The Oral Microbiome: The Hidden Biomarker Driving Aging, Fertility & Systemic Inflammation

The oral microbiome belongs squarely in the functional medicine toolkit, and my conversation with Staci Whitman, DMD, IFMCP, makes that more clear than ever. As a board-certified pediatric dentist and co-founder of the Institute for Functional Dentistry, Staci is reshaping her field into one that aligns with systems biology and root-cause care.

She lays out, with real clarity, how oral dysbiosis, airway restriction, sleep, hormones, nutrition, and even dental materials influence systemic inflammation and chronic disease. She also offers clear steps we can take as healthcare practitioners, including when to consider oral microbiome testing and how to use a straightforward six-question airway screener in patient visits.

For clinicians focused on longevity and upstream drivers of disease, this conversation shows how much more powerful our care becomes when dentistry becomes part of the clinical partnership.

~DrKF

The Oral Microbiome: The Hidden Biomarker Driving Aging, Fertility & Systemic Inflammation

Functional dentistry is emerging as a key driver of systemic health and aging. In this episode, Dr. Kara Fitzgerald talks with Staci Whitman, DMD, IFMCP, about the oral microbiome, airway function, and how dental pathogens shape inflammation throughout the body.

You’ll learn how to screen for oral dysbiosis in a medical visit, when to order oral microbiome testing, how pathogens like P. gingivalis and F. nucleatum connect to cognitive and cardiovascular risks, and how diet, hormones, saliva, and airway mechanics influence oral health. For practitioners working in inflammation, longevity, gut health, or chronic disease, this episode offers practical insights you can apply immediately.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: I am thrilled to be talking with Dr. Staci Whitman. She is a board certified dentist with a focus in functional dentistry, functional medicine, pediatrics, and women’s health. She co-founded the Institute for Functional Dentistry, which is launching January, 2026. She’s a global thought leader integrating the oral microbiome, airway, hormonal health, and root cause dentistry. And she also leads Bloom Kids Dentistry, the first functional pediatric dental office in the US.

Dr. Kara Fitzgerald: Dr. Whitman, welcome, welcome, welcome to New Frontiers. I am so glad to be able to pick your brain today on all things functional dentistry. But first, I want to hear your story. You’re a pediatric dentist by training and you transitioned into a functional medicine model and now you’re a real game-changer in this space. I’m thrilled, by the way, that you’re bringing forward the Institute for Functional Dentistry. That’s awesome as a side note. But what’s your story? How did you move into this space?

Staci Whitman, DMD, IFMCP: Great question. Well, first of all, thank you, Dr. Fitzgerald, for having me. I always appreciate having platforms to amplify the importance of oral health and how it ties into whole body health, so thank you. My story is similar to many who find themselves in a functional practice, where I was trained traditionally, kept my head down, and just kind of plowed through the curriculum. And when I came up for breath and was actually out practicing I realized how dissatisfied I was with my career choice and with the way modern dentistry was being performed. Actually, I was pretty depressed and I almost left my career, but I was handcuffed to my student loans.

Staci Whitman, DMD, IFMCP: So what was I so dissatisfied with? It was that we go into medicine to help people to heal and with the current model, it’s so ‘turn and burn” and you’re just dealing with end-stage disease. And dentistry particularly is just fixing end-stage disease. We’re fixing holes in teeth, we’re doing root canals, we’re doing extractions, dentures, partials, et cetera, and it’s too late. And so I didn’t have time to connect and work with my patient to get upstream. What were the antecedents? What were the triggers? What is this patient’s story? What have their exposures been? How are they in this state of disease right now and all this dysbiosis? And so I thought, how do I salvage this career?

Staci Whitman, DMD, IFMCP: I, myself, was very interested in more optimized living, for whatever that meant at the time, just trying to eat well and exercise and do all the things. So I thought, well, how do I get upstream? It’s with kids. I didn’t go into pediatrics because I love children, although I do, but it was truly to get to the beginning. I wanted to head upstream so I could educate, ideally, couples preconception heading into pregnancy and birth and beyond and then to educate so that these children grow up thriving and optimized so they weren’t in the dental chair undergoing all these dental procedures which are expensive and create emotional and physical trauma etc.

Dr. Kara Fitzgerald: Wow.

Staci Whitman, DMD, IFMCP: So I became board certified in pediatrics but then unfortunately, I got thrown out into the world after I graduated, and pediatrics is even more “turn and burn”. If anyone’s been to a pediatric office it’s high volume and so I became even less satisfied with my career, because now I had even less time with my patients. And so I thought, my goodness, the only way I’m going to save this is to completely rehaul it. And so it wasn’t overnight, it’s been a process and it’s been taking me to conferences, learning from amazing teachers like yourself and doctors like yourself.

Staci Whitman, DMD, IFMCP: I basically had to reeducate myself and kind of take all this information from functional medicine and biological, integrative medicine and put it into my practice. And so I created a functional pediatric dental practice, which to my knowledge is the first in the country, where we just take a whole body approach and we tie in all the concepts of functional medicine into our patient care. And I’m starting to work with women’s health too and looking into opening, maybe, a micro practice focusing on women and moms and the changes that we go through and how it impacts our oral health and our oral microbiome.

Dr. Kara Fitzgerald: Geez, that’s such a great story. Bravo you. God, bravo you for hitting that ontological abyss, as my philosophy professor used to say when I was an undergrad. Ontological abyss. Just hitting that place of feeling so dismal that you actually birthed something pretty extraordinary.

Staci Whitman, DMD, IFMCP: Thank you.

Dr. Kara Fitzgerald: It sounds wonderful and we just need more dentists thinking through a functional lens.

Staci Whitman, DMD, IFMCP: We do. Yes, I agree.

Dr. Kara Fitzgerald: So where do we want to go then? I mean, there’s a lot for us to talk about. Everybody, we’ll definitely link in the show notes to the various papers we reference. We’ll link to Dr. Whitman’s clinic, the Institute for Functional Dentistry, all of that and I want to talk about oral-systemic. I also want to talk about what we need to be thinking about—our audience is mostly functional medicine clinicians, non-dentists—I want to talk a little bit about what we need to be doing in practice and labs. But to your point of thinking about moms, thinking about in utero oral microbiome seeding, thinking about even before that, fertility. I mean, the fact that you were considering all of this as a student is absolutely mind blowing to me. So let’s start there and then we’ll move forward.

Staci Whitman, DMD, IFMCP: Yeah. So, let’s just talk about how the microbiome is established. And I don’t need to be lecturing you all about this because you’re experts in the gut microbiome. But are you that familiar with the oral microbiome? And I think, when I’m attending these functional medicine conferences, my answer is yes. I mean, you are paying attention much more than my dental colleagues are. But where is it established? It’s truly established preconception. What is the microbiome status of the man and the woman? Do they have periodontal disease? Do they have untreated oral infections or dysbiosis that is then going to seed their baby. And we’re learning in utero, the gut, the mouth, it isn’t sterile. The microbiomes are being established in utero.

Staci Whitman, DMD, IFMCP: And then of course all the things that lead into those first thousand days of microbiome establishment. We cannot treat the gut without treating the mouth and vice versa. I mean, the mouth is the gut. That’s the biggest take home here. As functional medicine providers and naturopathic providers, people are very focused on gut health. That’s amazing. But if you are not looking at your patient’s oral health, their gum health–- we swallow 2,000 times a day, that’s translocation– not to mention leaky gums. I want everyone to be familiar with the term leaky gums. This is gingivitis, gingival permeability. Are your patient’s gums inflamed and bleeding? That is systemic inflammation.

Staci Whitman, DMD, IFMCP: So the parents have to be healthy to then create this child that’s set up for success and we do know cavities and gum disease are the top chronic disease in humans globally. And in children, cavities are the top chronic disease that surpasses asthma and eczema and allergies and things. Unfortunately, we’ve just normalized it. So all these kids get cavities, but everyone says, “Oh, that’s just their family history.”

Dr. Kara Fitzgerald: It’s just part of childhood.

