SHOW NOTES
Guest: Sue Rusalen
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The Oral Microbiome: A Hidden Key to Chronic Disease with Sue Rusalen
00:05 – Oral microbiome impacts overall health.
02:49 – Sue joins the discussion.
03:24 – Role of dental hygienists explained.
04:15 – Hygienists are essential for prevention.
17:15 – Patient case links gum disease to heart attack.
22:20 – Oral disease is the “missing link” in healthcare.
25:40 – Bacteria connected to Alzheimer’s, heart disease, and cancer.
28:00 – Gum disease raises erectile dysfunction risk.
40:33 – Microscopes reveal bacteria and parasites.
42:59 – Patients shown live images for engagement.
45:24 – Photos/videos track oral health progress.
46:50 – Lab tests identify bacteria shared by families/pets.
49:32 – Bacteria build up like garbage bins over 90 days.
52:58 – Need for comprehensive oral exams.
54:46 – Healthy gums don’t bleed; early detection is key.
1:00:21 – Sister’s cancer linked to oral bacteria.
1:06:22 – Tools: water flossers, tongue scrapers, electric brushes.
1:16:48 – Patient involvement boosts outcomes.
1:18:42 – Ron closes, stressing the importance of diagnostics.
Dr Ron Ehrlich (00:05)
Welcome to Unstress Health. My name is Dr Ron Ehrlich. Well, we’ve explored dental health in many aspects today and it’s something that I’ve obviously been involved with professionally for over 40 years. I’ve actually written a book about it and presented many times on it, but my guest today has offered me a more detailed perspective of something that affects each and every one of us every single day of our lives.
My guest today is Sue Rusalen and Sue is a dental hygienist, background in dental hygiene. She’s a coach. She is a practice manager, advisor. She’s a woman with a great deal of passion. And she brings a message about the oral microbiome, which I truly believe is quite exceptional. And I must say, I’d encourage you to, there’s quite a lot in today’s episode, but
Hey listen, this is going on in each and every one of our mouths and we’ve heard so much over the last 15, 20 plus years about the gut microbiome and how important it is to our immunity, to our mental health, to so much of our life, our physical and mental well-being. Well, the mouth is the beginning of the digestive tract and it’s often said that good health starts in the mouth and that is true.
But today’s episode highlights another aspect to it, and that is that it can also be a window into chronic disease. Understanding the oral microbiome can give us hints as to underlying disease that may be years away. And I’d encourage you to slowly work your way through this episode and understand the implications of that because the diverse oral microbiome. mean, as Sue points out, there are seven or 800 different species. mean, there are trillions of microbes in the mouth, literally trillions, but the oral microbiome is made up of about 800 different species and 500 of them are good, 300 of them are not so good and 11 of them are very toxic. And if you have 11, any one of those to any degree in your mouth, then this could give you a clue. And Sue shares a story about her own sister, which was very confronting and really changed her professional life. So this is an important episode and one that I hope you enjoy. I hope you enjoy this conversation I had with Sue Rusalen. Welcome to the show Sue.
Sue Rusalen (02:49)
Thank you very much, Ron, for having me.
Dr Ron Ehrlich (02:57)
So we’re going to be diving into the oral microbiome. Now, people hear a lot about the gut microbiome, but the oral microbiome is another very important part of that digestive system. But before we started, I thought we might just start with something really simple, because a lot of patients, a lot of people, even a lot of practitioners, aren’t really familiar with the role of a dental hygienist.
Sue Rusalen (03:24)
Dental hygienists in the dental practice take on a lot of the preventive and periodontal and gum services. So we leave the dentist to do all the things that you need a drill to use or forceps. So all of the high surgical skills are left to the dentist and the hygienist. And the scope has very much grown over time. It started with just doing the scale and cleans. It started with being able to take radiographs, x-rays.Oral health education, diet and nutrition education, all of the things that help support a patient towards long-term health. But the beauty of not having a five-year degree means that we can provide these services to the patient over a longer period of time, spend more time and not charge things out at a dentist rate. So does that help a little?
