Oral Health and Fertility: Exploring the Connection with Dr. Katie Lee (Episode 590)

Full Transcript: Episode 590

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 590.

We’re about to dive into an interview that is going to completely change the way that you think about your mouth and your oral health and the potential link between oral health and fertility. For the first time on the podcast, we are exploring this topic of oral health and fertility. I am sharing my interview with Dr. Katie Lee, a functional dentist and author, and we go into some really interesting territory. Dr. Lee shares her incredible, compelling story of what drew her into dentistry in the first place. And she also talks about some very practical strategies that she employs in her dental clinic, namely regularly testing the mouth for various strains of bacteria, some strains that are actually known to have negative impacts on male and female infertility.

And so I feel like with this interview, we’re getting a totally different perspective of our mouth as the window into our microbiome because it’s all connected. And so if we have certain bacterial infections in the mouth, they actually are able to then go through our bloodstream and cause problems in other areas. So you may be brushing a little bit more intently and flossing more frequently after today’s episode.

Before we jump in, let me tell you a little bit more about Dr. Katie Lee. She is a dentist, author, and founder of the Collective Health Society, an integrated dental and medical center in Aurora, Colorado, focused on oral systematic health. She also leads the Collective Education Society, training clinicians in this emerging field. A former partner in over 80 dental practices, Dr. Lee is the author of Saved by the Mouth and serves as a clinical advisor to several dental technology companies. Her passion for dentistry began after a traumatic ATV accident as a teenager, which she shares more about in today’s interview, which shaped her understanding of how oral health impacts the entire body. So, without further ado, let’s go ahead and jump into today’s episode with Dr. Katie Lee.

I’m really excited to be here today with Dr. Katie Lee. Welcome to the show.

Dr. Katie Lee: Thank you for having me. I’m really excited to chat with you.

Lisa Hendrickson-Jack: Yeah, me too. I was saying to you before we hit record that we’ve never talked about oral health and fertility on the show. So I’m really excited to delve into the connection. But before we do, I would love for you to share a little bit about your background and what prompted you into the field of oral health. But furthermore, how did you sort out this connection between oral health and fertility?

Dr. Katie Lee: Yeah, so it’s kind of a long story. I’ll try and shorten it as much as I can. I really started getting informed about oral health affecting systemic health from an accident that I had when I was 14. I was on a four-wheeler with no helmet and ran into a telephone pole head first going 35 miles an hour. It’s a miracle that I survived, but I broke every bone in my face from my eyebrows down and lost a bunch of teeth and was in a coma for about five days. And they wired my jaw shut that night in the hospital just trying to stabilize everything. And of course, losing teeth, breaking teeth, everything else, they just wired them shut, they didn’t fix them. And over the next eight weeks, I survived off of ice cream, boxed mashed potatoes, not even the real stuff, boxed mashed potatoes, jello pudding, and I lost a ton of weight, had a ton of oral infection, obviously, because my teeth were rotting. And so my liver enzymes started spiking and my kidneys started shutting down and I became emaciated and severely malnourished. And so I learned at a very young age just how important your oral health is to systemic health.

And when they took off my wires, I was really excited to get to eat my first meal and they took my wires off and I couldn’t open my mouth at all. My jaw completely fused shut. So it took four years and nine reconstructive surgeries where I was completely locked, couldn’t open to fit a toothbrush in, and I was missing a couple front teeth. So I had to wear little retainers with teeth on them, which was mortifying, you know, in high school, because half the time I’d go to school and forget to put my teeth in, which was really embarrassing. And so there’s a big emotional component that went along with that, a big mental health component that went along with that. And back then in the 90s, we weren’t really talking about this stuff, right? It was just toughen up, like toughen up, buttercup. And so it really impacted my life in a profound way. And when I got my teeth fixed finally four years later, senior year of high school, I just remember the immediate impact it had on me having my smile back and being able to chew food and eat in a social environment with other girls. And so I said, you know, I’ve got to go into dentistry. I’ve got to help other people because this is really important.

And so that got me into dentistry. But then I started paying attention and noticing that most of my patients that had oral disease also had a lot of systemic conditions. And I kept seeing these correlations with heart disease, with diabetes. And I would try and work with their healthcare providers and their healthcare providers were like, “You don’t know what you’re talking about. You’re a dentist. Stay in your lane.” So that really got me going down this path of let’s learn more, let’s try and see if there is a connection. And so I read a couple of some great books, started educating myself, and I started integrating salivary testing in my practice. And one of the very first patients I had was a woman, but she came in with her husband. They were in their 20s, no health issues. They were trying to get pregnant and were having all these difficulties. And so they went to their OB/GYN and they said, “Well, nothing is wrong with you, but maybe you should go see your dentist.” Which to this day, that is the only time I have ever been referred a patient by an OB/GYN thinking that their oral health could be impacting their fertility. And I’ve been working really hard to change that. It really hasn’t changed that much.

