to trick the body into thinking that these sites. Because you're putting bones someplace where there was never bone. There used to be a tooth. So you have to trick the body. And this is what we're seeing as maybe the potential way to prevent them from reoccurring. And then the question would be, if they reoccur, it's not that they're there, it's what's in it. And what is that doing to you? Is it pathological or not? Really big questions yet to answer.

[1:23:25] SCOTT: So, give us just the short version of what you actually do. You're opening a window into that site.

[1:23:31] DR. POPP: Yeah. Well, what you do is you gently uncover the tissue and you're able to see the bony area. Let's take for instance the lower. You use an ultrasonic device that you can actually cut gently a one-by-one-centimeter window. And that window just kind of pops right off and you put that into the biopsy kit, and then you're accessing it. And believe it or not, a lot of times it doesn't bleed because it's kind of dead.

And so, you get in there and you start to just scoop out mushy, yucky stuff. And you take that. And until you get the site to have a nice, fresh surface with good bleeding and then you start to disinfect it with ozone gas, laser if you have it. And then you take the PRF. And we used to just take the plugs and put those in there. Now we're mixing the liquid PRF with; so you have all your growth factors from your blood with the bone graft placing that into the site gently and then putting a little PRF over the top, covering it up, and they heal beautifully. I mean, rarely is this a painful experience. Day two, I mean, surgery, granted. I think especially when you go and you have a sedated procedure, patients wake up and they're doing great.

[1:24:57] SCOTT: So, one of the issues that potentially can lead to cavitations in the first place is inadequate bone healing after an extraction. And that same lack of healthy bone can be a problem for placing a dental implant that we'll talk about in a little bit. So how do you support proper bone healing? Do you ever use bone from another person or an animal, or are there synthetic options available? What is Biological Bone Augmentation?

[1:25:27] DR. POPP: Yeah, all of the above. For CSR treatment, I would probably tend to use more of a synthetic graft. You're just trying to pick the graft that's best for the situation. So, there are human grafts. That's an allograft. And you can get live or cadaver. Cadaver is the most common. You can get a xenograft and get cow bone, pig bone, horse bone. You can get a synthetic graft, which is typically a mineral of tricalcium phosphate or hyaluronic acid and a mixture of those. And you could use no graft and just use PRF only, just the plugs. And probably the gold standard, thank you, Frank Zastrow, with the biological bone augmentation, you use autograft, which would be the patient's own bone.

Now, harvesting that amount of bone can be challenging. And there's different ways to do that. And we try to do that. And I try to always incorporate some of the human bone, but it's not always great bone. Imagine if it's a big CSR, it might not be very good bone. So, if I'm grafting around, say, an implant, the most, I think, tried and true, as far as I understand from my mentors, which would be Dr. Volz, Dominic Nischwitz, Rebekka Hueber, these are really wonderful people, Dr. Fernandez in Costa Rica, they have guided me probably to be doing more of the allograft or autograft, so that the human's own bone or a donor bone.

It seems to have maybe a little bit better, longer track record around implants. But if it's not an implant, the synthetic bone seems to be fine. It just takes a lot longer to turn over into real bone, okay? So, if you're going to have an extraction and you're unable to place an implant right away, which I would always recommend the implant right away if it can be in the right place and stable. And then you can graft around it. And it's not only in osteoconductive, it's both. It helps build bone. The zirconia implant is very Biocompatible. But if you can't place it in the right place, of course you have to graft and come back later.

And in those cases, it depends about how long it will be. And in some cases, when it's going to be years, it may be better to do a synthetic graft or even a xenograft in some cases. In, say, Japan, they can't use allograft. In the xenografts, they do fine. Again, everything works or it wouldn't be used until it doesn't. And everybody asks, all the dentists are always asking, "What bone graft did you use?" Because you wish that there was a magic bone graft.

But here's the real deal, Scott. I don't build the bone. You build the bone. I just do the scaffolding and set the environment. My job's 20% of this deal. 80% of it is you, the patient. 80%. I would totally stand behind that. And that's why you want the patient to have the collaboration. You want that person to get you optimized. Because I can't do that with my 20%. I can do everything right and I can recommend everything. But the reality is I'm setting stage and I'm going to do that really well, but I need the help of the body to do the real work.