Dr Ron Ehrlich (04:15)
It does. And look, it reminds me because I have been in clinical practice for over 40 years, not 50, not that far off. But I know that it took me 20 years to get my head around the fact that a dental hygienist was a good idea because I always used to think, I can clean the teeth. And by the time I retired from practice, we had four hygienists in our practice. And I would describe them as the most important people on our team because they kept our patients healthy. spent more time. Most patients are used to coming in for a checkup and have five, 10 minute clean and there we are, we’re out the door. In 15 minutes, we’ve had a checkup and a clean. But hygienists take a much more thorough than that. I have to say with all due respect to dentists, they take more time. They spend more time focused on prevention. And I would have often referred to them as the most important members of my team because they kept my patients healthy. You have a focus though on the oral microbiome and tell us a little bit about that. How did that develop over the time?
Sue Rusalen (05:27)
Yeah, I agree with everything you’ve said. in fact, the business that I run these days educates dentists on how to fully utilize hygienist in their practice and make the whole experience highly profitable as well. But going through my career, it must have been about 24. It was early days here still in Adelaide for dental hygienist. So there were still a lot of dentists around that didn’t have oral dental hygienists. And these days they’re referred to quite often as an oral health therapist. So you might hear the words used interchangeably. Half of the oral health therapy degree in education is equivalent to a dental hygienist. So they have dental hygienist capabilities as well as some other skills. So I’m 24.
Dr Ron Ehrlich (06:16)
Those are the skills it’s worth mentioning to do fillings on well, it’s on children, well, people under the age of 20, I think, or 21 or 18. And then they can apply for adult scope where they can actually do these relatively simple fillings on adults and so free up the time. So this distinction between oral, the dental hygienist, was a cleaning, you know, focused on cleaning and prevention to oral therapists with children to oral therapists with adult scope. So there’s kind of those three layers out there. Is that right?
Sue Rusalen (07:00)
Yeah, there is those three layers and these are all great questions. Other parts of the world don’t tend to have the therapy side. The government came out in the 70s and early 70s and said we need someone who’s less expensive to train and do simple restorations on children. It’s a public health program. It works very well. And in fact, in my first year in studying, the course that I was in had two therapists in my course who were transitioning to become hygienists.
And you would think, why on earth would they do that? They’re already qualified. But hygienists have always been in such high demand in practices that, and it was in the private system, we got paid extremely well. So it was a bit of a disconnect between therapy and hygiene. Similar amount of training. The therapist could use a drill and do restorative work and we didn’t, yet we were getting paid double. And it is that old supply and demand thing. So therapists for a long time went, we want what they’ve got. And so then became this complete flood of people transitioning into dental hygiene so that they could transition out of public and work in private. Fantastic. So we had dual-rolled people. I never took on the therapy side. And I’m going to say something very controversial here. I think there are lot of political reasons why the oral health bachelors came out, because I don’t have a bachelor’s degree. I have an associate diploma in dental hygiene.
Bachelor’s degree became a three year program and they said, let’s mush them all together and just make one degree. And universities, I don’t know, they really like, it’s money first. They want to make money. They attract people that pay. And they said, if we mush this together, we can create a degree and ta-da, we have a multi-skilled auxiliary that can work in practices. I don’t believe, this is where I’m controversial, that we need another restorative clinician. I just don’t.
I also believe that the skill set of a dental hygienist with all of their perio skills and the restorative skills are extremely different. I know if you had put a drill in my hand, I would have raced off down the road and be doing restorations because I’m a creator. I love to create. I love to build things and look at them and look back at them. And the role of a hygienist can be really disappointing and hard work sometimes because you go in and you educate a person, you train them, you teach them how to clean their teeth, they do the best they can, they come back, go real mess again. And every time you see them, all of your good work sometimes has fallen apart. So it’s very much a connect, it’s developed deep personal relationships, it’s leveraging this and creating data for the practice like gathering x-rays, all of those things and treating the perio. As soon as you step into restorative work, you need a DA. So it becomes a lot more expensive to I mean.
