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Episode 28: Oral Health and Quality Sleep with Dr. Dan Bruce, D.D.S





Podcast Drop Date: 1/24/2024


Join host Amber Warren in an exciting discussion with Dr. Dan Bruce, D.D.S, a leading integrative dentist and sleep specialist, as he explores the vital link between oral health and quality sleep. Dive into the impact of oral structure on sleep, uncover insights into sleep apnea, and learn practical tips for better sleep hygiene. Dr. Bruce's expertise offers a fascinating glimpse into the intersection of dentistry and sleep science, providing actionable advice for a restful night's sleep. Don't miss this episode for a concise yet comprehensive guide to improving your oral health!


Transcript:


Amber Warren, PA-C: Welcome to the Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts, and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Hi, everyone. Amber Warren, we're back here with Doctor Dan Bruce, who's a local integrative dentist. Hi, Doctor. Bruce. Hi. How are you tonight?


Dr. Dan Bruce, D.D.S: Doing great. How are you?


Amber Warren, PA-C: Good, good, good. Thanks. So we'll do a quick introduction. So Doctor Bruce is a third generation native of Boise. After attending Bishop Kelly High School, he received a BS in Biology and a Minor in Chemistry from College of Idaho while playing soccer and basketball. He graduated from the University of Washington School of Dentistry in 2005. While in school, he received awards and achievement based scholarships in Fixed Prosthodontics, which are crowns and bridges, Operative Dentistry Fold work, which are inlays and crowns. He is a diplomate of the American Board of Dental Sleep Medicine, as well as the American Sleep and Breathing Academy. He has completed a mini residency from the Alf Educational Institute, as well as an Orthotropic mini residency residency. Excuse me from Doctor Bill Hang. Well, I have been wanting to get you for months and months and months on this podcast. I'm so glad you're here. So we at FMI really recognize you as not only a fabulous, integrative dentist, but as one of our only resources for sleep and breathing issues, um, in your field. So we're just so thankful to have your, your knowledge and your expertise in the community.


Dr. Dan Bruce, D.D.S: Yeah, I'm glad we made it work.


Amber Warren, PA-C: Yes. I'm so glad we did too. With with your busy schedule and our busy schedule. So, um, I want to hear a little bit about your story and your journey into how you came into not only dentistry, but the area of of dentistry that you focus on.


Dr. Dan Bruce, D.D.S: Yeah. So kind of as you mentioned, you know, the in dental school I had was focusing kind of on restorative dentistry and full mouth reconstructions and cosmetics and all the things that you get excited about as dental student. My dad is a dentist who did a lot of that kind of comprehensive, restorative work, and it's really rewarding and neat. Um, in graduated in 2005 and in 2008, as the economy kind of went down, I one of my, uh, dad's friends who was a physician, Doctor Steve Spencer, reached out to me to help with some treatment for patients with sleep apnea who were not compliant with CPAp, um, or who just didn't want a CPAp. Yeah. So I then started taking courses with my newfound free time because I wasn't as busy. Right. Um, in in treating patients with sleep apnea, with oral appliances, which are appliances that have an upper and a lower piece, it kind of stabilizes and holds the lower jaw forward so that the airway can't collapse on itself. Yeah. Um, as I went through that training, I, um, received, you know, my diplomat, um, certification in sleep apnea from, um, American Board of Dental Sleep Medicine. There is no specialty designation for sleep apnea right now, but that's kind of one of the higher level certifications you can get and required, you know, doing case studies, observations course.


Dr. Dan Bruce, D.D.S: Um, you know, uh, it was fairly rigorous training.


Amber Warren, PA-C: So I bet.


Dr. Dan Bruce, D.D.S: Um, and then from there, you know, had it was really enjoyable to have patients who came with a problem, you know, they couldn't sleep. They were, um, not able to be in the same bed as their bed partner, um, all that kind of stuff. And so being able to, to get them a solution to help them, you know, improve their lives was, was great. And, you know. Once. Once you start looking at adults who have this issue, then it was easy to kind of look at their kids because they were kids. They'd come in like, you know, how do I prevent this from happening to my kid? Right. So that's what people are always looking at because. So then that led me down the whole educational tract of trying to figure out how to, um, improve airways for kids so that they, they may be able to avoid the sleep problems and the TMJ problems and the pain and fatigue issues that their, that the, their parents had.