Staci Whitman, DMD, IFMCP: Yeah, but it’s not. This is a sign of micronutrient deficiency. This is a sign of oral microbiome dysbiosis. This is a sign of intestinal permeability, genetic polymorphisms. We have to work the patient up, but this is not normal. Ancestrally, humans did not get rampant decay like we do now. And of course, much has changed. The diversity of our microbiomes have changed, our food clearly has changed, and that’s been part of the issue and we can get into that. But heading more into mom’s health, the baby is with the mom, breastfeeding, skin on skin, you know, was it a vaginal delivery, et cetera. So it is very important to support the women and to educate them on how to optimize their babies far before they’re even holding the infant in their arms.

Staci Whitman, DMD, IFMCP: And then thereafter, what can we do to support the microbiome of the mouth after the baby is born because that is going to help the gut microbiome too, so we just do a lot of education. And then as it carries on through these hormonal changes of puberty and pregnancy and then perimenopause and menopause, all of these fluctuations in hormones and how they’re impacting oral health and the oral microbiome as well. So there’s just a lot of education that can go into this, but I think we’re really doing a disservice for our patients if we’re compartmentalizing the body, which we have done. And in the mouth, it is the gateway. And I know dentists can be the brunt of the joke, and I understand that because we’re not looking deep and we’re not functional medicine minded and that is part of my passion is to change that because I do believe oral health is so critical for systemic health.

Dr. Kara Fitzgerald: Yes. Bravo. Yeah, bravo you. We’re swallowing 2,000 times a day, so 2,000 episodes of translocation per day. That’s a powerful statement. And leaky gums, like gums being a gateway to endotoxemia. Also another incredibly important underline, exclamation point, kind of a statement. All right. So I just want to go back and touch on fertility and oral microbiome involvement there. I mean, I can hear from everything you’ve just said that the oral microbiome, that the mouth, just has to be a part of the journey. We can’t isolate it. And we are better in functional medicine thinking about the oral microbiome, but we’re not where we need to be. I bet you would agree with that statement.

Staci Whitman, DMD, IFMCP: I do, but please give yourself more credit. I mean, you just told me offline that you’re oral microbiome testing your patients. There are very few dentists that can say that. So bravo to you. I really do think our medical colleagues are far ahead of us here. Dentistry is just not very data-driven. The joke is ‘drill, fill, bill’, but where are the metrics? We don’t run tests. We don’t run labs, really, but we need to. And so that’s the whole concept of functional dentistry. And we can get into that, like as a functional medicine provider, what labs would be helpful for you to look at?

Dr. Kara Fitzgerald: Yes, I do want to get there, but let me just ask you quickly– fertility. I mean, fertility issues are epidemic. Actually, there’s a provider in my office who’s been really specializing in it and doing amazing work and of course the oral microbiome is a part of her workup. What do you know about the oral microbiome’s involvement in supporting or negatively influencing fertility?

Staci Whitman, DMD, IFMCP: Yeah, it does influence and I think all fertility clinics should be oral microbiome testing both members of the couple, because it’s not just the moms, it’s the dads as well. If you have an untreated oral infection, that could be a failing root canal, that could be gum disease, periodontal disease, these pathogens— What happens in the mouth doesn’t stay in the mouth so localized inflammation isn’t localized, it is systemic and so it’s going to have downstream effects, as well as translocation. We know that men who have gum disease are more likely to have issues with their sperm, motility and mobility, and they’re going to have a harder time conceiving and there’s a lot of data around that.

Staci Whitman, DMD, IFMCP: With women, there’s a study, it can take two months longer to conceive if you have gum disease, which doesn’t seem like a lot, but if you’re on a fertility journey and you’re really struggling— And of course this is preliminary studies too, so we need more data. Not to mention that gum disease in women can lead to low birth weight and preterm labors, even negative outcomes like miscarriages. So it’s incredibly important to understand how gum health and bone health and the pathogens that are involved in that, the red complex pathogens, P. gingivalis and T. denticola, how these are impacting a couple’s ability to conceive. And we have to understand that inflammation in the mouth is going to have downstream effects.

Dr. Kara Fitzgerald: Right, what happens in the mouth doesn’t stay in the mouth. Oh my gosh, that’s really apt. Well, let’s talk about P. gingivalis and some of the other negative players. But actually to put a pin in the conversation around fertility, so then clearly a part of that journey is going to be going to your functionally trained– through the Institute for Functional Dentistry– provider and just getting a workup and just being mindful of oral hygiene as a part of the whole journey. But I want you to connect the dots with these players. What did you refer to them as? Red? Say that again.

Staci Whitman, DMD, IFMCP: There’s different complexes of bacteria. There’s red complex, there’s orange complex, and so the red complex can be the keystone pathogens, especially with inflammation. But P. gingivalis, F. nucleatum, and T. denticola, these are some of the bad guys, if you will, the real virulent bacteria that can get missed on just a clinical visual exam, of course. And this is why oral microbiome testing is so important and understanding protocols as well. Some of these bacteria do require antibiotic therapy if they’re in the ranges of being so severe. You were asking before, what are the protocols when you test the oral microbiome? Like, what do I do with this information?

Staci Whitman, DMD, IFMCP: And this is something we hope to train at the Institute of Functional Dentistry. The oral microbiome is in its infancy. I mean, you could even argue that so is the gut. We’re learning now about postbiotics and synbiotics and individualized treatment plans based on what bacteria you have. It’s the same with the mouth, but we do know some of these keystone pathogens need to be addressed, whether with herbal antibiotics or antimicrobials, if you will, or debridement, cleanings, but also looking at have we missed infection in the mouth? Does someone have a failing root canal? Do they have a crown that is ill-fitting that’s just leading to chronic inflammation in their body?

Dr. Kara Fitzgerald: Let me ask a couple of questions so you can go into more detail on this. As I was telling you also offline, we just had a rounds meeting in my practice with one of the oral microbiome labs, which was great, by the way. Clinicians, they will come to your rounds as well, or you can just schedule a one-on-one meeting with really anybody in the functional medicine space, any lab. We have these conversations quite a bit as just a side note. But this was fascinating to me, and I know this to be true about the gut: A lot of us carry some of these bad guys, but the quantities are manageable. And one of the interesting things they said— and this struck me because I have a laboratory background where I would witness over-treatment with aggressive antimicrobial therapy when doing stool testing– they were also concerned that if you’ve got a nice robust distribution of the favorable microbes, they’re going to keep the bad guys in check. So I wanted your thoughts on that. So the bad guys can be there, but as long as we’re doing what we need to do.

Dr. Kara Fitzgerald: And then the bad guys, when they do get out of control, we just talked about it in relation to fertility, both men and women, and then oral-systemic inflammation, but just more broadly, where are these guys implicated? What kind of conditions can we see if you’ve got a mouthful of P. gingivalis that’s poorly controlled? And I’ve got one more question, I’m sorry. How is that going to show up? If I do an oral exam— and look, I’m not trained– if I ask them, is it bleeding with flossing? Is there going to be evidence or could one have a relatively good looking mouth and be out of control?

Staci Whitman, DMD, IFMCP: Sure. Okay, so the first thing I’ll say is you’re correct. At some point, their pathogenic bacteria arguably aren’t pathogenic based on the numbers. So maybe they’re not bad guys in a certain ratio. This is what we need to learn more about. Maybe they have more of a beneficial component to them. There’s symbiosis there. There’s a reason that they need to be there. And there are some that have the philosophy that you need to eradicate all of the “pathogens” nearly to zero. That isn’t the way to go in my opinion. I think some level may be normal in certain patients.

Dr. Kara Fitzgerald:  Yes.

Staci Whitman, DMD, IFMCP: It’s when they get to an out of control ratio where they’re surpassing the commensal and beneficial bacteria. So it’s all about the ratio and the levels, right?

Dr. Kara Fitzgerald: Well, we know that’s true in the gastrointestinal tract.