So I did the saliva test and they didn’t know I was doing saliva tests. They just called up a new random dentist. And it turns out she had two bacteria in particular that are directly implicated in infertility. I also tested her husband because obviously it takes two to make a baby. So we’re swapping spit and he had it too. And I treated both of them and they were pregnant within three months. Nothing else changed with them. And so that got me thinking there’s more to this. And then I had my own fertility journey where I was a patient of traditional medicine for six years and just saw how myopic the treatment really is for women, right? We don’t even look at men except for we take one sperm sample and then that’s really it. And then we only look at their reproductive system and we don’t take into account other things that could be contributing to it. So really just kind of made this my mission to do oral systemic health in general, but specific focus on fertility because I think women deserve better and more.

Lisa Hendrickson-Jack: Oh my goodness, there was so much in what you said. I was welling up a little bit when you shared your story because that is just — I can’t imagine. You’ve probably shared it many times, you know, at this point, but that is just unimaginable. I don’t know if we’re around the same age range, but I was, you know, born in ’82.

Dr. Katie Lee: Yeah, ’84.

Lisa Hendrickson-Jack: Okay, so we’re in the same age range. And when you said you were riding without a helmet, I’m like, man, she’s got to be an ’80s baby, because this was — that was the ’80s. The reason that we have helmets today is because of the ’80s. And I just remember when they started really pushing helmets, but there was this image that they just kept putting on all the billboards to try to get everybody to wear helmets. And it was of a child who had fallen off his bike and obviously had to get — he broke his head open. And so when you were describing your story, I was like, oh my gosh, like that was you. Like you were one of the people who had to go through this horrible, horrible thing. So that changed everything for us now and now we put helmets on our kids to like walk from one side of the bed to the other.

Dr. Katie Lee: I know, right? In fact, that day when I got hurt, it was July 5th, 1998. There were two other four-wheeler accidents because I grew up in the country. One, someone got ran over by a four-wheeler and broke tons of bones. And then the other one broke their neck and died and had to be airlifted. And so there were three four-wheeler accidents that night, no one wearing helmets. Yeah, it was pretty awful what I had to go through. And it was all head and facial trauma. I broke my wrist, I had surgery on my wrist to repair that, but everything else was fine. It’s a miracle that I’m alive. It’s a miracle that I am not in a wheelchair. It’s a miracle that I still have some of my brain left, you know.

Lisa Hendrickson-Jack: Well, and it was such a profound experience for you and how long it took you to recover. And so it was really inspiring just to hear you talk about — I mean, I take a lot of things for granted. But when you said that when I finally got my teeth fixed and I was able to just enjoy a meal and chew food and smile — I’m thinking, like, I have never thought about that. So I just — that is an incredible reason that you went into dentistry.

Dr. Katie Lee: Yeah. Food is so communal, right? And high school girls are mean. So I would eat in the bathroom, you know. Sometimes I would go and eat in the bathroom. Sometimes a lot of times I’d eat in the principal’s office. The secretaries were always really nice to me. But there was no way I could take my teeth out at the lunch table. It’s pretty hard going in your formative years, in your development years, going through high school, having that kind of trauma. But it led me down a great path. So I am thankful for it at the end of the day.

Lisa Hendrickson-Jack: And then when you were talking about the early stages of what they were feeding you, and obviously that just made a whole lot worse with your teeth, right? There’s a lot of interesting — I’ve been a follower of the Weston A. Price Foundation, and they have a lot of interesting things to say about the connection between oral health, dental health, and overall diet and things like that. So at the end of the day, it really feels like you were called to do this work.

Dr. Katie Lee: I’m so impressed that you know who Weston A. Price is. That just went to the top of my hero list there. Yeah, it’s super important for our airway and how we develop and how our skeletons develop. And yeah, being back in the ’80s and ’90s, we were raised on Lucky Charms, right? And Wonder Bread with margarine, and then we’d put sugar on it. So we definitely were not eating the way that we were supposed to, and then it just exacerbated all my issues.

Lisa Hendrickson-Jack: It’s amazing that we survived the ’80s. Okay, well, so let’s get into the connection. When you shared about the OB suggesting going to the dentist — do you know why they said to go to the dentist? Was there an overt issue?

Dr. Katie Lee: When looking at them, looking in their mouth, you could tell it was apparent that they had gum infection for sure. And that’s where we see a lot of the issues going on between oral health and fertility — is airway health and oral microbiome. It was apparent just from looking in their mouth that they had gum infection. I don’t think they had really ever gone to a dentist before. But that doesn’t mean that they have the specific type of bacteria that impact fertility, because there are over 754 different types of species in the mouth. So it really just depends on if you have a couple really specific strains that impact fertility. And like I said, they had no idea who I was. They had no idea that I was doing salivary testing. It just happened to be fate that they walked into my office and I had just started doing the test.