Amber Warren, PA-C: Right.


Amber Warren, PA-C: So that's a good Segway into kind of the next question. Why do we care about airway issues. How does that impact overall health.


Dr. Dan Bruce, D.D.S: Yeah. So um. When you're sleeping. If you have, you know, everything working properly. And it's a, it's a, it's a mix of a lot of things. So it's airway size. It's the, the muscle tone of the muscles and the tension of the fascia. It's the rate of breathing. It's the inflammation in your body. It's all that kind of stuff. And and nasal breathing too, and how you breathe. And if you're doing that correctly, then your body can breathe comfortably and easy while you're sleeping. And you can get into your REM sleep cycles. You can, you know, in REM there's repair of nerves that happens. There's all these restorative things that happen when you're deep sleep and your REM sleep and you're in the right sleep cycles. Um, if the airway closes off, then you're constantly having to fight that. So it's like you're you're getting choked, you know, all the time at night, and your body's stressed out because it's trying to keep yourself awake and breathing.


Amber Warren, PA-C: I tell my patients, it's like you're trying to run a marathon at night, when you should be restoring and detoxing and making hormones and all the things.


Dr. Dan Bruce, D.D.S: Yeah, all the stuff that you guys look into, you know, if you're not in your deep sleep cycles or the proper sleep cycles, I should say, then you're not able to do that. So, um, so that's kind of how it fits into a whole health thing. So we have a lot of patients who, you know, they've been down the functional medicine path and they've done everything that they've asked, but they still feel really tired. And it's just it's an anatomical issue where the airways just not big enough, you know, and it doesn't perform correctly. So they're trying to breathe through this little tiny straw instead of this, you know, big garden hose.


Amber Warren, PA-C: So and what kind of symptoms do you have your patients see that have these obstructive or airway issues.


Dr. Dan Bruce, D.D.S: Yeah. So so kind of the easiest ones would be snoring. Right. Um, you know witnessed apneas. So if, if the bed partner or notices stopping breathing or you wake up kind of gasping, um, or if you wake up with like a real high heart rate, that means that maybe you've stopped breathing and your body's kicked in some cortisol and epinephrine and said, wake up, you know? Right. Um, but then there's also a lot of patients who don't know that any of this stuff happens at night because you're in a sleep cycle. But it's not just not the right sleep cycle, it's just a lighter stage of sleep. And so you may wake up feeling fatigued and you may, you know, sometimes as these airway issues happen, the body will react by kind of clenching the teeth. So even tight jaws, teeth clenching at night, TMJ problems, all that kind of stuff can be symptoms. Um, also, you know. There's there's, uh, the level of evidence is not great, but, um, Doctor Gould wrote a paper about somatic symptoms, and then Doctor Steven Park, who's an ENT, has also talked a little bit about this, too. But, um, things like irritable bowel syndrome, just upregulated autoimmune issues. Oftentimes when you're not sleeping well then then it just your body thinks something's wrong. And to say simply and then you end up having all these other issues. But the real one of the causative factors that you're just not sleeping.


Amber Warren, PA-C: Well. Yeah, it.


Amber Warren, PA-C: Makes a lot of sense that that it's that heightened cortisol. Right. And we know the direct relationship between cortisol and autoimmunity and inflammation. So yeah it's all.


Dr. Dan Bruce, D.D.S: Add your day.


Dr. Dan Bruce, D.D.S: Stress to your night stress. And that's.


Dr. Dan Bruce, D.D.S: Yeah bad doesn't work.


Amber Warren, PA-C: For sure. How do you see that presentation different in children versus adults. Because I know you treat a lot of children for some of these airway issues.


Dr. Dan Bruce, D.D.S: Right.


