Welcome everyone to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. About a month ago, Dr. Susan Creech, DDS joined me on the Common Sense MD podcast to talk about Oral Health and some of the controversies in dentistry. 

Dr. Creech is a progressive dentist who believes there is a direct connection between oral health and overall health. According to the National Institute of Health, your mouth is home to 700 species of microorganisms or bacteria that live on your teeth, tongue and even pockets between your teeth and gum. These bacterias can put patients at a higher risk for disease such as Alzheimer’s, Heart Disease, Diabetes, Cancer, and more. The good news is the bacteria in your mouth can now be quantified. 

The HR5 Pathogen Test is a simple, affordable, and highly accurate saliva test that analyzes the top 5 bacterial pathogens that cause patients to be at high risk for infection, inflammation, bone loss, and gum disease. Dr. Creech offers the HR5 Saliva test in her office and was kind enough to let me try it during our last podcast. In this Note, I will share my results from the HR5 and a few eye openers on the controversies in dentistry.  


HR5 Saliva Pathogen Test Results 


My HR5 test results showed an issue of oral imbalance. Out of the top 5 aggressive bacteria, 3 of them were found in my saliva. That’s the bad news. The good news was the two worst ones weren’t! That was a relief. 

The 3 bacteria found in my saliva were TD, TF, and FN. Dr. Creech told me that this is systemic inflammation which can contribute to the development, or progression of certain diseases such as: cardiovascular disease, dementia, stroke and heart attack, pregnancy complications for women, diabetes, airway issues, rheumatoid arthritis, and certain cancers. All are associated with these 3 bacteria. Wow! Fortunately, I have the 3 lesser ones, the most being TF. When TF is by itself, it behaves very well, but when it gets with another bacteria it behaves badly. Our goal is to get my bacteria to only FN, or decrease FN. 

Remember, we have hundreds of bacteria in our mouth. Regardless of your clinical symptoms (no bleeding gums, no gingivitis, no tooth loss) these bacteria are still associated with bone loss and systemic inflammation, which can lead to disease. In my case, Dr. Creech said, “the bad guys are winning in your mouth”. Your saliva is what routes bacteria all around the body. What is going on in your mouth is getting into your bloodstream.

Note: Any time there is an overload of bad bacteria in the body, you will most likely experience fatigue, due to the inflammation. When you decrease the inflammation, you generally feel better. That is why you want to treat bad bacteria in the mouth.  

Where did these bacteria come from?  

We acquire this bacteria during birth and the first years of life. Note: the birth canal is chock full of bacteria. This type of bacteria grows slowly over time which is probably why most of us don’t know we have it until symptoms occur. As Dr. Creech pointed out, each person’s body and immune system responds differently to bad bacteria. Some immune systems can get rid of it while others cannot.

What are the treatment options? 

From the test results, I learned my bacteria was imbalanced. Now we need to get it back in balance. The way to eliminate bad bacteria is through antibiotics and probiotics for the mouth. The probiotic that has been tested against this specific bacteria is Probiora Pro. The two antibiotics Dr. Creech recommends for this type of bacteria is Amoxicillin, and then Flagyl (10 day regimen). After I go through the regimen, we will retest and see if it’s gone. If it is, then hopefully, it will lessen my chances of having chronic diseases. 


Controversies In Dentistry


After Dr. Creech and I went over my results, the conversation ventured over into a few controversial topics in dentistry. Topics that I’ve been very interested in lately, such as: amalgams, root canals, implants, fluoride, bad breath (how we get it and get rid of it). Below are some of the highlights. 


Amalgams (Mercury Fillings)


An amalgam is actually a blend of silver, tin, copper, and mercury. Note: You don’t want mercury in your body because it’s toxic. Dr. Creech would only consider an amalgam if there is a hole in the tooth, so far down the gum line, that you cannot get the tissue dry. Note: you cannot place a resin or tooth colored filling in a wet environment. She noted that there is a time and place for an amalgam in 2023, but we should try to avoid them, if at all possible. 