Lisa Hendrickson-Jack: Well, so talk to us a little bit more about that because that’s really fascinating and interesting that you have adopted that as kind of one of the standard things that you do. So maybe share with us a little bit about what you’ve uncovered over the years just by doing salivary testing as part of your practice.

Dr. Katie Lee: Yeah. I would say the biggest thing that it’s shown me — two things. One is that a lot of people have issues and most of the time they don’t have symptoms. So a lot of people say, “Oh, I don’t go to the dentist because nothing hurts or nothing’s bleeding or I go to the dentist all the time and they tell me everything is great.” And I say, “Well, if they don’t do a test, how do they know?” It’s just like if you go to your PCP for a physical, if they don’t take your blood pressure, if they don’t take blood work, they have no idea if your blood sugar is high or if you have high blood pressure or high cholesterol. You can’t tell just by looking at somebody. And in dentistry historically, we’ve never really had tests or used tests to show us what’s going on beneath the surface. It’s always just been our judgment of what we see. So a couple of things — one is most people have an issue and they don’t know it. And the other thing is it’s really good at educating patients as to what is there and why treatment is needed. Because I think there’s this distrust between the population and dentists because the opinions are so all over the place that people naturally are like, how do I trust you? How do I know that what you’re saying is true? And so with testing, you can’t ignore results. That’s what I found really profound with saliva testing.

Lisa Hendrickson-Jack: Yeah. And one of the things that I talk about with our practitioners is my background, of course, is fertility awareness cycle charting. And so one of the main things that we do in our practice these days is to teach women’s health practitioners to actually use the menstrual cycle as a vital sign. And so one of the things that’s interesting about that approach is that you can look at the cycle and see a lot of implications about hormones and things like that, but often it’s the testing. So the cycle can then inform the tests that you are doing instead of just doing a barrage. You can be a little bit more precise, but then it’s the testing and the results that prompt the client to get into action because now they have that data to say, okay, there’s really a problem. You could talk about something all day, but then when they get the test showing that a nutrient is low or that the sperm count is off, all of a sudden now we’ve got some motivation to take some action.

Dr. Katie Lee: Yeah, definitely. And I find that in dentistry all the time. Unless you can test, it’s kind of hard to motivate. People are motivated by pain, right? So if they have pain, they’re motivated, but the problem with microbiome issues is oftentimes there’s no pain. Sometimes people have bleeding gums, sometimes they’ll have bad breath, but oftentimes there are no symptoms. And so it’s really hard to motivate someone who seemingly thinks they’re fine, that has no symptoms, that they need to act. And so yes, you’re totally right. The test results get people to move.

Lisa Hendrickson-Jack: Well, so question for you. You gave the example of this client of yours and they were trying to conceive and they both had this bacteria. So talk to us about that connection. How could a bacteria in your mouth have any effect on your ability to have a baby?

Dr. Katie Lee: Yeah. So the important thing to note is that the mouth is really the entry point to the body, the major largest entry point to the body, and it’s the second largest microbiome that we have, second to the gut. And so there’s this huge amount of bacteria that’s there and less than 1% of our total oral microbiome are bad pathogens. But what happens because of diet, stress, environment, the people around us, what have you, the microbiome can shift and become out of balance just like in your gut. And what ends up happening is when the body senses that something is awry in the mouth, it releases the body’s white blood cells to go attack whatever shouldn’t be there. The white blood cells are really large cells. They can’t fit through all the tissues to get to the source of infection. So the white blood cells release an enzyme called MMP8. This enzyme is a collagenase enzyme, which just means that it’s a scissor and it goes through and it cuts through all the tissues to allow the cells to get to the source of infection. It breaks down any collagen in the body. So if someone has leaky gut, they also have leaky gums. If they are suffering from arthritis, they’re going to have gum issues.

And so what happens is the gum tissue starts to break down. Our gums are supposed to be like our skin in the sense that it’s a physical barrier. So it keeps the environment out and keeps what’s in our body in. The gums are supposed to be the same thing except the gums are actually penetrated by our teeth, so they’re already kind of weakened because our teeth are coming out. But the gums then form these tight junctions around the teeth to kind of wall everything off. That collagenase enzyme will go in and break down that gum tissue. So then what happens is the gums are no longer sealed to the teeth. Now the bad bacteria that are in the mouth love to burrow into that gum tissue, and the gum tissue is where the blood supply is. That’s why gums bleed. So once the bacteria hit the bloodstream, they can circulate and go anywhere in the body. And one of the main places that oral bacteria love to go are the female and male reproductive systems. And there are a couple of bacteria in particular that really do a lot of harm.