Dr. Dan Bruce, D.D.S: So kids can be they can present in two different ways really. One is with, you know, the very fatigued kid who's falling asleep all the time. And again, those are the easier ones to to get right. You can see those same with adults. They kind of call it Pickwickian syndrome from Charles Dickens novels. But um, but then there's also kids that are that are hyperactive and can't concentrate. So, um, if you have kids and, you know, once they stay up too late, they go from being tired to being wild, you know, and they can't. They're just all over the place. So, um, they, they've done some studies showing significant decrease in hyperactivity symptoms and ADHD symptoms. When sleep apnea is managed, they usually do it through removal of tonsils because that's an easy endpoint. You start with tonsils and you end with no tonsils. And you know a large percentage of those kids get better. So that's that's probably the best one is these kids that are unable to concentrate, you know, poor grades, all that kind of stuff. Um, and as they get a are able to breathe more, then they're able to kind of balance their emotions. They, you know, all that kind of stuff.


Amber Warren, PA-C: Yeah. The hard thing with kids is too. And I struggle with just today's society, like the sports they get home from sports. Nine 930 at night. Sometimes they still have homework. And then, I mean, I see kids in our neighborhood catching the bus at 630 in the morning. So it's a quality versus quantity issue. Like are we just having our developing children getting enough sleep. Right. And they're probably not getting good quality sleep as well because they're on their blue light devices at night. And then a lot of them have these airway issues for I mean, we should talk about root cause on why we're seeing more. Are you seeing I guess I could start there. Are you seeing more children with with oral airway issues than you did in your practice? Say even.


Dr. Dan Bruce, D.D.S: Yeah, that's a hard part.


Dr. Dan Bruce, D.D.S: I mean, people kind of seek us out for that. So yes, I'm seeing a lot of them. So there's so.


Amber Warren, PA-C: Much more awareness.


Dr. Dan Bruce, D.D.S: And people ask that with tongue ties because because tongue thrusts or tongue tight tongue ties that lead to tongue thrust, right, can contribute to poor oral oral development. And so people always ask, are you seeing more tongue ties? I'm like, well, yeah, I see

a lot of them. But I'm seeing.


Dr. Dan Bruce, D.D.S: Patients that.


Dr. Dan Bruce, D.D.S: Are, yeah, sent to me for that specific reason.


Amber Warren, PA-C: So so let's break that down. What is a tongue tie. What is a tongue tongue thrust for our listeners. Yeah. So this is all new terminology for a lot of our listeners. Perfect. Yeah.


Dr. Dan Bruce, D.D.S: So so ideally as you swallow and this starts as the infant is nursing with the tongue pushing towards the roof of the palate, kind of peristaltic, moving food down the back of the throat. As that happens, the pressure of the tongue on the the bones of the palate, um, provide stimulus to expand it. So the tongue is kind of nature's orthodontic expander. So it's it's tongue posture, it's tongue pressure with swallowing. And it's also chewing hard raw foods. So the harder you chew, the more bone you build. It's like anything the more pressure you put on it, the more the body responds. Stressor by, by reacting to, to grow. Um, so so as those are the things. So if you have a tongue tie and the tongue can't get to the roof of the palate, then sometimes the tongue will squeeze out through the front of the teeth or through the side of the teeth, or kind of overlay over the top of the teeth, or the patient will mouth breathe. Um, and as that happens, the facial muscles on the outside kind of push inward so everything gets pushed in and back. Um, and as that happens, oftentimes you'll see kids that will compensate by kind of moving the head forward so they can get an airway space to breathe.


Amber Warren, PA-C: So, so really, it can be difficult for like new moms to recognize these things in the baby. Really. They need you to really examine these children.


Dr. Dan Bruce, D.D.S: Yeah.


Dr. Dan Bruce, D.D.S: So so things and I don't see a lot of babies. My my partners do the infant for nectomys. And they work with lactation specialists, craniosacral therapists. And so if you've got a good therapist who notices like feeding problems. Right. Um, then then it may be that the the baby's tongue tied like.


Amber Warren, PA-C: Issues with latching, latching.


Dr. Dan Bruce, D.D.S: Colic. They may be getting, you know, air or swallowing difficulties. Yeah. Um, all those things can be related to, to, like I said, a tongue tie or a tongue thrust issue.


Amber Warren, PA-C: And you, you're working more with older children.