[1:28:51] SCOTT: One of the more life impacting issues for people is trigeminal neuralgia, which can be really significant debilitating pain. I think some people, it almost brings them to consider suicide. What causes trigeminal neuralgia? How often is it being driven by a dental issue? How do you assess that? How do you find the root cause versus just managing symptoms? I know some people talk about maybe herpetic viruses like varicella-zoster being a driver.

[1:29:24] DR. POPP: Yeah, fuzzy wiring. The trigeminal nerve is three branches. So one, two, and three. And the nucleus of it sits right back where your coordination nucleus is right there too. So there's a lot of crossover with balance and bite stability. Every tooth is a nerve ending and it can feel 20 microns. I mean, it's amazing the feeling of your teeth.

And so, you can imagine if there's an imbalance or premature contact, the discrepancy between where the jaw is stable and the teeth come together, say after orthodontics, I think it can throw things haywire. And so can a virus. You said it. I mean, I think it's a big one. How about Epstein-Barr? I mean, that's a Herpes virus too. And that's chronically everywhere.

I think that there's a big overlap there. And this is in the field of neural therapy. I mean, this is where Dr. Klinghardt, I'd love to take his classes a little bit more, Neural therapy and trying to reset some of the ganglion to try to kind of break the cycle of neuralgia, trigeminal neuralgia. I find that looking at the bite and trying to deprogram or doing Dentosophy a little bit of working on cranial strain seems to have a really big effect. It's not just one thing. And it's probably one of the harder things to do in dentistry. You bet.

[1:30:42] SCOTT: Let's talk a little bit about anesthetics in biological dentistry. Can most of the procedures and surgical things that you're doing be done with topicals or injectables? Are there some where you have to do more systemic anesthesiology? Do you find that certain individuals or maybe genetic profiles are less likely to get an effect from an anesthetic? Maybe they metabolize it faster than expected. Are there certain genetic SNPs that you might look at when you're making that anesthetic selection? And are some of the more sensitive patients, knowing you work with a lot of mast cell activation syndrome patients, are they maybe less able to tolerate some of the anesthetics because of the preservatives or additives rather than the anesthetic itself?

[1:31:28] DR. POPP: Yes. And I'd say this is when I have patients that come in that are really sensitive, I kind of pull out my recommendations for, say, mast cell. Most of the time, the anesthetic that we use is Septocaine, and we buffer it. So, the patients that have trouble becoming numb, they almost always do very well when it's buffered. We are almost always infiltrating and not blocking. So, it's a little less of any of an epinephrine rush. We use half the amount of epinephrine in all of our anesthetics. Some anesthetics, we don't use epinephrine at all. The patient usually knows when that's an issue. And some patients, yeah, they have a reaction to a specific kind. So, it can get a little bit, not to say tedious, but individual, but it's usually not a problem.

Now, other things have come into play. Graphene, for instance, I think that was talked about for a while, or people talk a lot about like mRNA being in the anesthetic, maybe preservatives, I think could be an issue. Again, I have a privilege to have a dental license. There are limitations somewhat, and then there's a practical delivery. It's usually not a problem. And I would say that. And I definitely do not instill fear in my patients with unknowns. There definitely has been trends where patients are really worried about it. And I think a lot of those things have been and are debunked. But again, I don't want to live in fear.

And what's worked for so many years and what the Swiss has taught me is the anesthetics are safe and they're needed. In a lot of cases, you don't need them. You're right. Small fillings with lasers, you very often don't need any anesthetic. So, we use the least amount. But for surgery, it is so important to have the patient hold still. And some patients, they're terrified with the pain that you can have. Even if it's minimal, you don't want to traumatize the patient. So being able to get somebody numb is really important. And sedation would be on top of that. I think that is really important for some patients. You do not want to have a traumatized patient. Because in the future, if they're afraid to come back to the dentist, that could be a disaster.