Dr Ron Ehrlich (10:03)
Let me just stop you there, Sue, because you’ve used two terms that I know what you mean, but may not know. No, no. Let me just explain to the listener when Sue’s talking about perio, she’s talking about periodontal tissues like gums and periodontal tissue. And when she says a D.A., she means the dental nurse, the dental assistants. So go on. mean, I think this is an interesting discussion about about about manpower, because I know the dentists were at first, and I was one of those dentists that thought, well, I don’t need someone else to be doing what I’m doing. And in fact, it turned out I did. But then oral therapists came along and it’s a kind of protective of the marketplace, if you like. Do we need the oral therapists to do more fillings? Dentists can do that. Or why do we why do hygienists need oral therapists doing hygiene?
We can do that. So it’s kind of each protecting their own territory. But ultimately, these are people that are, I mean, I work, as I said, when we finished, actually, when I finished, I actually had four oral therapists that were trained as hygienists. And the majority of their work was actually hygiene, was actually prevention.
Sue Rusalen (11:18)
And unfortunately with, and I’ll try to remember that the audience doesn’t know my terms, I’ll absolutely pull me up if I do that. General hygiene has somehow in all of the new universities that have now spread across Australia and all of the courses are being run, there’s only two pure hygiene courses remaining. And that was the one that I did in Gillis Paines in Adelaide. And I think there’s another one in I’ll pull you up on it.
Bendigo, I stand to be corrected. But unfortunately, or fortunately, it depends on the way you look at it, young men and women are going out and getting a degree. They’re learning so much stuff and they come out thinking, I want to use my entire skill set. Wonderful. I think that’s so wonderful. But because the two skill sets are so different, I’m finding that they’re not interested in the periodontal disease side of thing, which is the hygiene side of thing.
I have a list of dentists at the moment, probably 20, waiting for dental hygienists to come and work for them. So going right back to, I mean, we can get into that discussion later, but I believe that the dental hygienist in any practice is so well-placed and particularly moving forward as time goes on to be the person to best support a dentist moving forward. Why I think that,
I’ll go back to my 24 year old story. I am sitting in a dental practice in Adelaide and I have two guys I’m working for, one of whom has never ever worked with a hygienist before. Lovely, lovely, lovely man. But he used to pump out, so popular he’d have people queued up out the door, but he’d pump out his appointments in 15 minutes. Checkup, bite wings, bit of a pick and a flick, brush a little bit more, floss a bit and out the door. And patients just loved him.
I started to see those patients in my chair and I was quietly horrified. really didn’t have the care level or the health of their gum tissue level that I was used to and I had my work cut out for me. More so than my previous job between 21 and 24 where I was the first outback hygienist. That’s another story for another day.
So there’s this guy in my chair, his name’s Alex. Alex was 36. He was an accountant and he had severe periodontal disease, which is very unusual for someone of that age. His gums were bleeding like crazy. It was really hard to work with him. He had lost a lot of bone and jawbone around his teeth. It’s part of the really severe part of periodontal disease. And he’s 36. And I guess he was
which is another indicator in the health of our bodies. I’m sure you’ve talked a million times about it. But I did everything that I had learned at hygiene school and sent him off for two months after probably four appointments of deep debridement and all of the things and all of the amazing things that we did. And after two months, I invited him to come back. And I had said in advance, I’d like to see you in two months. Alex didn’t turn up.
And I was a bit disappointed that all of my hard work was kind of…
Dr Ron Ehrlich (14:52)
Although, although given his young age and given the priority that he had already put on his oral health, it’s hardly surprising that he didn’t show up. I wanted to ask you one clinical question, though, because people may be listening this horrified that somebody loses jawbone and has infection and has this and has that. I’ll put money on the fact that he had absolutely no pain associated with any of that.
Correct.
An important point for our listener to take on, all of that could be going on, but no pain.
Sue Rusalen (15:36)
No pain, absolutely. So all of this was a surprise to him. Now I know he just didn’t turn up one day and this gum disease appeared in his mouth. had been brewing for at least a decade or more. My horror, the guy that I was working with would have been supervising that in his 15 minute appointments, I’m sure. And I tried my best not to throw my boss under a bus. But Alex, I didn’t hear from ever again.
A week later, one of his colleagues rang me and I thought, God, what have I done to him? Alex had died. Alex had a massive heart attack.