Dr. Dan Bruce, D.D.S: Yeah. I kind of see them once they hit three, four and then up basically.


Amber Warren, PA-C: And what are you looking for and how are you approaching, how are you diagnosing and how are you approaching some of these airway issues and children of that age?


Dr. Dan Bruce, D.D.S: Yeah. So so um, as a dentist from licensure standpoint, I can only screen for, for like airway type issues. Right. But things we look for would be. If say, they're chewing and there's like excessive lip activity because that means the tongue's not you should be able to kind of swallow without a lot of facial muscle activity. And if the lips are piercing or food, you know, they're messy eaters, things like that. Um, if you look at their, their bite and maybe there's a hole between where the teeth come together, that means the tongue is squirting in there. Um, a lisp can be the result of kind of a major tongue tie. And then we just, you know, when we see them, a dental exam. There's a grading scale. So ideal. The tongue should be able to reach between 75 to 100% to the top of the mouth. And then, you know, down from there that's restricted oral, oral tissue, um, treatment for that. You know, we don't always just go through and release the tongue. We we try to teach the kid how to do myofunctional therapy and swallow properly. And sometimes just through that therapy, they can overcome some maybe restricted tissue. So the release is in babies. Nursing is the myofunctional therapy, along with some stretching exercises. But for for kids, they have to go through and do these specific exercises to retrain how to to put the tongue in the right place.


Amber Warren, PA-C: So how about these kiddos with these narrow palates that you need to widen? Why? Why is that important?


Dr. Dan Bruce, D.D.S: So a narrow palate is indicative that the tongue is not sitting up there. Right. And that there's either some, uh, tongue posture or a lack of chewing force or tone. Right. And so if the tongue can't sit in the roof of the palate, it's got to kind of go down and back, which then impedes the airway and can kind of displace the position of the jaw to have improper facial growth. So when you see, you know, you the best palate is a palate that's kind of flat, meaning that it's it's not very high and then also wide. So we want these flat, wide palates. Um, the earlier we can get these kids and do some there's, there's appliances you can use. You mentioned the Elf training I've done. That's one of my favorite ones, especially in young kids, because you can use light forces to kind of widen the arch. And it's really functionally friendly for the tongue to sit up to the roof of the palate. So it's like.


Amber Warren, PA-C: A I mean, you're working with my seven year old, so it's like a retainer. And it's helped him tremendously. Yes. So it's that that's a great tool to help with these kiddos.


Dr. Dan Bruce, D.D.S: There are just there's there's a lot of. You know, when we do our assessments, we usually take 3D scans to see kind of where the bones are, where the joints are. If there's things in the nose and we send and we send you guys a ton of patients that have sinus congestion and maybe that's, you know. They always ask. They're like, what is that? Why can't I breathe through my nose? Like, I don't really know, but I know you can't. And so we.


Amber Warren, PA-C: Got to do something. We got to figure out why you can't. So go through and run through.


Amber Warren, PA-C: Old. Is it poor immune function. Is it toxins? Is it a food intolerance or allergy? Yeah.


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Amber Warren, PA-C: So what are what are things that we as parents with young children, or even maybe some new moms can do to help there to help make sure anatomically these kiddos develop appropriately so they don't end up. You touched on this a little bit so they don't end up later in life with breathing or sleep issues.


Dr. Dan Bruce, D.D.S: Yeah. Um, you know, really good question. So the first is just check for tongue tie with nursing issues when they're babies and then the, um, the faster you can get them to, you know, whole organic raw food, the better. So even things like smoothies, while they're nutrient, you know, high in nutrients, they don't help with chewing. So, um, you know, Weston Price did a lot of work on, uh, indigenous populations and seeing how the development happened. And a lot of his theory, you know, is this in the 19 early 1900s was that that processed and refined foods were leading to degeneration of the, um, of the facial structures and also decay and all that kind of stuff. Right. And that's part of it. You know, part of it is that the the nutrients are not there in the food that they have, but it's also the consistency. So if you have the harder raw foods, just the active force of chewing can help kind of improve facial development. So eating hard raw foods, if you notice that there's some narrowing, or if you notice that there's dark circles under the eyes, or signs and symptoms of sleep problems like we talked about with the snoring or fatigue or even hyperactivity. Then getting a sleep test early to check is really good. Yeah.


