Chicken or the Egg: What comes first in health?

For years, I have lived and practiced by the mantra “change your diet, change your saliva.” We live in a world where acid and sugar are the norm, and our saliva reflects this lifestyle. In my recent workshop at AAOSH, you learned first-hand how we can understand our patient’s oral health by understanding their saliva using tools such as the SillHa Oral Wellness System. But recently, after a patient encounter, I questioned whether or not changing your saliva would or could drive our carnal cravings, and ultimately diet change. What comes first in oral health, changing the diet, or changing the microbiome? I live and practice in New England, and as you may know, we recently survived the pumpkin spiced everything season. While this season is photogenic and tasty, these delicious treats are typically laden with lots of sugar.

In September, I had a patient who presented to our practice with very high caries risk, admittedly due to dietary habits that bombarded her oral cavity with sugar and acid all day long. I knew that changing these habits would take time.  To immediately decrease her, risk, I started with a combination of custom whitening trays and 10% carbamide peroxide therapy nightly, followed by a Probiora Pro tablet to help change her oral microbiome before I began restorative disease control therapy.

Three weeks later, the patient returned to our office distraught. She loved her white teeth and the feeling of a clean mouth, but she admitted “Dr. Kennedy, the pumpkin spiced donuts at Dunkin Donuts don’t taste the same.” I asked, “What do you mean they don’t taste the same?” She replied “I don’t crave them anymore; they are too sweet. Now, all I want is a handful of peanuts every night.” I chuckled and said, “Isn’t that a good thing?” She smiled and nodded, but I could tell she still wasn’t ready to give up her old habits even though her body was ready for the change. More specifically, I realized her new healthy microbiome was sneakily asking for their own form of good food, arginine, through her newfound craving of peanuts. Or perhaps, her less acidic mouth was no longer craving sweets to counteract the ‘taste’ in her mouth.

This patient encounter has me looking at health differently.  Perhaps instead of focusing solely on our patients making the changes we know would improve their health, what if we created a healthy oral microbiome through chemotherapeutics, and watch nature drive their dietary needs? Growing up my mother always said, “Your body knows what it needs.” While I shrugged it off and thought “my body does not need this donut right now,” I am starting to think she is on to something. The billions of bacteria driving your digestive system do in fact know what they need, and if they are a good bunch then if you listen to them you will be well on your way to health.  

Erinne Kennedy DMD, MPH, MMSc

Dr. Erinne Kennedy is an Ohio State University graduate and comes from Middleport, Ohio. She graduated from the Nova Southeastern University’s College of Dental Medicine in 2015. Dr. Kennedy loved everything about dental school, especially being involved in organized dentistry. While in dental school she was involved with ASDA (American Student Dental Association) as a local vice president and national contributing editor. After dental school Erinne attend a one-year general practice residency at the VA Hospital in Baltimore, MD. Erinne has a passion for community health, and is a board certified in public health dentistry after completing a residency at the Harvard School of Dental Medicine (HSDM) in 2018. In May 2019, she graduated as the pioneer student at HSDM with a Master of Medical Science in dental education.  She currently practices at the Alliance Dental Center, a dental office focused on wellness, in Quincy, MA.

She is a contributing editor for Dental Economics, and on the Junior Editorial board for Dental Entrepreneur Women (DeW). Dr. Kennedy‘s professional affiliations include: The American Dental Association, The American Association of Public Health Dentistry, The Massachusetts’s Dental Association, and The Academy of General Dentistry

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