[1:33:40] SCOTT: Let's touch briefly on the role of ozone in biological dentistry. What are some of the ways that you're using ozone in your practice? Are there cases where ozone is the solution to a particular dental problem? Is it more commonly supportive or maybe buying some time so that we can then get to the full solution to address maybe a localized infection? And one of the newer options, wondering if you have any experience with ozonated glycerin in dentistry.

[1:34:08] DR. POPP: Yes, yes, yes. The best example I have is this tooth is sensitive when I blow cold air on it. I cannot tell you hundreds of times. I bring the patient back, set them down, turn it up to a high gamma, 40 to 60. And I just blow gas where it's cold. And then you do that for a minute or two. And my assistant, I have them go get a glass of ice water to bring it back. Because when I'm done, they drink the ice water. It's so much better.

Ozone's amazing. Desensitizing, I think it's great, I think, for pain control. It modulates well in many cases. We bubble all of our extraction sites with it. You can inject it if it's medical grade. I do think it probably would hold down some localized infections could buy time. Sure. You asked earlier about how do you do biological root canals. There is more talk about using ozone lasers.

Val Kanter in California does some revitalization. I love that. I think it's great. In those cases where you just don't have a choice, you really need to consider it. It's better than doing nothing. I think have at it. But the ozone, I think it's so small, it penetrates everywhere and it kind of goes to the right place. I think it's very safe. Ozonated glycerin has come on the scene. So, I have had patients where their primary doctor or integrative doctor is having them do even IV ozonated glycerin. And it's very simple to do.

We used to do triple shot ozone IVs at a clinic I worked at. The medical part would draw the blood, ozonate it, put it through a UV light and put it back in. It was just so much stuff. The ozonated glycerin is a little bit easier way to administer ozone at a high dose, but you can nebulize it.

So, to go back to like the sinus issue with the biofilm and some of these persistent reactive sinuses that I told you, I wish the ENT would do something else. We often will turn patients to looking at ozonated glycerin with their doctor. And I would say even my doctor that we refer to very often here, he uses ozonated glycerin now as a post-protocol for all of his joint injections, and patients are responding quite well to that. So, I think ozonated glycerin, because of the way it stabilizes the ozone, it's a great delivery way. Now, if you have ozone gas, great, but it's going to degrade quickly. It's not like you can put it in a jar and do it later. I mean, you could, but it won't be very strong.

[1:36:26] SCOTT: So, let's talk now about dental implants. Many are done with titanium. More biological dentists tend to use zirconia instead. So, what's the difference between those two materials? What are the pros and cons of each? Which one is more functionally optimal? Which tend to last longer? Can we have a dental implant that lasts for life? When is an implant the right solution versus maybe another option for a given patient? And what's the process of preparing for installing and optimizing a dental implant? And when we have a zirconia implant, is it true that there's still a titanium screw that's used to hold in that implant?

[1:37:06] DR. POPP: So titanium is still the most prevalent, but knowing what biocorrosion can be in my mind, I just, I don't need any metal. We're able to do it with zirconia implants. Zirconia implants, they come in all different shapes and sizes. But the main company that I like is Swiss Dental Solutions. This is what Dr. Volz, he pioneered. And they're basically tissue level. They're almost all one piece and they kind of sit at the level of the tissue. You can have it be a two-piece where the little post you can put it in later. But there's a plastic screw that just holds that post in place that you cement into place. The screw doesn't do much. It used to be titanium, but that's not available in the U.S. I don't know if they use that anymore.

Other systems I think do have a metal screw. Again, there's hundreds of systems. In the U.S., there's primarily only a few. And some of them are designed at bone level, which is more like a titanium system. If you're going to use zirconia, you want to keep any micro gap away from the bone, which makes it more of a tissue level implant, and that's what these are.

The caveat behind them though is they really do need to be anatomically a little bit more properly positioned the way a tooth would be to take the forces like a tooth should be, versus put the implant where the bone is and fix the angulation with the metal abutment. Titanium, in some ways, Dr. Volz would say it's a little bit more – I don't want. Say amateur. It's a little bit more technical, I think, to be using zirconia because you really do need to put it where it should be and build the bone accordingly versus just put it where the bone is. Titanium will move a little bit. So, there's some bonus to that in using removable dentures. That's not very good for zirconia. Zirconia is hard. But you also want to split it together and it's even stronger and reduces bone loss. So, there's some caveats to the zirconia.