Amber Warren, PA-C: Um, yeah.


Amber Warren, PA-C: Even just like in in my youngest son, it was also just noticing, like he was just not a morning person. Like he was just so cranky in the morning. And that was one of my first signs of like, goodness. I don't think he's getting really good quality sleep because everyone in our family pops out of bed and wants to go, you know, 100 miles a minute in the morning. And he was my only kid that I was like, get up.


Dr. Dan Bruce, D.D.S: The hard thing, too, is like. Everyone wants to compare their kid to what their friends are doing or their peers, right? And a lot of kids have issues with sleep. And so, you know, some people will say, well, my kid's really hyperactive. He can't concentrate. But yeah, that's the way all boys are. Yeah. And that's.


Amber Warren, PA-C: You know, so true.


Dr. Dan Bruce, D.D.S: That's there's there's some of that's true. But some of it's also could be a sleep issue.


Amber Warren, PA-C: Yeah. So I think.


Amber Warren, PA-C: It's always really important to investigate those things. So moving kind of into your field of integrative dentistry and what you and your partners do at your clinic. Um, what is it. What's integrative dentistry and why do we care about it? I mean, I know why we care about it big time in functional medicine, but I want our, our listeners and our community to really know why it's important to maybe think twice about the dentist that they're seeing.


Dr. Dan Bruce, D.D.S: Yeah. So so integrative dentistry is looking at root cause issues instead of just trying to kind of treat things as they come up. Right. We want to educate patients on why they could be having issues, and then also how the issues that they may have can affect the rest of the body. So sleep's the biggest, you know, that's one of the huge ones we look at. Um, one of the other ones is periodontal disease. So that's a that's an infection in the gums that can occur due to a number of things. But, you know, bacterial plaque, um, certain types of bacteria in the gums, uh, genetic predisposition to inflammatory conditions, all that kind of stuff. So when when you see, say, for example, periodontal disease, you know, is interesting. We talked about Weston Price. He had a focal infection theory in the 1900s that there was if there was an infection in one part of the body, it can move to other places and cause other problems. Right. And then that was dismissed over time. And now we're kind of coming back to it because we're seeing that, you know, if you have periodontal disease, it may you see some of those periodontal pathogens in, uh, arterial plaques and things like that. So that's wild. Yeah. So, so we're kind of coming back around to think that. Yeah, something in one part of the mouth may, it may not be just that you lose this tooth. It may be that it affects your overall health.


Amber Warren, PA-C: Yeah. Influence.


Dr. Dan Bruce, D.D.S: So so a lot of dentistry, you know works on that. But integrated dentistry is is looking at trying to look at all the different root cause issues and then paying particular attention to things like infections or, you know, failing root canals or things that that may be kicking off bacteria and being fairly comprehensive and aggressive with, with diagnosing them.


Amber Warren, PA-C: I want to touch a little bit on the oral microbiome, because I think we're recognizing that more and more and more what are things that we, as just patients, can do for ourselves and our families to help improve the oral microbiome? And why do we care about an oral microbiome?


Dr. Dan Bruce, D.D.S: Yeah.


Dr. Dan Bruce, D.D.S: So so oral microbiome just being the type of bacteria that live in the mouth.


Amber Warren, PA-C: And I think too much. We only recognize that our gut has a microbiome.

When we forget that head to toe our skin. We have a microbiome everywhere in our body that's important to be aware of.