Staci Whitman, DMD, IFMCP: Exactly, yes. And so it makes sense. I think if we just think logically, the mouth is the gut so we should think of it the same way. So when you see P. gingivalis on your result, if it’s within a normal range, that’s fine. It might actually be serving a beneficial purpose that we don’t quite understand yet. And we do know these bacteria are important for helping with immune health and mineral exchanges and even some vitamin synthesis and just communicating within the saliva. Saliva is a really special solution in your body that I think many of us ignore. So that’s the first thing. You have to treat if it’s truly off the charts, but otherwise it may be normal, so nothing to worry about. I do know there are some that still want to completely eradicate, the “keystone pathogens”. My argument is, I don’t believe they’re pathogens at certain levels.

Dr. Kara Fitzgerald: Yes. Well, just again, going to the gut where I have more experience, but you could work on building the commensal population so they can keep the bad guys, or the so-called bad guys managed, right?

Staci Whitman, DMD, IFMCP: Exactly, you crowd out. Exactly. And so how do you do that? Prebiotics, prebiotic fiber, it’s your diet, it’s your fermented foods. How are you breathing? Are you nasal breathing? And we’ll get into airway potentially, but if you have patients that mouth breathe, this is a very important thing as functional medicine providers that I think should be on your intake forms, is an airway screening. And I’m happy to share a quick six-question screening tool that you just add into your intake form.

Dr. Kara Fitzgerald: Awesome. Yes.

Staci Whitman, DMD, IFMCP: But if your patient is mouth breathing, not only are they going to have oral dysbiosis, they’ll have gut dysbiosis, they’re going to have generalized inflammation, not to mention all of the sleep issues that come with that, hormone issues, immune health issues, just feeling like garbage, brain fog, et cetera, weight gain, et cetera. So you then said, how can we tell if we’re dysbiotic? What are we looking for in the mouth? Cavities, bad breath, halitosis, a white coating on the tongue, tonsil stones, gum disease–

Dr. Kara Fitzgerald: Bleeding when brushing, bleeding when flossing.

Staci Whitman, DMD, IFMCP: Bleeding, yeah. We say to a patient, “Pink in the sink”. When you brush and floss and you spit, is there pink in the sink? Many will say yes because oral inflammation– and this is outrageous— it affects 90% of the adult population! 90% have some level. Now that could be mild, moderate, severe, okay? Periodontal disease can affect up to 50% and once it becomes chronic periodontal, that’s when it starts to affect the bone. That’s when we start losing attachment. We lose bone levels in our alveolar bone. This is more end-stage disease and these are the very virulent pathogens so we want to catch this upstream.

Staci Whitman, DMD, IFMCP: So if the gums are puffy and bleeding, that’s gingivitis. That’s more acute. That’s early and we want to correct it then before it becomes more chronic and end-stage 2. And the connection of the the microbes— so you said P. gingivalis and what are the other downstream effects? There’s so much research in this right now, but P. gingivalis specifically has been found in the brains of Alzheimer’s patients and they did control and look at the autopsies of patients without Alzheimer’s and they did not find P. gingivalis. And so this can create inflammation, amyloid plaques. How is this happening? The actual microbes are translocating, not only through the circulatory system, but they can travel up the trigeminal nerve, arguably maybe the vagus nerve, and also their endotoxins, lipopolysaccharides, the cytokine storm that they’re creating. So it’s creating an immune response.

Staci Whitman, DMD, IFMCP: F. nucleatum is a bad bacteria when it’s out of control, that’s linked to pancreatic cancer, colorectal cancer, breast cancer. So you need to think about cancers if your patients have a very high F. nucleatum. T. denticola can impact fertility and pregnancy. And of course they all have some role in all of it as well. Cardiovascular disease, this is why we’re worried about bacteremia if you have a valve placed or some heart cardiac surgery. So we’re worried about that. Rheumatoid arthritis, autoimmune disease, gut health issues, as I mentioned before, so you’re swallowing 2,000 times a day, so do you have intestinal permeability? Do you have IBD or Crohn’s, celiac? Like this could all be exacerbating it. Yeah, the list goes on and on. Fertility, I mentioned as well, mood disorders, and again, that goes back to gut health and just general inflammation as well. So, it’s a lot. There’s a lot. So it affects, arguably, every system in the body.

Dr. Kara Fitzgerald: Incredible. Yeah. Why is saliva a special solution? I think you’re the first person I’ve ever really heard say that. I mean, it makes total sense, but why is it this magical special solution?

Staci Whitman, DMD, IFMCP: Yeah, I call it the golden elixir of the body. If you lose your saliva, your teeth will just disintegrate. If you’ve ever experienced someone in your life going through radiation or chemotherapy they usually get extreme xerostomia and this also happens with certain prescription medications. When we lose our salivary health, our teeth will just start to decay and demineralize and you’ll get rampant disease. And it’s because not only does it moisten and lubricate, but it has protective minerals, calcium, phosphate, so it’s important for ion exchange. It has enzymes that are critical for digestion and immune cells as well, so for these nutrient exchanges. It’s important in the nitrate reduction pathway for nitric oxide production. There are specific bacteria in the mouth that are important for this and it’s all carried within the saliva

Staci Whitman, DMD, IFMCP: Also think about how important it is for speaking. So we’ve all had dry mouth when we’re trying to speak. It’s very hard to articulate your words without proper hydration of the mouth. And swallowing, you can’t swallow effectively without saliva. You need to do something to help with that because that can impact digestion.

Dr. Kara Fitzgerald: What do we do in Sjogren’s? How do you take care of somebody who comes to you with Sjogren’s?

Staci Whitman, DMD, IFMCP: Yeah. There are salivary substitutes, so there’s products that they can use. You suggest to them they just rinse their mouth frequently throughout the day. Nasal breathing is especially important. Obviously, we want to try to work upstream and help them get their Sjogren’s more under control. But generally, it’s just keeping the tissues as moist as possible and being very on top of their oral hygiene. But hydration is so important. I mean, if you’re dehydrated, you’re going to see this in your salivary health. And another thing that impacts saliva is cortisol.

Dr. Kara Fitzgerald: Yeah. Of course.

Staci Whitman, DMD, IFMCP: When you are stressed, your body makes less saliva– fight or flight. We don’t need spit when we’re running away from the tiger, so chronic stress can greatly impact oral health because it’s impairing salivary function. As well with stress, we clench, we grind, we hold on to so much stress that over time it creates microfractures in our teeth, we get recession, abfraction of the teeth, and the teeth can chip and break over time too. So stress management, which, of course, is something we always educate and encourage our patients to undergo. It can very much help their oral health too. And so if your patient is struggling and we can’t figure out what’s going on, their diet’s good, their hygiene’s good, they’re breathing well, I wonder if it’s their stress. It’s just something to look into, and that is one test that I think is very important, especially as we age.

Dr. Kara Fitzgerald: I was going to ask you about that, the aging journey. Before we go into it I want to talk about the influence of hormones during the aging process. Dentists can predict that a woman is pregnant just by the hormonal changes to gums, so maybe we can start there but I’m curious about what happens through the changes. So perimenopause, menopause, and then just aging in general. I do, though, want to link back to the comment you made about giving us the six questions to diagnose oral breathing, so we’ll get that from you. We’ll put it in the show notes. I have a conversation with Mark Burhenne we can actually link to, but that is a conversation in and of itself, diagnosing and then treating oral breathing instead of mouth breathing, like that whole piece.

Staci Whitman, DMD, IFMCP: Yes.

Dr. Kara Fitzgerald: So any resources you have, we’ll put them in the show notes. And if we have time today we’ll circle back and talk about it because I know it’s incredibly important, you know, the differential and how to address it. And it can be challenging. I mean, it’s not always sleep apnea.

Staci Whitman, DMD, IFMCP: That’s right. And it’s very layered and this is why there’s a lot of people speaking about airway health, which is wonderful, but you really need someone that’s trained and certified, I think, and practicing because the more I treat airway, the more I realize, wow.

Dr. Kara Fitzgerald: It’s complicated.