I do think the best time to build bone is right when the tooth comes out. Because when the tooth comes out, you're going to do one of two things. You're going to place an implant and graft or you're just going to graft. And so, if you just graft, you have a tendency to lose more bone. And then you come back later, you place an implant, you graft it back up. But you'll lose tissue. The best way to retain as much tissue as possible and as much bone as possible is if you can use the support of the implant in the right place, graft at that time. That's when we see, I think, the best results. There's always a risk, no matter what you do, whether you graft, whether you implant. So, Dr. Volz, I liked his terminology of grafting 2.0. You graft with the implant if you can. And in a lot of cases, you can with this type of implant system.

[1:39:57] SCOTT: And will that last most people a lifetime?

[1:40:00] DR. POPP: That's always the question. Everybody says, "How long will it last?" Well, I always use this as a sort of like tires. Well, it's probably a bad analogy. But if you have a Jeep and you just Sunday drive, those tires last forever. But if you are always on the trail, how is your bite? The question we go back to, what is the harmony in your bite? Did you break all the teeth off and now you're putting an implant in? Are you replacing all the teeth or just that one? It really depends on they should last a lifetime. I will tell you that. They should last a lifetime. But that does take an important look at the whole chewing harmony in the system.

[1:40:34] SCOTT: If someone has osteoporosis and they're on a bisphosphonate medication, can that create problems for placing an implant, particularly around the viability of the bone or the bone healing after?

[1:40:49] DR. POPP: Absolutely. I don't know if this is still true, but I do think that if you have a bisphosphonate, at least Dr. Klinghardt's clinic with Dr. Volz's, they wouldn't treat you because of the risk of osteonecrosis. However, I think there's some tests that you can do to see how susceptible are you to an osteonecrotic event. And I think that those are the cases that are best to send to an oral surgeon because there might be a bit more follow-up with that and more risk, of course.

[1:41:20] SCOTT: You talked earlier about the Biocomp for material compatibility. We also have historically talked about the MELISA test from Dr. Vera Stejskal. I know it was available here for a while. I'm interested in whether or not we still use that. And when you have used MELISA testing or even Biocomp testing, how commonly do you see people are reactive to titanium? Do they even look at zirconia reactivity? Is that even a possibility? Or do we believe that most people are not reactive to zirconia? Talk to us about the MELISA test and a little more about compatibility testing.

[1:41:57] DR. POPP: John Clifford had a test of looking at reactivity of all dental materials, and that has now become the Biocomp test. DNA ConneXions, I believe, has taken that up. I think that that's useful. The MELISA test might be a little more gold standard when you're looking at metal sensitivity. Yes, questionable if that's available now. Now, Orthopedic Analysis is another company that does do testing. And I do think they test for zirconia, too.

How prevalent is that? Great question. My mother was, which was a big reason why she decided to have metal mercury and metal crowns removed, her metal implant removed. And I would say overall, immune system function-wise, because we did do some testing, she had some great improvement. I like to believe that that was a really good step. And she's still here, thank God, my mom.

I like the MELISA test. I don't know, again, if that's available. You'd have to send it to Germany. But it does help people if they're on the fence, and they have a metal implant, and it might not feel right. They're just not sure. Because it was a big investment. And so, it's tough. And it's definitely a non-standard procedure to start removing metal implants and placing ceramic. I'm sure that the dentist that places the metal implant would not like that either. So, to do something without a real reason like a MELISA test I think is risky. So that's when we would bring in that test. And I recommend it periodically.

[1:43:21] SCOTT: Let's talk a little bit about crowns placed over damaged teeth or parts of damaged teeth. When is that the best option compared to an inlay or onlay? How do we know that the remaining tooth beneath the crown isn't still potentially decaying over time, having issues that we're then not able to see? How would we catch that before that becomes a bigger problem? And is that even a potential consideration with dental veneers as well, that the remaining tooth structure underneath potentially then is decaying and another source of burden to the immune system, to the body?