Lisa Hendrickson-Jack: Okay, that is mind-blowing. So let me just try to backtrack to make sure I understood what you just said. One of the questions that I have for you is, is it the chicken or the egg? Like, is it that I have this issue with my gut and then it’s manifesting in my mouth? Or is that a product of bad oral hygiene that the gums have gotten to that stage and then it’s allowing the penetration of the bacteria? Maybe explain it a little bit more so that I can understand where it’s coming from.

Dr. Katie Lee: Love to. I just got done talking with a patient about this that is having gut issues. So the gut microbiome is critically important, right? But we’ve got to take a step back and think, how did the microbiome get to the gut? We’re swallowing over a trillion bacteria a day. Most of that bacteria are going to get eradicated in the stomach and small intestine. The ones that we’re really concerned with are the ones that get to the bloodstream and get to the gut that way, because they can really bypass our protective mechanism organs like the small intestine and stomach. There’s about a 45 to 50% overlap between the oral microbiome and the gut microbiome. I have definitely seen it go both ways where someone has gut issues that then first show in the mouth. In fact, before we really knew a whole lot about this oral systemic health connection — which is crazy to think about, because your mouth is the opening to your digestive system — most gut issues show up first in the mouth. So we’ll see people with Crohn’s and IBS actually have certain sores and present certain ways in the dental office and say, “Oh, I think you have IBS or Crohn’s, go see your doctor.” That’s been going on for decades. We always say the mouth is really a mirror to the body.

So sometimes I’ll see it that they have something in their gut that then works its way back up to the mouth, but I also see it the other way where sometimes it starts at the mouth and it goes to the gut. I did have a family member that was like the epitome of health — she gets up every day at 5:00 to work out, no plastic in her house, all glass, makes all of her own food, nothing processed, doesn’t drink alcohol. She’s just the epitome of health and never had a cavity. I would never really save a whole lot of time for her at my office because I knew her cleanings were going to be super quick. And then one day she came in and I started doing her cleaning and I was like, “Oh my gosh, what is going on with you? Something is not okay.” She was bleeding like a stuck pig, tons of inflammation. And I said, “Have you been sick lately? Do you have any gut issues?” And she said, “I’m so glad you brought this up because I have not been feeling well for months. I’ve gone to GI doctors, my primary care, they’ve done a colonoscopy, they’ve done an upper GI, they’ve run blood work, they say everything is fine.” I ran my test and I’m like, “Everything is not fine.” So we treated her, and she actually found a functional medicine doctor and she ended up having SIBO. So in that case, I think she had SIBO in the gut first and it translated to the mouth. It’s hard to tell if it’s chicken or egg, but I do know you have to treat both. You can’t have a healthy gut without a healthy mouth.

Lisa Hendrickson-Jack: Oh, that’s so fascinating. So one of the questions I have then is what do we do about this? I mean, your family friend was flossing, right? It sounds like she was on top of it. So this was a different thing. Is inflammation of the gums called gingivitis? Is that what it’s called?

Dr. Katie Lee: So gingivitis just means that the gums are inflamed, and that is reversible, meaning we can treat it and the gums will shrink back. Periodontitis is where you have inflammation of the gums, but you’ve also lost bone. So now the bone is dying around the teeth. That we say is irreversible because we can’t get the gum tissue or the bone to grow back. Either way, the bacteria are the same and the process is the same. It’s just the time frame in which you caught it. So if you caught it early enough, the patient will just have gingivitis and you can reverse that. But the bacteria are still getting into the bloodstream and damaging the body. So it doesn’t matter if the bone is there in terms of the disease process and the systemic implications.

Lisa Hendrickson-Jack: So tell us what the impact is of someone who is brushing and flossing but has a deeper issue that is then manifesting. Because it sounds like you could be doing the brushing and flossing but if you have an issue it could still be presenting.

Dr. Katie Lee: Absolutely. And that’s actually the patients I see at my new office — “I’m a good patient. I brush, I floss, I’m doing all the things that I’m supposed to be doing, I go to my dentist every six months and I still have all these issues.” And so a lot of other things can impact it. Diet is a big one — high sugar or carbohydrate diets will affect it, food sensitivities will affect it, airway health is so critical to our overall health, so oftentimes our patients have airway issues and don’t know it. Environment, maybe they’re low on some nutrients or vitamins, that can do it, and stress, sleep and stress are big ones. Another big one is alcohol. Unfortunately, everyone — me included — loved a glass of wine a few nights a week, but it’s not good for the oral microbiome. It wipes out all the good bacteria and leaves only the bad.

Lisa Hendrickson-Jack: Well, and you’ve mentioned airway issues a couple of times. Could you briefly just give us a rundown on what that means?