Staci Whitman, DMD, IFMCP: Yeah. It’s so complicated. It sometimes can be micronutrient deficiencies that are impacting it. I mean, it’s just not such a slam dunk that you throw in an appliance and boom, life is good and dandy. But what is important for you as physicians is just to know that this is something you should be looking into and who to refer to and then quick screeners that you can do just to help guide your patients.

Dr. Kara Fitzgerald: Perfect. Yes. Okay, so we’ll pop those in the show notes. So let’s talk about hormones, changes to the oral microbiome and to the whole oral cavity, and then the aging journey and what happens.

Staci Whitman, DMD, IFMCP: Yeah. So fluctuations in hormones significantly impact oral health. I mean, we have estrogen receptors and hormone receptors in our oral tissues and our gums and in our pharyngeal walls and it can impact salivary health as well. Actually, this all starts in puberty and so very commonly, 11-, 12- and 13-year-olds come to the dentist and they get shamed for poor oral hygiene because their gums are inflamed and puffy. I used to be guilty of this too. So often their teeth were actually clean when they came in and they’d say I brush and floss, and then they just shut down. And I now have had this aha experience to say, “My gosh, they’re going through puberty!” They have gingival inflammation just like pregnancy gingivitis.

Staci Whitman, DMD, IFMCP: So, 70% of women experience pregnancy gingivitis and it’s from fluctuations in estrogen and progesterone while we are pregnant that can create gum inflammation. If it gets really out of hand it can cause pyrogenic granulomas, which is this really tender bleeding overgrowth of tissue. It usually resolves after the birth of the child and after we’ve gone through breastfeeding and hormones normalize a little bit. And also relaxin that is made to loosen ligaments to prepare us for birth. Well, where else are there ligaments? The periodontal ligament is around our teeth. So you hear these phrases, women say that their teeth shift, or “I lost one tooth per child,” I think is an old saying. It is a real thing. Women’s bite can change and shift and this also is seen in perimenopause and menopause.

Staci Whitman, DMD, IFMCP: So then we flash forward again, and now women have dry mouth, burning mouth, they might say they have a metallic taste in their mouth. They might start experiencing TMD, joint pain, headaches. This results from fluctuations in estrogen and progesterone. Progesterone specifically can impair collagen synthesis. We get more gum inflammation and as we age, we do tend to get more xerostomia, dry mouth. Sometimes we are experiencing more airway issues, more sleep disturbances, so this just compounds.

Staci Whitman, DMD, IFMCP: It is nice to stay ahead of things and that’s why I’m so happy that women’s health is getting more attention because a lot of women in their 40s, 50s, 60s and beyond do experience a lot of dental health issues that they never had before– bone loss specifically, and the bone metabolism. We are screening with DEXA scans and osteoporosis, et cetera, because there’s alveolar bone that’s going to be impacted too. And so if we could stay ahead of it and support women, whether it’s nutraceutically or pharmaceutically, I think that’s very important. You could be helping their oral health as well. And we’re living longer so we need to keep our teeth for a much longer time than we used to. So it’s really important to stay ahead of these things.

Dr. Kara Fitzgerald: That’s a really important aha moment you had with your teenage girls going through puberty. God. And that we just didn’t have the awareness of it. Oh my goodness it’s so heartbreaking. The last thing they need, you know, a teenage girl.

Staci Whitman, DMD, IFMCP: I know, it’s the last thing, and I have a 12-and-a-half-year-old right now so it’s a lived experience now. It’s one thing to speak about this and lecture about it, et cetera, but when you live it, I mean, I really see how it’s hard for her to get criticism especially when it’s not valid. The other thing– this is a total side note, but as providers, I think it’s important for you to know– nickel sensitivity is fairly common in patients. I’ve read studies–

Dr. Kara Fitzgerald: Yeah, like cheap jewelry sensitivity.

Staci Whitman, DMD, IFMCP: Yes, and I’ve read it can be as high as 17% of the population. A lot of kids in braces or with retainers, their gums will be very inflamed. And again, their teeth are clean, they say they’re flossing and brushing. It’s actually a reaction to the nickel and so you take the braces off and the gums go back to normal. So this is just something to tuck away if you have children of your own or you have teenage patients. And then also, everyone should just look into the links between nickel and IBS and IBD. If you have orthodontic appliances and things and you have a patient with a lot of gut health issues I think you should look into the metals as a potential source of issue.

Dr. Kara Fitzgerald: Yeah. Very interesting. Really interesting. I mean, just being on faculty in the immune module at IFM and talking about different variant underlying causes for refractory dermatitis, nickel is one of them. And it can be from foods that we’re eating, like nickel-high food, like chocolate and so forth. And it can show up in the skin. It would be interesting if a kid with braces who has a nickel sensitivity would have it show up on the skin.

Staci Whitman, DMD, IFMCP: Yep, or those permanent retainers that so many adults have behind your front teeth, there’s nickel in there. It’s just something to be aware of. And then another little nugget is a lot of the plastic retainers have methyl methacrylate in them and that’s gluten.

Dr. Kara Fitzgerald: Oh, interesting.

Staci Whitman, DMD, IFMCP: So if you have a celiac or gluten sensitive patient and they’re doing well and then all of sudden there’s a flare up, did they just get an orthodontic retainer? That’s something to look into.

Dr. Kara Fitzgerald: You know this is a side topic. We could talk for a long time here, Staci, but one of the things that I wanted to talk to you about is the materials that we’re putting in our mouth, and the bite guards, and Invisalign, and so forth and the fact that the enclosed environment could contribute to dysbiosis. In fact, I’ve seen that in my patients. People who are using Invisalign, if you do an oral microbiome analysis, you can see some pretty crazy patterns. What are your thoughts? Like the materials? How concerned do we need to be? I mean, grinding trumps probably… I don’t know, the dysbiosis? Anyway, what do we do?

Staci Whitman, DMD, IFMCP: Yeah, this is such a tricky one. So this is a cynical way to say that this is hard, but the best dentistry is no dentistry. But of course, that isn’t always the option, but that is our goal. Prevention. Because dentistry isn’t a super clean field. Regarding mouth guards and retainers and things of that nature, they’re not perfect but it’s a risk versus benefit conversation. And to me, airway trumps everything, so to make sure a patient has grown optimally. And if people want a deeper dive on this, I highly suggest you read the book Breath by James Nestor and/or the book Jaws by Dr. Sondra Khan.

Dr. Kara Fitzgerald: Okay, we’ll link.

Staci Whitman, DMD, IFMCP: Our airways are shrinking. Twelve thousand years ago, you look at a skull and we had big wide jaws. We had big wide broad pallets. Our third molars, our wisdom teeth, had room. Our teeth were perfectly straight. What has happened? We are now a disaster. It’s our food. We went from hunter gatherer to agrarian to industrial revolution. We started milling and processing. Not only is that nutrient devoid, but more importantly, we stopped chewing so much. It’s the act of chewing that expands the face. It’s the lateralization of the tongue. It’s that outward motion. The anthropologists estimate we used to chew four or five hours a day. Now we chew for only a few minutes a day because everything’s essentially pre-digested. I mean it’s ultra-processed, right?

Staci Whitman, DMD, IFMCP: So why am I saying this? Because as the jaws shrink, the teeth get crowded, you don’t have room for your tongue. So your tongue slips out of your mouth, your mouth pops open and you become a mouth breather and this is detrimental to your health. It’s going to cause inflammation, you’re going to get cavities, gum disease, you’re going to have oral dysbiosis, it’s going to impact your hormones and you’re going to feel like garbage. It will shorten your life. You’re going to have cardiovascular issues. It’s on a continuum, so eventually it will lead to sleep apnea. So going back to the retainers. I don’t love the materials in some of these retainers, but I also want a patient breathing better and so if it’s for a short duration of time, I think it’s worth it.