Dr. Dan Bruce, D.D.S: So so in my opinion, I think, you know, having a balanced diet, eating foods that that are body is, is meant to kind of handle which is be lower sugar, lower processed type foods. Right. Um, and then. You know, there are some oral probiotic treatments out there. There's some evidence on them. I personally have not felt convicted enough to start recommending them. Really? Well, yeah. Um, one of the big things is full time nasal breathing. Mouth breathing really dries the mouth out. As the mouth dries out, the, um, minerals in the saliva don't have a chance to act on the bacteria. And you create a more acidic environment which can cause tooth sensitivity, breakdown of the enamel, higher risk for decay, all this kind of stuff. Um. Even things like silent reflux, which is kind of down your pathway to, you know, making sure that that you're not having reflux because that can cause damage to the tooth, all that kind of stuff. Mhm. Um. So yeah from oral microbiome. Good oral care, great eating right eating, doing the things you're supposed to, you know, avoiding processed sugary foods and then, uh, nasal breathing and then also, you know, addition of of different. You know, there's toothpastes that have hydroxyapatite or.


Dr. Dan Bruce, D.D.S: Baking soda.


Dr. Dan Bruce, D.D.S: Things that are kind of kind of get that pH in the right kind of balance and make the environment more favorable for the better. Good time type of about oil pulling.


Amber Warren, PA-C: Do you believe in that? Do you think that's of benefit?


Dr. Dan Bruce, D.D.S: Yeah. I mean I think.


Dr. Dan Bruce, D.D.S: The oil has. Really good anti-bacterial microbial properties. So that's really good. You know, as far as what it does beyond that, I'm not 100% sure, but I've had patients that have had success with I.


Amber Warren, PA-C: Know I have to I have patients that really like it and think it's very helpful. Um, so back to when you mentioned the the mouth breathing and all the issues that that has, you know, when we're not breathing through our nose like we're designed to breathe through, I find, um, a lot, you know, my, my, my clinical approach to these patients is kind of already what we've talked about. But a lot of times it's hypertension, cardiovascular disease, you know, trying to identify if they're not sleeping well at night or they are having fatigue or even just I'm doing a lot of metabolic weight loss. So my obese patients I'm trying to screen them really well for sleep apnea. But a lot of their responses I'm not going to wear a CPAp. So why would you test me for sleep apnea. And that's where your name comes into play. So what are you doing for some of these people, and why should they not be fearful to go get a sleep study because they think the only option is a CPAp.


Dr. Dan Bruce, D.D.S: Yeah. So so for one, people are very fearful of sleep studies because they think they go to the hospital and they got to get.


Dr. Dan Bruce, D.D.S: All this stuff, the.


Dr. Dan Bruce, D.D.S: Cords and everything. But great point. You know, that there's most patients would qualify for a home sleep test, which is much easier to.


Dr. Dan Bruce, D.D.S: Administer and much.


Amber Warren, PA-C: More affordable.


Dr. Dan Bruce, D.D.S: They are. Yes. Yeah. And insurance companies like affordable options. So they kind of push you towards that. Yep. And if you're not a candidate for, you know, maybe there's a type of sleep disorder that or a medical condition that would make you not a candidate. Then you go to the hospital, which is good. Um, so so once you get the sleep study, those are fairly easy. And then, uh, generally, you know, if you have mild to moderate sleep apnea, which is judged based on the number of times per hour that you breathe and to a certain extent by the oxygen saturation that your blood has. Um, then an oral appliance could be an option. So that's an appliance that just basically takes the lower jaw and pulls it forward. So if you kind of think of like the head tilt chin lift from CPR, that's the first thing we do is create an airway. That's what this does is kind of pulls the jaw forward and creates an airway for a number of patients. We just need to kind of more stabilize it so that it doesn't fall back for other patients. We have to kind of move it outward. Um, they're generally well tolerated. Um, they're easy to use. They don't make noise, you know, there's they're easy to clean. Um, the downside to them to, to in all full disclosure is that with long time use, some patients get bite change. So if an especially if you know we talked about underdevelopment of the upper and lower jaws. And so if if those are underdeveloped and we kind of pull the lower jaw forward out to where it should be, sometimes it wants to stay there. So we give we give patients exercises to move the jaw back in place. And but but yeah the risk of bite changes is definitely there.


Amber Warren, PA-C: And you find that they're as effective as a CPAp as the big overwhelming mask you have to put on to treat sleep apnea. Yeah.