Dr. Katie Lee: Sure. So airway, what I’m talking about is a couple of things. One is nasal breathing. People absolutely need to breathe through the nose. Our nose has all these turbinates with trillions upon trillions of cilia, which are little hairs that filter the air. So we have our own air purifier on the front of our face. We’re born nasal breathers, but we develop into mouth breathers. When you breathe through your mouth, you get less oxygen into the body. You get more inflammatory pollutants, so it’ll cause a lot of lung issues, a lot of systemic inflammation. It dries out the mouth, causes our saliva in our mouth to become acidic. We reduce our nitric oxide, which is a vasodilator that we need. So there are all kinds of issues with breathing through the mouth.

But then that can go even further into someone developing airway disordered breathing or sleep apnea. As we age, we lose collagen, we lose our muscle tenacity, and as women, we lose our bone mass. And so we have less structure for our muscles and skin to attach to. So when we go to sleep at night, everything collapses and our airway collapses. You combine that with what Weston A. Price was saying — that our jaws have actually shrunk over time because of our modern-day diets — and so there’s not enough room for our tongue, our sinuses aren’t developing properly, we’re not breathing correctly, and so people will develop sleep apnea. And about 80% of people who have sleep apnea are undiagnosed. And that is critical for fertility, critical for oral health, critical for heart health and brain health. So we know that patients who are having fertility issues, I’m always going to run a sleep apnea test on them, because if they’re not breathing well, and when you get pregnant, you start snoring anyway, right? You’re gaining weight, you’re getting big, you can’t sleep comfortably. And if you’re not oxygenating your blood, you need oxygen and blood getting to that fetal artery to help that baby develop. So we see a lot of preterm births and low birth weight babies in people who have airway issues.

Lisa Hendrickson-Jack: Oh my goodness. I just didn’t realize there were so many ways that our oral health was connected to our reproductive health. But it makes perfect sense. I do have a question before I go into some of the fertility-specific questions, which is about root canals.

Dr. Katie Lee: Yeah. You know, it’s kind of a hard question to answer. And what I always try and do with my patients is just give them as much information as possible and let them decide. So our teeth are organs, which is crazy to think about. They have a blood supply and they have a nervous system and they’re connected to the body’s circulatory system and they’re connected to the body’s nervous system. That’s why teeth hurt, right? And so when they become infected by a cavity and you get pain and the nerve and the blood supply gets infected, that’s not good for our bodies either. We don’t want our bodies fighting any sort of infection anywhere. And so then the question becomes, okay, what do we do about it? Do we take the tooth out and replace it with a foreign body such as an implant?

Most people — 95 out of 100 — respond just fine to an implant, but it is a foreign body that you are implanting. Ceramic implants have not been better historically; in fact, they fail after five years, which the immune process that happens for a failing implant is very significant on what that does to the body. But the problem with implants is implants aren’t teeth, and so they’re not connected to the circulatory system and they’re not connected to the nervous system. So they’re much less able to fight off bad bacteria than our teeth are. Implants get diseased easier. They have more damage around them faster. So the amount of bacteria that it takes to cause damage around the tooth is a lot higher than what we see with implants.

Now on the flip side, do you get a root canal? The problem with root canals is because they can be done biologically and pretty healthily, but the problem is that now we’ve killed off the tooth and we’ve left a dead tooth there. Now the tooth doesn’t have an immune system either. So it’s more prone to decay, it’s more prone to gum disease. But the bigger issue is because that nerve is gone, if the root canal is not done properly and it’s not monitored, they can develop an abscess around the root of that tooth and that abscess can go unchecked for years because the patient has no symptoms. I actually had a situation like that when I was undergoing fertility treatment or getting ready to start. So I wanted to make sure I had no infection. So I took an X-ray and it turns out I had an abscess on a root and I had no idea.

So I try and let patients make their own decision on that. If they choose to do a root canal, we want to do it safely. We want to do it with a specialist that has microscopes and advanced imaging to make sure we get everything cleaned out. And then we monitor it twice a year to make sure it’s not developing new infection. If they want to take the tooth out and do an implant, that’s great too, as long as they know that we have to take even better care of an implant than we would the teeth. But I would personally like to try and avoid the cavities going to the nerve in the first place, so we don’t have to make that choice.

And the other thing you don’t want to do is take the tooth out and leave it. If you take out your first molar, your chewing capacity reduces by 45%. You take out your second molar, reduces by 55%. That creates way more issues for TMJ, airway, digestion, and systemic inflammation. So a lot of patients say, “Just take my tooth out and leave it.” That is probably by far the worst thing you could do.

Lisa Hendrickson-Jack: So fascinating. So I wanted to ask you about the interesting connection between the oral microbiome and certain conditions, like whether it’s endometriosis or PCOS, or even bacterial vaginosis. So I’d love to dig into that a little bit as well.