Staci Whitman, DMD, IFMCP: Now, permanent retainers, things of that nature, if everything’s in balance, we shouldn’t need a retainer forever. And so we have to be dealing with bone health and muscular health and this is where myofunctional therapists come in. Myofunctional therapists are like physical therapists for the muscles of the face and the tongue and airway. Traditional orthodontics is only dealing with the skeletal changes, but in a battle between muscle and bone, muscle will always win. And this is why with traditional orthodontics, we haven’t addressed the muscular imbalances so things tend to relapse in patients. That’s why they say just wear your retainer forever.

Staci Whitman, DMD, IFMCP: My argument is if you balance the muscles and everything is in harmony, you don’t need the retainer. And so this is just a different way of looking at things. People ask me all the time, are these materials clean? They could be better, they could be worse, but I want you breathing well. So you have to make that personal decision yourself, but I certainly think, especially in children, they often have to wear them for—

Dr. Kara Fitzgerald: They need to be breathing.

Staci Whitman, DMD, IFMCP: Yeah, they can wear them for such a duration of time. They need to be breathing better.

Dr. Kara Fitzgerald: Yeah. Okay. Myofunctional therapy. We’ll definitely link to some of those resources as well. Way back in the day when I went through my braces journey and all of that, we did myofunctional therapy.

Staci Whitman, DMD, IFMCP: Oh really? That’s amazing.

Dr. Kara Fitzgerald: We did. I know. Isn’t that amazing? I mean, I remember doing exercises with a button on a string.

Staci Whitman, DMD, IFMCP: Yeah. And you pull it and pull it. Yep and pops.

Dr. Kara Fitzgerald: Yeah. That’s very interesting that it’s still around and that’s what we want to do. So you’re just always bringing us back to the root cause. Going back to talking about the changes to gums in response to hormones, and then the changes with aging, bone loss, etc., just thinking about it from an intervention perspective, it’s just part of that journey and I’m imagining that most of the time it’s okay. I mean, obviously if somebody has a bone loss disorder, if you’re working on rebuilding bone, you’re going to see oral improvement happen as well with the bone. But in general, is there guidance for us as providers to be thinking about in supporting patients? When we need to be concerned and refer? What are your thoughts?

Staci Whitman, DMD, IFMCP: Yeah, this is great. I think the best thing is just to talk about oral health with your patients because you as their medical provider, “Oh my gosh, I’m going to take this seriously.” Again, the dentist is like the brunt of the joke. But if you start speaking about oral health to your patients they’re going to start paying attention. Sometimes you just asking questions: When’s the last time you saw your dentist? How is your hygiene routine? Are you flossing? Are you tongue scraping? Are you brushing? Do your gums bleed? It’s just a quick conversation, but it’s instilling in them, “Oh wow, this is my body doctor asking me about my mouth,” and all of sudden the mouth is now back in the body. So that’s my ask of you.

Staci Whitman, DMD, IFMCP: But yes, as we age, we do get less saliva. Our salivary content decreases and we will get some bone loss. Some of this is normal and we obviously want to minimize it and a lot of this comes from nutrition. So vitamin C optimization, B vitamins, zinc, trace minerals, all the fat solubles. So all the things that you’re already educating your patients on from a diet and lifestyle preventative perspective, it’s going to come back and help their oral health too. Hydration, electrolytes, minerals, emphasizing to them how important hygiene is at home, but also seeing their dentist regularly. Some patients really do need cleanings more frequently. Some patients are more prone to tartar, or calculus buildup. Now I would look deeper into that. Is that an issue with vitamin K2 because that’s directing calcium or is there a calcium imbalance or mineral imbalance? Or are they mouth breathing? I want to know why do they get so much tartar and calculus, but that’s going to create a lot of problems if it’s not cleaned off the teeth.

Staci Whitman, DMD, IFMCP: And then again, stress management. When you clench it’s creating a force and over time you will expedite bone loss and fracturing of your teeth and recession. And all these things that are normal to happen to a degree, but we don’t want to exacerbate them, of course.

Dr. Kara Fitzgerald: Right, right, right. Is everybody who is grinding at night going to experience symptoms or might it only be something that’s going to be identified on examination?

Staci Whitman, DMD, IFMCP: That’s a great question.

Dr. Kara Fitzgerald: Or, is everybody who’s grinding at night where it’s pathological, where it’s a problem?

Staci Whitman, DMD, IFMCP: I think no. I think the pathology is there but it’s not always noted. There are patients that the spouse will say, you grind, and I’ll look in the mouth and I really don’t see any wear. But if you did interaural palpation and you hit the masseter muscle, or if they see a craniosacral therapist and do interaural work, they might be through the roof because they’ve been compensating using different musculature than they should be, or they might have fascial adhesion. So this is where we get more into craniosacral, chiropractic, osteopathic work. This is where maybe we’re getting chronic headaches or neck aches or tightness in the jaw, TMD (temporomandibular disorder), tinnitus. All of this can be connected so I’d want to look into that a little bit for them. But I clench when I sleep. I’m just tight and I have to force myself to relax. But when I go in for intraoral manipulation, that’s the only place I can tell because I’m just holding on to so much stress and it’ll probably catch up with me at some point if I don’t address it. In another decade of life I might have temporomandibular joint issues or chronic headaches.

Dr. Kara Fitzgerald: Interesting. And the therapy that you’re doing is through what kind of a provider?

Staci Whitman, DMD, IFMCP: She’s dual-trained craniosacral and chiropractic and she’ll do intraoral work. And a lot of the fascial providers, the body workers that are doing lymphatic drainage and fascial adhesion manipulation, they’ll do intraoral work too, because there’s all kinds of lymph in here that can get stagnated as well.

Dr. Kara Fitzgerald: Fascinating. Listen, I just want to say, speaking of small mouths, this crazy evolutionary change, again in my teaching in the nutrition physical exam, we look for this macroglossia, for the tongue pushing up against the teeth. I think about it in immunology as evidence for almost a mild allergic reaction, like a swollen tongue like you might see on the continuum of allergy, where anaphylaxis would be a severe case. Or sometimes in B12 deficiency and you could see macroglossia in some other things. But obviously, probably the most common cause, or at least right up there, would be these small jaws that we have, right? I mean, you must see this all the time.

Staci Whitman, DMD, IFMCP: That’s right. That’s exactly right. Yes. I love Traditional Chinese Medicine and looking at the tongue. I think the tongue is so powerful, what it can tell us. And certainly, you can diagnose yeast infections on your patient and just all kinds of gut health issues as well, inflammation. And it is true, with B vitamin deficiencies you have red burning tongue, there’s all kinds of things. But if you see scallop borders on the side of the tongue, that can be a sign of inflammation, that can be a sign of cardiovascular issues, high blood pressure. But are the jaws too small? Because if the jaws are too small, the tongue has nowhere to go, it’s just going to push out, yeah.

Dr. Kara Fitzgerald: Yeah. It’s going to push right up. What percentage of your patients have jaws that are too small? I mean, I had a bunch of my molars pulled out during all my years of orthodontic care.

Staci Whitman, DMD, IFMCP: Oh my gosh. This is a scholarly debate, but I’ve seen data show as high as 85% of children now have malocclusions, or basically their jaws aren’t growing optimally or lining up appropriately. And I would say that’s pretty accurate and it might be conservative. So it’s very rare now when I see a child and I say, “Ooh, you look great.” In primary teeth, we’re supposed to have space. Adult teeth are wider and they need more room. If you have a child and their teeth are perfectly straight but there’s no room, they’re going to be crowded. Parents don’t believe me, but they will. They’re not going to outgrow that. And so it’s very common. It’s very common.

Staci Whitman, DMD, IFMCP: We are we’re ‘disevolving’, as James Nestor, the author of Breath has coined, and I agree with that. I agree with that. Our faces are shrinking. But the cool thing is if you find an airway-trained dentist, which more and more are becoming this, and you have a child with a quick retainer, we can help grow the face back to how wide it ideally should have been. And there’s really wonderful things to do as adults now too, that are less invasive. You don’t need double jaw surgery. There are appliances. There’s a MARPE (Miniscrew-assisted rapid palatal expander), Homeoblock™ Appliance, the ALF Appliance, myofunctional therapy. There’s just things that you can do to optimize your tongue posture and your occlusion and your jaw relationship too.