Dr. Dan Bruce, D.D.S: So so typically not as effective with mild sleep apnea. About 80% successful moderate maybe 60% and severe 30 to 50%. And obesity plays a role in that too. So the more weight you have in your neck, the less likely the appliance is going to work. But I've had patients that I didn't think it was going to work on, and it does. So we don't have a good predictive right, um, test to know if it's going to work, you know, without just kind of trying it. Um, there are some. Uh, devices that you can go into a sleep lab and they can titrate remotely your jaw to see if you're a responder to it. But, um, we don't have one in Boise here. Yeah, so.


Amber Warren, PA-C: We can't do that locally. Yeah.


Dr. Dan Bruce, D.D.S: But. Yeah. So. So basically you try it on, you see if it works, you test it at home and you go do a follow up sleep study. Cool.


Dr. Dan Bruce, D.D.S: So yeah.


Amber Warren, PA-C: Um, mouth taping. Yeah. Do you like it? Are you a fan? Do you think it's a little bit of a Band-Aid approach for people who are fatigued, snoring, mouth breathing?


Dr. Dan Bruce, D.D.S: Yeah, I think it's a great thing personally. I mean, you got to get around the idea of of having if you can't breathe through your nose, then that's don't tape your mouth. Right. So if we see someone who's got a deviated septum or, you know, is so inflamed that they can't breathe through those, then that's then they need to breathe through their nose. But if it's more of a habit where you just mouth breathe because that's the way you've always done it, right? Your body has CO2 sensors in the blood, and when you mouth breathe, you, you actually off gas a little bit more CO2 than than you do nasal breathing and CO2. Having the right and having enough CO2 actually changes the pH of the blood, and therefore the oxygen can get off, um, into the end tissues a little more easily from the hemoglobin. So it seems counterproductive to have less, you know, to breathe, to have some CO2 in your blood. But it's really important. Yeah. So, um. We have a number of patients that have just mouth taped or they've mouth taped and they've used, say, nose cones or breathe right strips or something. And they they've been able to manage their mild sleep disruptions with that. So it's yeah. And I'm all for simple like if that works great.


Dr. Dan Bruce, D.D.S: Then that's.


Dr. Dan Bruce, D.D.S: Fantastic.


Amber Warren, PA-C: Um, and there's.


Amber Warren, PA-C: Improvements to your oral microbiome there too, right. Because you're not you're not mouth breathing and you're breathing the way we're designed. Yeah. I'm blown away how patients that are really resistant or maybe can't afford don't have I have a lot of patients that don't have conventional medical insurance. I know you do too. Right. So that that whole path becomes very expensive for them. If we do think they have maybe even a mild case of sleep apnea. So if we just get them taping their mouth shut, I'm pretty, pretty blown away by how much better they can feel.


Dr. Dan Bruce, D.D.S: Yeah.


Dr. Dan Bruce, D.D.S: So there are also, if you want help with it, you know, there's always the do it yourself, which is just, you know, so there's a book called uh The Oxygen Advantage by Patrick McCown. And he's a batco breathing expert. And so you can read that and kind of go through and see how mouth taping works. You can also find a boutique breathing specialist. Yeah. And go through and get coached to that. And then most myofunctional therapists which are um practitioners who specialize in tongue posture. Right. Also do some breathing work also. So, so if you have, you know, it's kind of like you can go to the gym, you can work out on your own and get in really good shape, or you can find a personal trainer who can coach you through it and do it. You probably have better luck with the personal trainer because they keep you accountable. They help troubleshoot all that kind of stuff. Yeah. Um, but some people, you know, they just do it on their own and they do a good job. So yeah. Yeah. Mouth taping is something that I do myself and we find to be fairly effective for a number of patients, but, um, only when you can breathe through your nose.


Amber Warren, PA-C: Yeah, absolutely. When you've got, if you can't come see us.


Dr. Dan Bruce, D.D.S: Yes, exactly. And get that figured out.


Amber Warren, PA-C: I don't feel like any conversation surrounding integrative dentistry is complete without us talking about mercury in the mouth. Amalgam fillings. Why do we care about these older? And can we clear this up? We're no longer using. Most dentists aren't using mercury to do amalgams to do fillings in the mouth anymore, correct? Yes. When was the time.


Amber Warren, PA-C: Frame that that.