Dr. Katie Lee: Yeah. So the same bacteria that are causing infertility issues are the ones that are going to be contributing to these issues. So there was a study that was done in 2023. There were 155 women that they looked at to see if the oral bacteria Fusobacterium nucleatum was contributing and or causing endometriosis. And what they found is that in 64% of those women, they had oral FN present in their endometriosis lesions, versus they sampled women that had healthy endometria and only 7% of them had oral FN. So pretty significant finding showing that FN does at least contribute to or find a way into endometriosis lesions.

And I actually had that experience in my practice. I had a patient come in, a young woman, had no systemic symptoms that she knew about. We did her exam and my hygienist was like, “Doc, something’s wrong with this patient. She is bleeding. I don’t see any buildup on her teeth.” Because typically the more buildup someone has, the more they’ll bleed. She looked squeaky clean and she said that she had always bled since her teenage years. We tested her. Her FN was off the charts. Her MMP8 was off the charts. We treated her. She came back three months later and she was better, but it wasn’t great. And so I sent her to her PCP and to an endocrinologist and they started digging and they found she had systemic endometriosis. She had lesions in her lungs. Had no idea. And so she was treated successfully and was in remission. So anyone that has any kind of female issues, even if they’re not trying to get pregnant, should definitely come and get a saliva test just to make sure that they’re okay.

PCOS, very similar. FN and PG contribute to PCOS. We know that PCOS has implications with insulin sensitivity. When we have insulin sensitivity issues, we’ll have a lot of systemic inflammation, and the oral bacteria can cause that systemic inflammation and can contribute to insulin sensitivity issues. And then bacterial vaginosis — so there’s a microbiome down there too, right? So we’ve got to make sure that everything is in balance. There are a couple of lozenges that I recommend for patients with oral microbiome issues. And what we know is that if they insert one of those lozenges vaginally, oftentimes it clears up their bacterial vaginosis. So it’s all microbiome stuff that we’ve got to balance.

Lisa Hendrickson-Jack: So then what do you recommend? I suppose this is like the natural question.

Dr. Katie Lee: I don’t like to scare people because there are so many solutions. That’s the thing. So first thing is I would get a saliva test because you’ve got to know what’s there. Oftentimes people have issues and they have no idea. So figure out what’s there, because half of the bacteria don’t respond to regular cleaning. So a lot of people say, “My gums bleed, but they’ve always bled.” Well, that’s probably because they have certain bacteria that don’t respond to cleaning. So they’re getting the wrong treatment. Get tested first, get that fixed, and then after that, things that you can do at home: I love patients to be on an oral probiotic. Oral probiotics are different than gut probiotics. We need the oral probiotic to dissolve in the mouth so the bacteria stay in the mouth. If you’re swallowing a probiotic, that’s helping your gut but doing nothing for your mouth.

You also need to be on these two lozenges that I love from Daily Dental Cares. One is Fycompa which is great for preventing cavities and the other one is Protectin, which is great for preventing gum disease. There’s also a water additive of that that you can drink to help your gut, and then you can insert that one vaginally for bacterial vaginosis.

I tell everyone that they must brush twice a day with an electric toothbrush and they must floss. So in between, floss twice a day. In between our teeth, we have our gum tissue. Our gum tissue is where our blood supply is, and in between the teeth is the only place that the toothbrush does not hit. So I tell people, if you’re only brushing, you’re hitting three out of the five surfaces and you’re missing the two most important ones that are directly next to your bloodstream. So you must floss every time you brush. If you brush twice, floss twice. And then tongue scraping is really important. Our tongue has its own microbiome. That’s really critically important in preventing bad breath and things like that. And then get an airway health test to make sure that your airway is good, because like I said, 80% of people are undiagnosed for airway issues.

Then when we talk about supplements and diet, the oral microbiome loves plant-based foods. The thing that can really support your oral microbiome is prebiotics. So if you don’t want to be on a plant-based diet, just make sure you’re getting tons of prebiotics — lots of fiber. And then our teeth actually love more animal-based stuff. So if you want super strong teeth, you need to make sure you’re getting vitamin A, which is critically important, vitamin K2 and D3, which are really important, and magnesium. Everyone is so depleted on magnesium. They should be taking a magnesium supplement.

Lisa Hendrickson-Jack: Well, so there’s this really interesting book that I often share with our practitioners called Cure Tooth Decay. I think it’s by Peter Nagel. It’s along the lines of the Weston A. Price philosophy, and the concept basically is when someone has a cavity in the early stages, to potentially reverse it through diet. So you know, liver for the vitamin A, cod liver oil, and then reducing the consumption of processed foods and all that good stuff. And I suppose one of the ways that I have seen dental health reflect overall health would be — if I have an intake with a client and I notice that they’ve had like six root canals, that’s a pretty good sign that they are potentially undernourished.