[1:43:59] DR. POPP: Yeah. Well, good dentistry needs to be cleanable dentistry. So, depending on the patient's situation, again, if they have a lot of crowding, sometimes dentistry is going to make things worse. Just depends on the end result and how cleanable it is to prevent additional recurring decay.

But your question based on inlays, onlays, I would say everything should be an onlay. Everything should be conservative. And you have to take out what decay is there, take out the old filling. Look at the tooth. If you have cusp tips, we call it the isthmus, the depth of the cut and the width of the cut from a filling for instance. What's left of that functional cusp tip? The part that bites. If there's not much left there, then we usually skirt and we cut that cusp out because it's not going to be strong enough to withhold chewing. If you see a horizontal crack now that you've taken out the filling and there's a crack under that cusp, you take that cusp out.

And so, you're looking at every tooth basically from a conservative lens to hopefully do it onlay, which is more challenging than a full crown. But you have some criteria that you're trying to keep that tooth alive, to be honest with you, Scott. You're trying not to traumatize that tooth to the point where it's going to die.

Now, in general dentistry, outside biological, that may not be as important where you can just say, "Hey, just get a root canal, kill the tooth." And then we don't have to worry about that if the tooth becomes sensitive. So, you could be a little bit more aggressive and just do crowns. But when you start to do that, you will find that sometimes those teeth become sensitive, they're traumatized, they can become pulpitis and die. That is a risky situation in somebody like in my practice where I'm really trying not to have additional dead teeth that somebody might elect to do a root canal on. That's a challenge, of course.

So, I'm always being as conservative as possible. I probably do more fillings in some cases where you would do a crown. And then this is where I like printed restorations. I think that there's a development into a better situation and the materials become beautiful. So, it's nice.

[1:46:12] SCOTT: Is there ever a scenario then if there is a crown or veneer that there's decay underneath and you have to remove them and do something with what's remaining underneath them or not?

[1:46:21] DR. POPP: Yeah, it could happen. This would be in the case of recurring decay. Now, wherever you place, say, a veneer, you've etched and prepared that surface, it's unlikely you're going to get decay right underneath it. It's usually at the margin. And this is why I say the cleansability is important because you're going to collect biofilm depending on what bacteria is in the oral cavity. What you feed the bacteria, the lemonade for an hour.

Some people are going to get recurring decay and it starts on the margin and then it starts to leak into the restoration. And you would want to remove that to treat it adequately. Again, that's tough for some patients because they might have a crown they did two years ago and they got a little bit of that stain underneath this margin. We can chase it with the laser, but the reality is you can't see it. And so, the best treatment is to remove it. But that comes at a high expense when you start replacing crowns.

[1:47:11] SCOTT: So, let's talk briefly about the width of the palate. What issues can arise when the width of the palate is not enough? Is that best addressed in childhood? And if someone's already an adult, when is it worth exploring palate expansion using something like an ALF or Alternative Lightwire Functionals device? I'm seeing more people talking about something these days called the Vivos. What are the potential treatment options and what health-related issues could be improved by going down the path of palatal expansion?

[1:47:43] DR. POPP: I think this is a topic that's been around for a little while. In general, it's safe, but I am hearing more complications come about. And there's also the MARPEs and the SARPEs. These are all expansion devices that either screw into the palate or they sit on the teeth like a Vivos where they expand.

Now, what patients don't always realize is a lot of times you get expansion, you might have improved airway. That's huge. But now the bite is completely off. And you still have to go through a full mouth restoration to fix everything with spaces between the teeth. So, it can become a very, very big project.

I tell patients, when you start going down that road, you're very much looking at redoing the kitchen. This is the only kitchen that you really have, but it probably costs about the same and takes about as long as actually redoing your kitchen. So, it's an investment. Sometimes the best thing you could do. But the expansion part, you're talking about airway dentistry. And I think that having an airway dentist, like an orthodontist, it's huge, especially in development.