Dr Ron Ehrlich (16:09)
Wow, interesting. Well, we are going to talk about what are some of the local and systemic effects of gum disease, which often has no pain associated with it. But people can die without any pain also. Interesting. You’ve raised a couple of issues there. And I would say this and this is not unusual in the in the dental industry, in fact, in the medical world as well, where people build their practice around a 15 minute appointment.
I mean, many dentists would see 30 or 40 patients a day. Many doctors see more than that a day, and they feel the more patients that they can see, this is the way to run a practice in health care. And I don’t think all that many patients are familiar, or certainly not enough, are familiar with the concept of what a comprehensive oral exam is all about.
But let’s just talk about that for a minute, because that is a very important part of why a hygienist is so important. Go on, you were going to talk more about the patient that died.
Sue Rusalen (17:15)
I will get to that, promise you, because it all comes together. I knew in that instant, I had never been taught this at university or at the dental school. We were touching on things, but I knew in that moment that a young man with gum disease that severe was quite uncommon. I also knew that a heart attack at the age of 36 was quite uncommon.
And in my mind intuitively, I knew the two were connected and I have spent the rest of my entire working career pulling this together and trying to get answers. And I now have answers and I have quite an interesting story and it has everything to do with the oral microbiome. And oral microbiome is, we have a gut microbiome, we all understand that we have a gut microbiome. Charles Mayo back.
In 1915 said the greatest portal of entry to disease is through the nose and the mouth. And we have a pandemic to prove actually what occurred there. So I can tell you if you’ve got a gut microbiome, it starts at the mouth and the nose and it ends up traveling through your entire body, whether it’s, and it’s the three I’s, it’s either injury, inflammation or infection. But in our mouths every day, when you have a solid material meet a liquid material, so
cheek and saliva, tongue and saliva, tooth and saliva, any wet versus hard object, you’ll get the creation of what’s called a biofilm. In the biofilm exists trillions of bacteria and parasites, if you’re unlucky. within the parasites and the, well, within the bacteria in the mouth, there’s 800 species. There’s 500 good ones.
There’s 300 not so good ones, but there’s 11 really nasty ones. Now when you go for a checkup at your dentist, and you’re in and out 15 minutes, firstly, there’s absolutely no time to talk about things like this. Secondly, there’s no way that you can possibly even find or look at the microbiome in a patient’s mouth. It just gets pushed to the side. It’s not.
It’s not, we can’t see it. We don’t worry about it. There’s no pain. Let’s push it to one side. So there’s this silent thing that begins in our mouth that you can pick up in a four year old that will indicate whether that person down the pathway of their life will actually become unwell. And it will affect if the good bacteria and the bad bacteria get out of balance. So we call it microbiome.
We call it, when they get out of balance, it’s dysbiosis. So dysbiosis occurs in the mouth and it’s the very first sign prior to any gum disease, infection disease, anything. So how do we, the question becomes, how do we discover whether we have oral dysbiosis? If we have oral dysbiosis and we have high levels of bacteria, fungus, viruses or even parasites, we can’t forget to talk about them. They will cause those three eyes. Those little bacteria will travel into the bloodstream and burrow into the tissues, the bloodstream and all parts of our body, the brain, the heart, the gut, the liver, the whole colorectal, everything. It’ll affect everything.
And it either will occur, will create inflammation in the rest of the body because if you’ve got dysbias in your mouth, you have an inflammatory response. It will cause infection and it will float through the body and lodge on heart vessels and it will cause injury elsewhere in the body. If you look at these little bacteria under a microscope and I’ll get to that a bit later too, they…
burrow their way in, they’re so tiny, they burrow their way in and we can’t see them with their eyes at the dentist, you just can’t see them. And for decades and decades this has been forgotten about. And dentistry has been so much about the white bits, the teeth. And nobody really has connected the mouth to the rest of the body, but it’s very connected. And if we start looking at the pink.
And if we start looking at the invisible, which is almost invisible, which is the microbiome, the secrets there and the information that lies there can either lead us to a life of health or disease. so balancing your microbiome and balancing your gut microbiome should be everybody’s, as well as air, good water and good sunshine and good food and nutrition, should be everybody’s game plan.