Dr. Katie Lee: First off, I want to just commend you for connecting those two and thinking about it because most people don’t pay attention to it. And you’re absolutely right. If you look in someone’s mouth and they have tons of root canals, tons of fillings, tons of cavities, you know something is wrong. And oftentimes they are undernourished, oftentimes they are eating a ton of processed foods and/or sugars. And we know that processed foods and sugars spike our immune system, right? It causes a ton of inflammation, and we know inflammation is not good when you’re trying to have a baby. So there’s a lot of work that can be done with diet alone. Which is why in my office I have a certified nutrition specialist. So everyone that sees me sees her because I can fix your teeth and fix your microbiome, but if you’re not eating sustainably, all my work — three months later we’re just going to be doing this again. Nutrition is critically important, and you need both, right? You need plant-based stuff for the microbiome and you need animal stuff for teeth.

The other important thing is if someone has a lot of root canals and a lot of abscesses on their root canals, that tells me that their immune system is shot because they should be able to ward off infection. So if they have a root canal and the root canals just keep getting infected, I know they have no immune system, which tells me that cortisol is probably through the roof and adrenals are fatigued. It also probably tells me they have infection and inflammation going on in other places. And so we just now have to go on a hunt and try and find where all this stuff is coming from, because the body should be able to heal itself to some degree.

Lisa Hendrickson-Jack: Well, for anyone who isn’t familiar with Weston A. Price — he was a dentist in the ’30s and ’40s. He traveled the world and as a dentist he had this one question, which is: how could people be living in these industrialized societies with access to all of this money and all of these things, but have horrible teeth? And then he would go into places whether it was the Swiss Alps or African places where they’re not yet in the modernized world. People who aren’t even brushing their teeth, who have no cavities and perfect jawline structure. And I think one of the things that really stood out to me when I first discovered this information was that when I was a kid, they taught you to brush your teeth, and I had the idea that it was the sugar on your teeth causing the cavity. But when you talk about this concept of nutrition and what you’re actually eating and how that could almost make you immune to cavities, it challenges the idea that you’re just brushing the stuff off your teeth.

Dr. Katie Lee: Yeah. So a couple of points there. One is cavities are caused by a couple of specific strains of bacteria — Streptococcus mutans and Streptococcus sanguinis. If they’re out of balance — if they’re high and your good microbes can’t keep them down — then you’re more prone to getting tooth decay. I will test patients in my practice who say, “I always get cavities.” I want to know — is this a bacterial issue? Is this a diet issue? Or is this like the mineral makeup of your teeth issue? A lot of people say it’s genetic. You know, “I got it from my mom.” That’s usually not the case. It’s more of a bacterial issue.

So you have to have the bacteria, and then you have to have food for them. Those bacteria love sugar and processed carbohydrates. What happens is it’s not the sugar that causes the cavities — the bacteria love that sugar. So they’ll eat the sugar and then they excrete or poop out acid on your teeth. It’s the acid then that’s dissolving the teeth and causing cavities. The other thing is that every time we eat, the acidity level in our mouth rises, so the pH in our mouth goes down because that’s the way that the body can start digestion. So we secrete salivary amylase, which is an enzyme that starts to break down carbohydrates. So the more often you eat, the more times you’re pushing the pH in your mouth acidic. So the more times you are triggering this whole cavitation process to occur.

What you really want to do: stay away from processed carbs, stay away from sugar, make sure you don’t have those two types of bacteria. But if you just stay away from sugar, stay away from processed carbs, and don’t eat that often, you’ll be fine. So oftentimes nutrition counseling for my patients — I’d rather you eat bigger meals less often.

Lisa Hendrickson-Jack: Well, so one very practical question for you — how do our listeners who are now concerned about their oral health find a dentist that is in line with this? Is it a standard thing? Can we ask for a salivary test from any dentist, or do we need to be looking for a holistic dentist?

Dr. Katie Lee: So you know, it’s tough because there really isn’t a whole lot of people that practice this way. Unfortunately, I’m trying to change that obviously. So a couple of options. Yes, certainly look for a functional or biological dentist. You can go to the IAOMT website and search for biological functional dentists near you. However, they may just be biological or functional in that they remove amalgam fillings a certain way to make sure it doesn’t get in your system, or maybe they place ceramic implants, or maybe they do ceramic fillings. The range of what a biological functional dentist is greatly varies, so it’s not necessarily that they do saliva tests.

OralDNA.com is a great resource. It’s a type of saliva test that’s out there, and they actually have a directory. If you type in your zip code, they can tell you what dentists in your area do a saliva test. So yes, try and look up a functional biological dentist, try and look up to see if they do saliva testing, but call ahead and just ask. And you’ll probably have to call several people before you find someone that will do it. But it’s critically important to get this kind of testing done. I do remote telehealth testing for people. So if they contact me, I can ship them a test, go over results, and then help them get a care plan with a local dentist so we can get them treated.