Amber Warren, PA-C: Yeah, I would think no.


Dr. Dan Bruce, D.D.S: It's. Yeah. I mean for a number of reasons. For one, patients want the esthetics of having a white filling. So yeah it's it's more common to do. And the materials for uh composite fillings have gotten better. So it's become a material of choice for most dentists.


Amber Warren, PA-C: Okay. That makes a lot of sense. Why do we care about it? Why do we care about Mercury being in the mouth? Why is that a problem?


Dr. Dan Bruce, D.D.S: Well, as a. Dentist. I don't have the licensure to necessarily say that. I mean, there is there is some evidence that there's a small bit of off gassing for mercury, and that's where I really rely on having a good medical team to do the diagnosis and figure out if we do care. Yeah.


Dr. Dan Bruce, D.D.S: Um, yeah.


Dr. Dan Bruce, D.D.S: One thing that I tell my patients is when we do remove those fillings, you know, there can be a little bit because of the heat of the bur even though you use lots of water, all that kind of stuff, um, there can be some mercury vapor that comes off with that. So we do our best to isolate the the staff and the patients with specific protocols for that.


Dr. Dan Bruce, D.D.S: Yeah. You do you it's like I said.


Dr. Dan Bruce, D.D.S: It's we don't want to promise any health benefits or do be a medical provider. Um, but we do realize that's important for a lot of patients. And personally, for me, I want to isolate any exposure I may have. So we take, um, specific. Recommendations from the Iomt as far as removing those. Yeah.


Amber Warren, PA-C: To have the good safe protocol. Yeah. Keep everybody safe when you're getting those removed. Yeah. I think that for especially some of our, um, I don't want to say older patients because I could even be in that camp, but those patients that have mercury in their mouth were it can impact. You know, I'm seeing a lot of a lot of oxidative stress in the body, even people who may be in that pre-diabetes camp but don't actually have high blood sugar. Right. But it's oxidative stress from heavy metals being in the body or some kind of foreign toxin being in the body and can be driving those issues. And then we know Mercury loves to attack the brain. So when we're talking about, you know, issues in the brain, cognitive decline, Alzheimer's disease, dementia, um, that's something I'm really making sure I'm checking off the list is making sure there's none of those old fillings in there that maybe need to be replaced.


Dr. Dan Bruce, D.D.S: Yeah. I mean, I think that's where the team approach really works because it's it's just so important to have the proper people doing the proper things.


Amber Warren, PA-C: Absolutely.


Dr. Dan Bruce, D.D.S: And it's hard to get comprehensive care unless you have a full medical workup and evaluation and figure out where the first part to attack is.


Amber Warren, PA-C: Yeah, yeah.


Dr. Dan Bruce, D.D.S: There's times where dental issues are there and they may be the first thing we look at, you know, if it's an acute infection, a tooth infected like yeah we got to get that out. Yeah. Sometimes that you know, one other thing we do, which I didn't mention is, is we do use ozone for um, for bacterial infections sometimes or periodontal infections, things like that. So yeah. Um, it's it's specifically kind of attacks bacteria, viruses. And so it's, it's a good, um, thing we use for that. But like I said, it's, uh, having the physician or the health care provider on board to be understand. When to take the amalgam out. If it's even needed, then that's super important.


Amber Warren, PA-C: Yeah, yeah.


Amber Warren, PA-C: Head to toe approach. Definitely. We all need to work in concert. That's really important. Well, to learn more about Doctor Bruce's practice, Boise Integrative Dentistry will definitely create a link down below for you guys to look at and go check out his website and his team. And they're right here in Boise, Idaho. Two offices. Right?


Dr. Dan Bruce, D.D.S: Two offices. Yep.


Amber Warren, PA-C: One is up off of Cole and Ustick. The other one's downtown in Bodo. Bodo, right? Yeah. So two different locations where you can get this awesome care. Thank you for your time, Doctor Bruce.


Dr. Dan Bruce, D.D.S: Thanks for having me I appreciate it.


Amber Warren, PA-C: Yeah. Of course. Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today, programs offered at Renew Institute, and the highest quality of supplements and more, go to Fun Med foundations.com.


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