Dr Ron Ehrlich (22:20)
I mean, this is a theme that we’ve championed on the program many times. And that is to say that oral health or disease is the missing link in health care because, almost like the black hole of health care because so often it’s overlooked or completely ignored, particularly by dental practitioners who are running 15 minute appointments.
And certainly, gosh, as far as medical practitioners are concerned, their idea of a comprehensive oral assessment would be to ask a patient, have you been to the dentist lately? Yes, I have. Was anything done? No, there wasn’t. And tick that box. We now have eliminated the most common disease in man, woman or child. mean, think the WHO did a report in 2022 which identified
You know, cardiovascular disease, 500 million people globally, diabetes, 500 million people, mental health, big problem, one billion people, oral health, oral diseases, three and a half billion people. And I would say that’s an underestimation because half the population don’t go to the dentist. So three and a half billion is pretty impressive on its own, but it’s still an underestimation.
You mentioned, inflammation, infection, injury, is that the process? It starts with a buildup and imbalance of dysbiosis. It develops into inflammation. It then becomes infection and eventually somewhere else in the body or even in the mouth, it leads to injury. Is that the process?
Sue Rusalen (23:59)
Yeah, I’ve listened to some, look, I’ve been in this world now for quite some time and I’ve got so many podcasts and educators that have taught me things. One of the most brilliant people I’ve listened to is a Dr. Victoria Sampson in the UK.
Dr Ron Ehrlich (24:19)
Yes, I met Victoria in Sydney a few years ago. She works with Food for the Brain. That’s the organization which I’d recommend anybody listening to this does is go on to Food for the Brain and do the cognitive function test to determine your dementia risk. But Victoria is a young dentist who is working with Patrick, who I’ve had on here. Patrick.
Gosh, the name escapes me just at the moment. But his food for the brain is one of the great public health initiatives globally. Go on, tell me about Victoria Sampson.
Sue Rusalen (24:53)
Look, she manages to tell these stories extremely well and because she’s young and she’s so intelligent and she’s got the science behind her, it’s really lovely to listen to people like her. But one of her podcasts, look, she’s got some really interesting, one of her interviews with Trevor Bartlett, Diver CEO, if anyone gets the chance to actually listen to her, she’ll speak for about an hour and a half and break this down.
to Trevor who asks his guests to speak to him as a 10 year old so that, and you will learn so much from her. So Victoria, I’ve listened to some,
Dr Ron Ehrlich (25:31)
Patrick Holford is the founder and CEO of Food for the brain.
Sue Rusalen (25:40)
Its important people that have, or such clever people everywhere and I just zap it up from everywhere. So with the mouth and the bacteria in the mouth, what can happen is in the brains of Alzheimer’s patients, 70 % of the time there’s a bacteria found there called porphyromonas gingivalis, PG. And porphyromonas gingivalis, PG we’ll call him, sometimes I call him Pete, powerhouse Pete gets in there.
And there are things called ginger pains that actually travel through the brain and the blood brain barrier. And they are always present in Alzheimer’s patients. So I’m not going to show you, I’m not going to tell you how, but Victoria says it’s either through metastatic infection, metastatic injury or metastatic inflammation. So with the case of porphyromonous gingivalis, the pathway is an inflammatory pathway.
And so that’s the problem. With the heart, it’s injury and inflammation. So with the heart, 60 % of people have a heart attack. The bacteria found at the site of the blockages quite often, 60 % of the time, they’re of an oral origin. So we can’t overlook these things. There is another one, Fusobacterium nucleatum, which is one of those 11 nasties. I call it FN and FNA, Fusobacterium nucleatum anomalies.
You got to be good with this stuff. Thank goodness I’m Italian and I can say those big curly words. And then there’s the other fancy one of ours, the AA, the actinomyces actomycetamocometans. I don’t know who names these things, but FN is responsible for transporting cancer cells across to into the cells of the liver and are always present in colorectal cancer ovarian cancer and the list goes on preterm birth weight and the most interest diabetes, rheumatoid arthritis. We can actually link them now with specific pathogens. The most interesting one, if you have periodontal disease and you’re male, you have a 2.85 times more higher chance of erectile dysfunction.