And then in terms of the state of dentistry, I would say the information about oral systemic health is getting out there, which is really exciting. The American Dental Association is finally acknowledging that the mouth is connected to the rest of the body. And so they actually have a meeting coming up this summer talking about oral systemic health. So more and more people are getting aware of it.

Lisa Hendrickson-Jack: And if somebody is struggling with fertility challenges, they’re trying to conceive, or they have certain menstrual challenges — are those themselves a flag for oral health? Or are there a few specific signs?

Dr. Katie Lee: Yeah. So I always tell people if you’re thinking of trying to start a family, if you’re trying to start a family and you’re having difficulty, or if you have endometriosis or PCOS, you need to get a saliva test because it’s just another place to look under the hood, right, to see what’s going on. Signs and symptoms would be bad breath, sensitive teeth, bleeding gums, frequent cavities. That’s another big one. And then for airway health, it’s going to be anyone who breathes through their mouth, if you wake up at night frequently to go to the bathroom, anyone who clenches and grinds should have an airway test, if they’re suffering from acid reflux, if they’re on two or more high blood pressure medications — and this is irrespective of whether they snore or not. A lot of people say, “Oh, I don’t have apnea. I don’t snore.” Snoring can be a sign, but I see a lot of patients who have apnea that don’t snore.

Lisa Hendrickson-Jack: Well, so many, just so much information. This has been wonderful. So let us know a little bit more about your practice. Tell us again where you are physically, your website, your socials, all the things, and your book.

Dr. Katie Lee: Yeah. So I did write a book called Saved by the Mouth. They can get it on Amazon or from my website. It’s all about oral systemic health, but I tried to write it in a fun, cheeky way. So I talk about patients in my practice and them having a certain systemic disease and what we did to treat it from an oral perspective and how their symptoms resolved. It’s a great easy read for people. My website is katieleedds.com. They can also book their telehealth saliva test with me too. I coach, consult, and do saliva testing for people all over the world. What we do is we’ll do the saliva test, we’ll figure out what’s going on, and then I’ll get a holistic care plan together for the patient and work with their current dentist or help them find a new provider if we need to.

And then I just opened up my brand new practice a month ago. It’s called the Collective Health Society. It’s been a two-year project — a fully integrated dental and medical center. I have a medical director, a certified nutrition specialist who does cellular health testing, hormone imbalances, toxins, parasites, nutrient deficiencies. We do myofunctional therapy, we do airway, and I have an IV clinic also here. And then I have a training and education center called the Collective Education Society where I’m trying to educate providers all around the country on this topic.

Lisa Hendrickson-Jack: Well, that is amazing. I am excited to just sit back and watch you change the face of dentistry. This is going to be very enjoyable, I think, for me to watch.

Dr. Katie Lee: Thank you. Thank you. And follow me on Instagram — Katie Lee DDS on Instagram.

Lisa Hendrickson-Jack: Awesome. Well, thank you so much for being on the show today and sharing your wisdom. I feel like you’ve blown a lot of minds and you’ve reminded us how important it is to focus on our oral health.

Dr. Katie Lee: Thank you so much for having me.

Lisa Hendrickson-Jack: Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page at fertilityfriday.com/590. I hope that you enjoyed today’s episode as much as I did. I had so many takeaways from this episode. I think the biggest takeaway I had was the connection between oral health and fertility. Certainly very eye-opening to think about all the bacteria that could be building in your mouth. And not only that, it doesn’t stay in the mouth — it can have full access to your bloodstream and go into various different parts of the body and cause all kinds of problems.

One of the other points that stood out to me from today’s interview was the potential link between unexplained infertility and these hidden infections that can start in the mouth and then cause these different problems. Her recommendation for if somebody has experienced unexplained infertility — even to be thinking about their oral health and potentially having their saliva tested for certain strains of bacteria — that is just not something that typically comes to mind. So a really great reminder on the complexity of our bodies and how our body is a system that is connected, and even our oral health can play a role in overall health.

So if this episode resonated with you and you can think of somebody who would benefit from hearing it, then please do share. The share link is fertilityfriday.com/590. If you have been listening to this podcast for a while, loving it, and you haven’t yet left a review on Apple Podcasts, I would invite you to leave a review. It’s how people learn about the podcast. It really helps people when they’ve just recently found it to see what others are saying about it. So I really appreciate all of you who’ve taken the opportunity to review the episode and to share it, because that is one of the most powerful ways that this podcast has continued to reach new people over the years. So with that said, I hope you have a wonderful week or weekend whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.