Dr. Kara Fitzgerald:  Wow, that’s fabulous. So there’s hope for this.

Staci Whitman, DMD, IFMCP: There’s hope, absolutely. And then if all else fails, I mean, I’m going to go here, but I personally sleep tape. I mouth tape. This gets very controversial and I don’t understand why, because there’s no data to show that it’s damaging. But it’s just the ability to physically close your lips and breathe through your nose. You want to work with someone who knows what they’re doing. You have to make sure you don’t have blockage and that you can breathe through your nose. Be smart about this, but if you’re interested in all this airway conversation you can look into that. I lip tape every night. My jaws don’t line up, they pop open. I’m not going to undergo invasive procedures when I can just put a piece of tape to keep my lips closed. I use fabric so you can breathe through it. In fact, Life magazine, in the 20s they used to have these bands that people would wear to keep their jaws up because nasal breathing is so important. It really is. And ancestral women used to always be closing their baby’s mouth to train them to keep their tongue up and close their mouth. So it’s really important.

Dr. Kara Fitzgerald: Yeah, very interesting. Let’s talk a little bit about labs. I mean, I just have a classic case that comes to mind, a patient that I’ve worked with now for years, but she came to me with pretty severe gingival disease, gingivitis and periodontal disease, actually. Just severe, and she required quite a bit of work. And I think for her, there was a genetic component to this, but her CRP was profoundly elevated for years. We did all sorts of our work, but it really wasn’t until she had the procedures, both things together, that her CRP normalized. But CRP was our tool, I mean, it just tracked with what was going on in her mouth. As you and I have already talked about, I’m doing oral microbiome testing, but I’m doing all the functional testing and stool testing and I’m looking at standard inflammatory markers and so forth. What do we want to be thinking about in our space?

Staci Whitman, DMD, IFMCP: Yeah, all the things you just said. So inflammatory markers, absolutely. I don’t know if I necessarily go– It just depends on your patient, right? This is where critical reasoning and you making clinical decisions is important. Certainly if there’s gum disease or periodontal disease, doing an inflammatory marker panel is amazing. I love oral microbiome testing, of course, because that just tells me what’s happening in the mouth and what microbes are we dealing with, or what with fungi, and all kinds of things. We can see a slew of issues. Sometimes we can see H. pylori, and so that would bring us to the gut. Maybe we do gut mapping, as you mentioned. If a patient has a lot of tooth disease, like cavities, I think we need to look into micronutrient testing. What’s their vitamin D status? Even organic acid testing, I think, can be really important from a dental perspective.

Dr. Kara Fitzgerald: And why is that? Just touch on some of the analytes on an organic acid test that would be particularly useful.

Staci Whitman, DMD, IFMCP: It will help with gum health. If you cannot figure out why a patient has gum disease, periodontal disease, it can just help isolate that. And sometimes when we address the things on the labs, things improve, as well as inflammation and sometimes we see improvements with airway health too, believe it or not.

Dr. Kara Fitzgerald: Interesting.

Staci Whitman, DMD, IFMCP: And parasites, especially if we’re working with kids, can impact how kids breathe and they’re clenching and grinding. I think those are those are the basics. So inflammatory markers, vitamin D, you know it’s nothing crazy. We don’t need to run all these intense functional labs, but I do think you’re going to see more pairing of gut testing and oral microbiome testing together, which I’m so excited about.

Dr. Kara Fitzgerald: It makes sense.

Staci Whitman, DMD, IFMCP:Yeah, it makes sense. You have to treat them together so I think that’s really a great place to start. And then if you have a patient who’s a high risk of cardiovascular disease, family history, if you see their gums look inflamed, if they have that really bad, bad breath, people describe it as like mothballs, that’s periodontal disease. That’s just tissue disintegration, that’s bacterial debris. Those patients are the highest risk so inflammatory markers would be really important with them.

Dr. Kara Fitzgerald: Yeah. In this one particular case– I think it’s been more equivocal in my experience elsewhere with other patients, but this one was a standout. I actually had her pierce open a capsule of specialized pro-resolving lipid mediators, SPMs, and just…

Staci Whitman, DMD, IFMCP: I love that. Great. Yeah, there’s a lot of really cool stuff happening in the oral health space with stem cells and peptides. I mean, it’s absolutely in its infancy so I’ll have to come back on in maybe a year or two and give an update, because it’s very preliminary and there’s some integrative endodontists that are doing really cool stuff there.

Dr. Kara Fitzgerald: That’s really cool. That’s just fabulous. Yeah, definitely come back. There’ll be so much more science too on the oral-systemic connection. So listen, two more questions for you. Big one, first: Fluoride. Tell me, just like in a super nutshell, what do you think? Is there a place for fluoride in our world?

Staci Whitman, DMD, IFMCP: Okay, when I speak of fluoride, have to differentiate systemic from topical. So let me touch upon systemic first.

Dr. Kara Fitzgerald: Yes, fair.

Staci Whitman, DMD, IFMCP: So systemic means water fluoridation, prescriptions, things that we’re ingesting. I think there is no place for systemic fluoride in our world. It doesn’t even work systemically. We’ve proven that it works topically, primarily. I mean, a significant portion is a topical benefit. It is a neurotoxin. People will say the dose makes the poison. It’s cumulative. There are people who are more sensitive to fluoride. Do they have iodine deficiency? Calcium deficiency? Are they pregnant? Are we talking about an infant? A child? How much do they weigh? What’s their body composition? Genetic polymorphisms? But what is left out of the conversation with systemic fluoride is that fluoride is antimicrobial. What is that doing to your gut microbiome? What is that doing to your oral microbiome? There is data to show us that it is damaging. It impacts diversity. It is wiping out commensal bacteria, not to mention impacting mucosal integrity. So when you’re drinking water every day with a low dose of fluoride, it has a profound impact.

Staci Whitman, DMD, IFMCP: So I think that needs to go and we should focus on topical applications. I wish that alternatives to fluoride were more readily available and more affordable for people. I wish fluoride wasn’t the gold standard because of the things I just mentioned, the neurotoxic effects and the antimicrobial effects.

Dr. Kara Fitzgerald: So using it topically, we are using its antimicrobial potential with the dysbiotic organisms locally. That’s the indication for it? But then we–

Staci Whitman, DMD, IFMCP: That’s right. Well, Yes, the benefit of fluoride is that it makes your teeth more acid resistant. So it takes the hydroxyapatite crystal in your enamel and it converts it into fluorapatite. So it’s actually changing the bonds and this makes it more acid resistant, which on paper sounds great, but this is not a natural process in the body. And some will argue if you look under electron microscopy, that actually the bonds in the enamel integrity are weaker. But that being said, it is a nice band-aid for populations that maybe need a little extra protection. And this is the issue.

Staci Whitman, DMD, IFMCP: The real villain in the room of the fluoride conversation is the food industry. That’s who we should be fighting against because if we didn’t have ultra-processed foods, and all the frappuccinos, and all the over consumption of crackers and chips and pretzels and granola bars and fruit snacks, and all of these things that are feeding the pathogenic bacteria, that are creating dysbiosis, that are lowering the pH in the mouth. Plus we’re just eating too much and you all know how that impacts gut health. We need to allow the system to rest. We just eat too much. That’s the issue. We wouldn’t have the disease that we have if it weren’t for our food system. So fluoride is just a band-aid. I will tell you if you’re eating an extreme, ultra-processed diet, no amount of fluoride is going to protect you. This is why cavities are still the top chronic disease globally.

Dr. Kara Fitzgerald: Despite tons of fluoride.

Staci Whitman, DMD, IFMCP: Exactly. If this stuff works, why do up to 90% of adults, why have they experienced a cavity in their life? That is an outrageous statistic. You know, 250,000 children a year are estimated to undergo general anesthesia in the United States for dental decay that’s mostly preventable. This is food. This is a food fix that we need, okay? So, topical fluoride can help, but it’s only going to help a little bit. It’s not going to surpass the Mountain Dew all day, okay? There’s nothing that’s going to fix that. Now there are alternatives. There’s hydroxyapatite, which is more biomimetic. That’s calcium and phosphorus, which is what our teeth are made out of. There’s theobromine, a derivative of a cacao, and so that can help remineralize. Xylitol. Yeah, so there’s more research going into alternatives, but until our national organizations support them, it’s going to be very hard to get all providers on board.