Now, my most recent take is I'm less interested in some of those expansion devices, more interested in cranial orthodontics. This includes Dentosophy. This includes cranial orthodontics, say, by a really great dentist in San Antonio, Dana Hodge King, who she's going to be publishing a few different publications in a book. Really using some splint and rubber band technology to work on the cranial strain. And then everything else just kind of follows afterwards. And it's sort of like doing physical therapy for the body to help itself versus trying to force something, if you will. And a lot of times the orthodontist, as I'm learning now, or the airway specialist, they kind of go right to one thing without looking at is there any neck, cranial strain first, because I think we in some cases make it worse.

[1:49:39] SCOTT: So speaking of that, my biodynamic cranial osteopath loves a system that you are using in your office called Dentosophy. So talk to us about where Dentosophy originated. What are the goals of wearing a Dentosophy balancer or appliance? How does it help the body to reorganize itself, maybe have implications that go beyond the mouth? And what are the applications of Dentosophy in your clinical practice?

[1:50:08] DR. POPP: Yeah, I mean, this is my newest training with Dr. Rebekka Hueber. Now, okay, so interesting is Italy, I think, is a big part of this. The appliances I use now are from Italy. But this is where they would – the orthodontists in Italy, they take long breaks. So, you get a big, long summer and a couple of breaks in between. And so, the kids that were in orthodontics, instead of having the ability to come in and to address their needs in orthodontics, they would give them these balancers to go away from the summer. And the kids would come back, and a lot of times their crossbite was fixed. Their deep bite was better. And they're like, "What the heck's going on?"

And so, the use of these balancers is a book called The Wisdom of Teeth. It's been around some time, but it's really working on exercises that improve and train you to breathe through your nose better, better tongue position, proper breathing and swallowing and chewing. And what happens is you massage these cranial plates to give them a little bit of freedom to equilibrate, maybe, if that's the best way to explain it. So, it's myofunctional therapy, in essence, in starting from the cranial plates before moving forward to the jaw stability. And of course, last, the teeth.

So, in my practice, what I really like about it is we're trying to always improve outcomes. So if we can improve circulation and improve, say, you've mentioned this earlier, nitric oxide production by breathing through your nose, we try to incorporate this device for every large procedure or any type of jaw stability procedure. I feel like it works really well in the Bioesthetic world where we're trying to stabilize the jaw. But first, we try to stabilize any cranial strain, and then the jaw, and then the teeth. And we're already seeing really wonderful results in some people. And they have had neck issues that have resolved. There's some really fun things. And it's very conservative.

[1:52:15] SCOTT: So, you mentioned myofunctional therapy. So, I want to touch just briefly on your observations around tongue-tie releases. So, what role does the tongue position play or tongue-tie play in that airway conversation, maybe also in terms of sleep, or speech, or feeding? We talk about this a lot in kids, but I know some adults are doing it as well. So, what are your thoughts about tongue-tie release?

[1:52:40] DR. POPP: Yeah, I think there's an order of doing it. Again, dealing now with my newest training, again, dealing with the cranial strain first. But the tongue is tethered. It's a fascia thing all the way down maybe to the Achilles heel. The release, there's a lot of talk about this. So I'm really open ears on this of doing the release even in a way that you're preventing scar tissue. So maybe less laser release, believe it or not. A little bit more atraumatic type release. And these are techniques I really look forward to learning from Dr. King in San Antonio, who does this a lot. Because we see this to be huge for kids that are trying to nurse, that have trouble because of the tongue-tie is a little bit; everybody has a tongue-tie, by the way. Some are just more tethered.

So, if that's impeding nursing, for instance, it's magic, like immediate. But if it's done improperly, you can develop scar tissue, and it can cause problems later in life. But some people, when they have it released properly, it's a whole different ball game, the neck release. And it's immediate in many cases.

I'm not a big tongue-tie releaser yet. I just want to learn how to do this a little bit more proper. But there are dentists that that's their whole living. And so, there's definitely something there. But there's an order in which you want to do that. You don't want to just do that. You want to make sure to do the myofunctional part first so that the procedure is more effective.