What if you already have amalgams? Should you get rid of them? 

Dentists can use suction and a dental dam to prevent spread of the mercury. Before you have amalgams taken out, I recommend taking: (a) liposomal vitamin C and glutathione before and after the procedure, and (b) probably a gut binder as well, like GI Detox which has zeolite, charcoal, and herbs in it as a full spectrum binder. Personally, I have one amalgam left from many years ago, and I’m definitely getting it replaced. 

Note: You don’t necessarily need a biologic dentist to take them out. The real hazard is to the dentist. Although amalgams are still used, we do have much better materials today. 


Root Canals vs. Implants 


I had heard that you should not get a root canal, but there are times it may be necessary. Some research says there is a link between root canals and systemic disease, making it seem dangerous, but Dr. Creech thinks there is a place for root canals. A root canal is an option for someone who wants to preserve a tooth, but the cavity in their tooth has gone too far into the pulp (middle part). A root canal is a good option for a healthy tooth with enough bone around it. For a tooth with a poor prognosis (not a lot of bone), Dr. Creech would talk to the patient about an implant instead. 

Most implants are metal (titanium). They take the place of the root of the tooth. It was interesting to hear her describe how they do implants. There’s a screw that goes into the implant and the crown goes on top of that. It’s actually three different pieces. The surgeon will place an implant in the bone after the bone is healed from where the tooth had been removed. Then, a restoring dentist will come in and do an abutment (substructure) on top of that, and then a crown

So, if you’re just looking in a patient’s mouth, it looks just like a natural tooth. What the implant will do is: 

  • restore the ability to chew
  • keep the jaw stable
  • keep the bone in that area, and
  • prevent adjacent teeth from shifting 

There’s only a couple of reasons why an implant would ever fail, the top one being SMOKING.  




I haven’t fully developed my opinion on Fluoride, but Dr. Creech did a great job of explaining to me its usefulness. Note: This is very controversial. 

Most dentists love fluoride. Fluoride decreases cavities by about 40%. It’s in our water and it’s regulated. No one needs to be taking fluoride tablets if their water is 0.7 parts per million. At these levels, you don’t need to worry about toxicity. Note: Fluoride tablets are sometimes given to children, if they are on well water. 

We also talked about the use of fluoride at dental appointments. You have calcium and you have phosphate. When you combine fluoride with your calcium and phosphate, it forms a really strong compound called fluorapatite. This makes your teeth super resistant to acid. When you eat, bacteria and sugars form together and produce acid, which demineralizes the teeth. Then fluoride comes along and remineralizes the teeth by combining with the calcium and the phosphate. Fluoride also strengthens the enamel. 

Dr. Creech also mentioned prescription fluoride toothpaste. 80% of her patients are on this toothpaste. If a patient’s teeth are prone to decay, this toothpaste protects them. 

Note: If you are concerned about fluoride, there are a few alternatives that Dr. Creech recommends: Xylitol rinse or Spry Gum which contains Xylitol. With fluoride you have to weigh the risks versus the benefits. There are some people who are definitely against fluoride. It’s a controversial topic.

What about bad breath? 

If you use mouth rinse to freshen your breath and it doesn’t stop the problem there is probably something internal going on. Most likely it is coming from the gut. It’s the sulfur compounds that are creating the bad smell. Again, this goes along with gut health. 

What about teeth cleanings? 

A healthy patient should get their teeth cleaned every six months. If a patient has periodontal disease, they should get their teeth cleaned every 3 months. One of my good cardiologist friends gets his teeth cleaned every 3 months for heart health. That right there should tell you something! Also, remember to floss your teeth! 


In closing…


“Oral health is health. Period.” writes Heather Denny / Harvard University. I’m really doubling down on oral health for my overall health. I’m excited to start my treatment for the three bacteria found in my HR5 Pathogen Saliva Test. Be sure to check out the full conversation with Dr. Creech.  

Till next week. 

Stay educated. Stay healthy.