Dr. Kara Fitzgerald: Right.

Staci Whitman, DMD, IFMCP: And again, we’re bioindividual so fluoride might work for someone and not for someone else. Someone does really well with hydroxyapatite toothpaste and maybe the other person doesn’t. I’m not here to say there’s a quick fix for everyone. So you do need to do what’s right for you, but I will say, the carnivore crowd will come out and say, “Well, I don’t even brush and floss”. They aren’t wrong. I mean, they’re not consuming anything that’s going to feed the pathogenic bacteria. The pathogens love fermentable carbohydrates and they’re anaerobes. They love low oxygen, they love low pH, so if you eat a more ancestral diet, you’re going to be much better off and your toothpaste doesn’t matter as much.

Dr. Kara Fitzgerald: Really? Yeah, of course. That’s great. You’ve been such a font of incredibly interesting information. So it really goes back to what we’re eating, how we’re living, all of that. And then your fluoride or your toothpaste is the icing on the cake.

Staci Whitman, DMD, IFMCP: Yeah, it’s a little extra protection. I see so many people, especially online say, “I used this toothpaste and now I have cavities.” You do not have cavities from your toothpaste. And if we are pushing that narrative, we are missing an opportunity to get our patients healthy because that patient might have a bacteria that could lead to something much more bothersome in a decade or two. Or they have nutritional deficiencies, especially vitamin D deficiency, that has so many more negative consequences systemically. So we’re just missing opportunity if we’re…

Dr. Kara Fitzgerald: So we don’t want to put a lot of energy into implicating the toothpaste. We really want to get over that. All right. Yeah.

Staci Whitman, DMD, IFMCP: No. Think of toothpaste as a pharmaceutical. It really is. I mean, there are some cleaner ones that you could say are more nutraceutical, but if the human is in balance and we’re going back to the basics, it just matters less.

Dr. Kara Fitzgerald: All right, a few more questions as we’re in the home stretch. I know that you have a toothpaste out that I think includes hydroxyapatite. We can link to that. Actually we have it in my house.

Staci Whitman, DMD, IFMCP: Thank you.

Dr. Kara Fitzgerald: What else? What’s a good toothbrush? And you can give me brands.

Staci Whitman, DMD, IFMCP: Oh sure. The data is strong that electric toothbrushes really do disrupt the biofilm better. Some of it is because the average patient doesn’t have the patience, dexterity or understanding of dental anatomy to do a proper brush with a manual toothbrush. I like Sonicare. Some people like Oral-B, I prefer Sonicare.

Dr. Kara Fitzgerald: But it’s a preference.

Staci Whitman, DMD, IFMCP: It’s a preference. But again, if you’re eating a cleaner diet you’re going to have less biofilm, less plaque. I don’t get a lot of plaque, but I also don’t eat muffins and bagels and crackers. I eat more meat and vegetables and fruit and nuts and seeds and all of that.

Dr. Kara Fitzgerald: Yeah. It’s like you’re giving that whole environment a workout too with the chew and the…

Staci Whitman, DMD, IFMCP: Yeah, exactly. With mastication, your tongue does a lot of cleaning and chewing. If you’re eating carrots and apples, that is cleansing and now your saliva comes in, it flushes everything away. This is how it was supposed to be. This is how the body was designed to work. But we’ve thrown in processed foods and it’s just kind of thrown a wrench in everything. But I love Sonicare toothbrush, I love Oral-B.

Dr. Kara Fitzgerald: Are we flossing? Are we water picking?

Staci Whitman, DMD, IFMCP: Yes, please. You’re flossing, that is so important. If I had to pick between brushing and flossing, I would always choose flossing. Again, it’s because of our diet, but the bad guys, what did I say, they’re anaerobic so they love low oxygen…

Dr. Kara Fitzgerald: So between the teeth,

Staci Whitman, DMD, IFMCP: Yes, and the crackers and the chips and the pretzels and the granola bars get in there, whether you feel it or not, and they’ll sit there and they’ll just have a smorgasbord and just populate and then create inflammation. And this is when you get gum disease, and if the gum disease lasts too long, you start to get bone loss. So we have to be doing interdental cleaning. If you’re only brushing, you’re only cleaning three surfaces of your teeth. So you’re only cleaning three-fifths of your mouth because two of the sides of your teeth are always in between.

Dr. Kara Fitzgerald: What kind of floss?

Staci Whitman, DMD, IFMCP: So be careful. A lot of floss has PFAS, so please be careful, especially the more tape-type floss and the Teflon. Even the cleaner flosses– I don’t know, there’s nothing super perfect. If you really are a purist, I would use silk floss or bamboo. That’s really the cleanest on the market. But some people have really tight contacts and I do like water floss too. And as we age, as we mentioned, we will start to lose some bone around our teeth so just flossing alone sometimes doesn’t clean out the pocket. So what I do, I’m in my 40s, I will floss one night, waterpick the next night. Floss one night, waterpick, give or take. I’m not neurotic about it, but I kind of mix it up. Some patients have oral sensory issues, like your autistic patients, or they have oral motor dysfunction or aversions to having their hands in their mouth and so a waterpick can be really great for that population too.

Dr. Kara Fitzgerald: Do you put anything in the reservoir? Would you put anything in?

Staci Whitman, DMD, IFMCP: Yes, great question. Yeah, I like a little baking soda. So I think baking soda is the best low cost/no cost strategy because it’s going to buffer and alkalize the mouth and bacteria. They like alkalinity. They want a more basic environment, not acidic environment, so baking soda. But a water pick. If we do find pathogens on our oral microbiome test, it’s a place that we often will say if we’re not going to go right to antibiotics, tea tree oil or grapefruit seed extract, hypochlorous acid, iodine, silver, ozone, there’s just different things you can rotate through that can help lower the bacterial count if we’re trying to take a more natural approach.

Dr. Kara Fitzgerald: Awesome. If you’re not water picking, you could do like a swish and spit with some of those. Sort of like a mouthwash alternative.

Staci Whitman, DMD, IFMCP: Absolutely. Yeah, and I love baking soda rinses. They’re just the way to go. Yep.

Dr. Kara Fitzgerald: You have a book coming out, which is going to be great. You’re probably going to cover a lot of this. You’re an over-the-top font of knowledge. Is a lot of this in your book? So you’ll have a lot of like top tips.

Staci Whitman, DMD, IFMCP: Well, thank you. Yeah, it is. Yeah, it’s still in– I won’t say infancy, but it’s coming but t’s going to be really great. It’s a nonfiction narrative all about saliva. I said how much I love it. So about spit and saliva and the oral microbiome. I hope it helps move this mission forward, that we need to pay attention to this part of our body and this microbial area that we just tend to ignore. But also how important spit is.

Dr. Kara Fitzgerald: We’ve been ignoring it. We compartmentalize our different organ systems in this way that we’re putting a lot of energy into merging. But yeah, you’re right. The oral cavity has been so ignored. It’s beyond compartmentalized. You’ve really kicked it out.

Staci Whitman, DMD, IFMCP: Yes. There’s this book called Teeth by Mary Otto, if people are interested in this, and it speaks a lot about the discrepancies of access to care and things. But in the beginning, she does talk about why medicine went this way and dentistry went this way and so it’s really fascinating. But dentists, we were like the barbers. We were just like never taken seriously and some of that’s deserved, I think, to be honest with you, but we’re trying to reshape that narrative.

Dr. Kara Fitzgerald: (1:09:09) Good.

Staci Whitman, DMD, IFMCP: But I think that’s partly why the mouth just wasn’t taken seriously is that those dentists weren’t taken seriously and we underappreciated how important it is.