[1:54:09] SCOTT: So, talk to us then about sleep apnea. When is it best addressed with a dental solution like a mandibular advancement device or something like NightLase versus a CPAP? Is it common for you to have your patients do a home sleep study? What are some of the tools that you might use to hint in the direction of sleep apnea? And is a dental solution then something that is commonly employed or deployed for obstructive sleep apnea? One of the concerns that I heard about these mandibular advancement devices is the potential to create more stress on the condyles over time. So, what are your thoughts on using devices to really work with sleep apnea to build a stronger airway?

[1:54:50] DR. POPP: I would first try the Dentosophy route of trying to have the body trained to improve sleep apnea. And now that's not always going to fix everything. So that's when you start to move to other appliances. And again, the ends justifies the means. If there's a device that you have to wear that slides your jaw forward, it may put more pressure on the joints, may disturb the bite. But if it improves sleep, maybe that's the lesser of the two evils.

And so we do employ sleep devices. I'm just much more of the thought of trying to help the body naturally try to improve the situation. This is why I like Dentosophy a lot because it does focus on nasal breathing. And that can improve things a lot. Myofunctional therapy, the same.

Now, the NightLase is more of an anatomical treatment where you're shrinking some of the soft tissue to open the airway. In that, I would say I think reports of upwards of 80% of patients do have improvement. So that and a combination. I would always try to be conservative first. Because when you start to move to a mandibular advancing device, you can alter the bite a little bit and that can cause problems as well.

[1:56:04] SCOTT: So, since we're talking then about sleep, where do you land on the topic of mouth taping? How important is nasal breathing over mouth breathing? Can mouth taping actually offer real benefits and solutions? And given everything we discussed about sleep apnea, is there anyone that shouldn't try mouth taping? Maybe someone that has an undiagnosed or more severe obstructive sleep apnea where it could potentially be risky.

[1:56:29] DR. POPP: Yeah, absolutely. That could be a contraindication. Now, again, I'm very pro Dentosophy balancer device. If it's a proper device, you don't need mouth tape because you can't really easily breathe through it. Now, I have patients that do mouth tape and I do recommend at least doing in the day to train yourself a little bit and work up to it. But some people really do benefit from it. And I think that's great. There can be reaction to the adhesive. So there's some issues that could come about with mouth taping. But there's always going to be the outlying cases and the severe cases where it's probably not a great idea because the obstruction is so high.

[1:57:08] SCOTT: So, let's touch on, we talked about condyles a little bit. That's kind of the core of the TMJ conversation. So, let's bite down on that connection for just a moment. What are some of the most common causes that you see for TMJ or TMD? Is that clenching and grinding? Is that a bite that's out of alignment? Is it really a symptom of something upstream, like maybe the airway or the palate rather than the root problem itself? And when someone's dealing with TMJ, what are some of the treatment options you might consider? Is that an appliance, or jaw stabilization, or physical therapy, or maybe a totally different approach?

[1:57:45] DR. POPP: And I would say all of the above. And causes are multifactorial. So, it can be airway where you're trying to get air. And so you can grind and you can get joint discomfort. The bite, I think, is a very, very big part of it, as is the airway. Now, medications can cause parafunctional habits that can affect the joint as well. Stress alone can do it. But I think toxins are probably another aspect of that. So again, multifactorial, I would always try to utilize either the Dentosophy balancers in addition to some harder splints to deprogram, to try to diagnose it a little bit better and to see what you can do that's very conservative yet has a positive effect. But it can be debilitating. And these patients that have this, sometimes they're going to be – they're just really, really uncomfortable. It's hard.

[1:58:46] SCOTT: Given that many patients today are dealing with hypermobility and EDS, which is interesting that you brought that up first in the conversation. Some people also dealing with cranial cervical instability or CCI. What are the unique considerations in working with that patient population when connective tissue itself is part of the issue? Does having connective tissue issues change the dental options that you might consider, how you approach treatment, how they might respond to anesthesia, or how their recovery after a surgical intervention might go?