Dr. Kara Fitzgerald: Yeah. Right, that makes sense to me. I mean, we don’t have time to talk about mercury, but that whole journey was just a really outrageous, many-decades sidestep.

Staci Whitman, DMD, IFMCP: And we’re still in it. I mean, we still haven’t banned it. Europe banned mercury. The United States hasn’t.

Dr. Kara Fitzgerald: We haven’t banned it.

Staci Whitman, DMD, IFMCP: We probably won’t because they’re too worried about litigation. And just from an environmental standpoint, it’s outrageous that we’re still placing alloy fillings.

Dr. Kara Fitzgerald: Yeah, that’s absolutely outrageous. I remember when I was in my post-doctorate training, there was a scientist studying mercury toxicity and he would work with you guys, dentists and dental assistants, to have a steady supply of people with a mercury burden.

Staci Whitman, DMD, IFMCP: Yeah! I was just going to say, we’re the ones most impacted by it. If you’re a dentist out there listening, please go get a heavy metal test. Please get tested. I was through the roof when I tested and I hadn’t placed an alloy filling in 10 years when I finally tested myself. This was residual from dental school when I first was practicing and maybe the occasional filling that I was replacing. But luckily in pediatrics, thank goodness, there’s fewer and fewer mercury fillings so I really wasn’t around it that much. This was just long-standing from over a decade ago of dentistry. So I really had to clean that up.

Dr. Kara Fitzgerald: That’s outrageous. Yeah. Anybody who comes into our practice, who’s affiliated with the dental industry at all needs to– I mean, everybody gets tested anyway, but we will see higher burdens. It’s beyond absurd. I have no words for the fact that this is allowed, you know, that OSHA allows certain handling of something that’s one of the most toxic compounds known.

Staci Whitman, DMD, IFMCP: They use something called formocresal in baby teeth root canals, which is directly connected to the vascular system. It’s formaldehyde. It’s still allowed.

Dr. Kara Fitzgerald: It’s so heartbreaking. But you’re making really amazing steps, Staci, to changing that. I’m thrilled that you’re starting this organization and it will make it easier for us as functional medicine providers to find dentists to collaborate with because that’s not always that easy. In fact, I’ve had to refer to dentists in other states, et cetera, just to find those that I want to connect my patient with.

Staci Whitman, DMD, IFMCP: I know. Thank you. And that was the main driving force is that we were frustrated that there’s so many calling themselves functional dentists out there on social media and what have you, but they really have no functional medicine training, or really any training. And that creates a problem for providers and patients because there’s just no standardization. You don’t know what you’re going to get. So we did that because yeah, I can come on these podcasts and speak of this, but then at the end of the day, people say this is great, but there’s no one to send my patients to, or there’s nowhere for me to go. So it is a residency level program. It’s similar to becoming functional medicine certified. It will take a year and a half to two years to finish and then they’ll get certified in functional dentistry and there’s going to be an exam. They have to pass the exam, they have to do case studies, all of this. It launches in January and so we hope by, let’s say, summer 2027, you should start having people to refer to. We have 600 dentists on the wait list.

Dr. Kara Fitzgerald: Amazing.

Staci Whitman, DMD, IFMCP: It’s really cool. Yeah. And they’re going to have functional medicine training, which means that you can communicate collaboratively as colleagues to help your patient. You don’t need to stay compartmentalized.

Dr. Kara Fitzgerald:  Absolutely fabulous. Well, keep me posted on that and we’ll definitely support you in getting the word out.

Staci Whitman, DMD, IFMCP: Thank you.

Dr. Kara Fitzgerald: And I know you’re doing this in collaboration with the Institute for Functional Medicine where I’ve been on faculty for many years. So bravo. Bravo to you and your team. Thanks so much for joining me today. It’s been great. It’s just really been interesting.

Staci Whitman, DMD, IFMCP: Thank you. It was really fun. I appreciate being here.

Dr. Staci Whitman is a board-certified pediatric dentist and functional dentist who brings a root-cause, systems-based approach to oral health. As a Co-Founder of the Institute for Functional Dentistry (IFD), she is at the forefront of integrating the oral microbiome, oral-gut-brain axis, airway and sleep medicine, hormonal and nutritional health, and pediatric/infant development into dental practice. She also co-founded Fygg Oral Care Products (premium oral microbiome-driven oral hygiene line) and Bloom Kids Dentistry (a micro-practice blending biomimetic, airway and functional pediatric care). Dr. Whitman authors an upcoming book on all things the oral microbiome and offers online consultations to empower patients and practitioners worldwide. Her newsletter is where listeners can get deep dives on all things functional dentistry.  Her mission: transform dentistry into a compassionate, science-based discipline for optimal whole-body health.

Institute for Functional Dentistry

Bloom Kids Dentistry

Fygg Fluoride-Free Toothpaste

Upcoming book by Dr. Staci Whitman from Crown Penguin Random House · Institute for Functional Dentistry (IFD) Certification Program

Oral Microbiome – Alzheimer’s Connection

Oral Microbiome and Alzheimer’s Disease

Oral Microbiome Stamp in Alzheimer’s Disease

Unlocking Modifiable Risk Factors for Alzheimer’s Disease: Does the Oral Microbiome Hold Some of the Keys?

Oral Microbiome – Prenatal and Neonatal Connection

The prenatal gut microbiome: Are we colonized with bacteria in utero?

Contributions of the maternal oral and gut microbiome to placental microbial colonization in overweight and obese pregnant women

Maternal and Neonatal Oral Microbiome Developmental Patterns and Correlated Factors: A Systematic Review—Does the Apple Fall Close to the Tree?

Microbiota during pregnancy, childbirth, and postpartum, and its relationship with health and disease states

Oral Microbiome – Systemic Aging Connection

Functional Dentistry and the Oral-Systemic Connection with Dr. Mark Burhenne, DDS

Human oral microbiome in aging: A systematic review

Oral Microbiome – Fertility Connection

Exploring the link between periodontal disease and sperm quality: a comprehensive systematic review study

Bacterial foci in the teeth, oral cavity, and jaw–secondary effects (remote action) of bacterial colonies with respect to bacteriospermia and subfertility in males

Gum disease increases time to conception

Another reason for impeccable oral hygiene: oral hygiene-sperm count link

Is there an association between periodontal disease and infertility? A systematic review

Oral Health Status and Fertility Treatment Including IVF

The association between oral inflammatory load and semen and sperm functional analysis: A cross-sectional study

Can periodontal disease affect conception? A literature review

Evaluation of Periodontal Status among Men Undergoing Infertility Treatment

Gum Disease – Adverse Pregnancy Outcomes Connection

Periodontal disease and preterm delivery: a nationwide population-based cohort study of Taiwan

Relationship between periodontal disease and preterm low birth weight: systematic review

Assessing the association between periodontitis and premature birth: a case-control study

Books mentioned in the podcast

Breath: The New Science of a Lost Art by James Nestor

Jaws: The Story of a Hidden Epidemic by Sandra Kahn and Paul R. Ehrlich

Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America by Mary Otto

Appliances mentioned in the podcast:

MARPE (Miniscrew-assisted rapid palatal expander)

Homeoblock™ Appliance

ALF Appliance

Podcast: Functional Dentistry and the Oral-Systemic Connection with Dr. Mark Burhenne, DDS

Podcast: A Fresh Take on Exposomics: Resiliency Factors That Offset Environmental Risks

Research, News, Ideas: Toxins and Aging: How Environmental Stressors Impact Longevity

DrKF Clinic: Patient consults with DrKF physicians including Younger You Concierge

Bio Age Lab Test

Bio Age Self Assessment Quiz

Younger You Practitioner Training Program

Younger You book

Better Broths and Healing Tonics book

Younger You Daily Supplements are Now Here!

What could be more convenient than having your daily supplements all pre-portioned in one pouch? Choose your level to get the combination of supplements that’s right from you. Monthly subscription available.

(note you’ll be leaving www.drkarafitzgerald.com to go to www.vitaboom.com to complete your purchase)