[1:59:21] DR. POPP: My initial take is less is more. Look before you leap. That's when I pump the brake. And I'm not one to push treatment in general. Again, I told you, if you're on the fence, I'm not your guy. But I do think that we really need to reiterate with patients that may not heal real well. And this is the case in a lot of this subset of population.

[1:59:44] SCOTT: So, as we start wrapping up here, I know Dr. Klinghardt would not be happy with me if I didn't talk about the occlusion. So, if we think about the bite, the occlusion supporting overall balance of our structure, even our nervous system, what are some of the issues that can lead to an imbalanced bite? What are some of the approaches that we can use to optimize it? And I'm guessing Dentosophy may play a role. How does clenching and grinding wear down the teeth, sometimes unevenly on one side where we can create an imbalance in the bite? What are some of the tools that you have in your toolbox for helping to rebalance maybe the damage that resulted from clenching and grinding over a long period of time? How do you stabilize and balance the jaw and the bite?

[2:00:29] DR. POPP: You're going to get dominant side chewing in a lot of patients. And I think the maxilla, which connects to the sphenoid, kind of the middle bone of the head, if that's rotated, again, you're talking cranial strain, you start to see this in the teeth and then there's an imbalance. And then you might have a dominant side, you wear that down, you lose a tooth.

Once you wear that tissue, the tooth down, the reality is you've got ideally to get the shape; you need to get the shape back. But this is where we've learned stabilize back here, stabilize the joint. And you have to use balancers and appliances to do that and to deprogram and to get stability. And then you look at how those teeth come together in harmony consistently. So same bite, jaw stable. Then you look at the shape of all those teeth. Are they points or are they in like a point in a hole? Because as you move around, you'll get interferences. And those teeth are nerve endings. And so, it's very, very much important to have the proper shape or the morphology.

But ultimately, the biggest goal in the end of all this, efficiency in chewing. You got to have sharp cusp tips to chew food. If you have flat denture teeth, it doesn't chew the food. So, I would always tie it into like all of this, the Dentosophy, the OBI, the bone augmentation, the replacing teeth with implants and biological materials. The goal in the end, tooth morphology, genetic tooth; more sharp cusp tips so you can chew your food efficiently.

I think that the bite; I love this about Klinghardt. Because he said the key to a healthy life is a healthy bite. And I totally agree with that. And this is what really led me down to learn about the Bioesthetic restoration, because it looks at that at a level that's in microns. But now we know more. We even go further back to, hey, cranial strain first, then the joint, then the teeth.

[2:02:21] SCOTT: My last question is the same for every guest. And that is, what are some of the key things you do on a daily basis in support of your own health?

[2:02:28] DR. POPP: I love on my dog. I think animals are huge because they just pull the stress right out. I think grounding is great. I like to sit in the red light. We mentioned red light a little bit, but I think we're all light beings, so getting good light. I love the Gary Brecka's and the recommendations of get out and see that sun. See that sun for five minutes before everything else takes over. I think that some of those beauties in life, I need to do more. But when I do those, it's great.

Working out, of course. I don't dance much anymore. My wife will take me to yoga at 5:30 in the morning on Monday. But I think that sets the week. And time with my family is absolutely key. So I think that the interaction with you and with the patients, we need a little bit of that human love back and forth. I think that the more we can do that, that's what helps me.

[2:03:24] SCOTT: I want to thank you for being generous with your time, for all of the great information. I really appreciate your curiosity. I appreciate that you continue to search the world for new, for better solutions. It's a blessing for me to personally work with you and know you and just really want to honor you for your work. And thank you so much, Dr. Popp, for being on the show today.

[2:03:44] DR. POPP: I super support everything you're doing because you're uncovering a lot for all of us listeners to learn and be better and feel healthy.

[2:03:53] ANNOUNCER: Thank you for listening to today's episode of the BetterHealthGuy Podcast. You can learn more about today's guest, including relevant links and resources in the show notes. This podcast may provide community discounts and occasionally share links from affiliate partners. You can find this and other episodes on YouTube, Spotify, Apple Podcasts, Amazon Music, iHeart, and more. To learn more about Scott's personal journey to better health, visit BetterHealthGuy.com. Join us next time on the BetterHealthGuy Podcast.

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