Dr Ron Ehrlich (28:00)
Yes, I know that is one that I that I like to quote because, well, not the statistic. That’s great. You’ve got it. But it certainly gets men’s attention when you when you start. maybe flossing might not be a bad idea.
Dr Ron Ehrlich (28:36)
No, no, we’re going to talk about that.
Sue Rusalen (28:40)
Interesting flossing is not the answer but certainly gets my husband with a toothbrush in his mouth let me tell you and he’s so I’m quite funny about so in answer to your question every part of the body is affected and impacted differently by these oral pathogens but they all play a role now in dentistry we open a mouth and we look at the mouth and unless it’s doing anything wrong with the mouth then we ignore it.
But when I discovered that young Alex had had a massive heart attack, I realized my role was more than a tooth fairy. I was standing with the keys to his health and for his longevity of life. And so if you’re someone listening to this and you are interested in lifespan, it’s more than lifespan, it’s health span. Because what our goal is to get our health span almost as long as our lifespan, because what’s the point of being here for an extra 20 years if you don’t have your health? And the oral environment is so forgotten when it comes to this. And so I went on a 30 year quest to find out, and I was that pest at periodontal meetings with other doctors that was asking all the dumb questions. And I just did that forever. And it wasn’t until
I became a consultant in 2019 and I was in America when I finally found some answers.
Dr Ron Ehrlich (29:44)
On, well, do share some of those answers. What were some of the questions you were asking before you came up with the answers? What was the question?
Sue Rusalen (29:52)
So with Alex in mind, and honestly I don’t remember his last name, but I do remember his first
Dr Ron Ehrlich (30:00)
It’s okay, we wouldn’t, we’d change the name to protect the innocent anyway.
Sue Rusalen (30:03)
So with him, I just went, well, what happened here? Surely there’s got to be a connection between what was happening in his mouth and his heart. no, no, no, no, no, no. I was told it was associative, but we couldn’t prove it was causative. So you can’t say that to your patients. And I think that’s where I felt most hindered is.
All of these things started to become very obvious to me, but I actually wasn’t allowed to say them to a patient or report that this even could possibly happen. So even when you’re sitting down with a patient with a toothbrush and you’re trying to motivate them to, you know, perhaps disrupt that biofilm a bit better and more often, and to get rid of the pathogens more frequently in their mouth, that I couldn’t actually talk about the consequences. All I could say is it might make your gums, you know, heal.
It might not, know, whatever, but we couldn’t talk about, you know, a toothbrush could save your life. And that sounds ridiculous when you say it, but I truly believe that a dentist and a dental hygienist and a toothbrush can save your life. So I’m in the US in 2019. And honestly, I had got to the point where I wanted to be as far away from dental hygiene as possible. I went into practice consulting and I wanted to help dentists just design better business, a better patient experience. And by doing that, they were actually developing much better patient compliance and acceptance. Patients were turning up and happy to pay more because their experience was better. But I hygiene is my gene. I had been pushed in the corner as a hygienist, we’d been disrespected. We had been pushed to the side, we’re not valuable. This had happened for such a long time and I just
I felt that I was on this treadmill, really boring profession where all I was doing was picking plaque off teeth. And so I wanted more. And when I created my consulting company to help dentists, I didn’t march out the door saying, we’re going to talk about microbiome and we’re not going to talk about dental hygiene. Chuck that in the bin. And I completely felt unfulfilled in my career. Why had I chosen to do this?
Why didn’t I go and do mathematical science? Why didn’t I continue with all of those things? And I think I made my fun out of traveling to Switzerland for two years and working as a hygienist with Mount Pilatus in the background. I did all of these really cool things. I studied NLP, I studied business, I studied all this other stuff. And there I was in 2019 at a seminar. And as you know it, on the very last day, some guy walks up to me, corny little guy, funny little glasses.
His name was Dr. Mike Subiak and he wouldn’t mind me talking about him this way. And he handed a book into my hand called Hygiene Superstar. And I went, yeah, here we go. Another hygiene thing. I want to be as far away from that as possible. I tucked it in. He signed it. I tucked it into my bag and I didn’t open it until I hopped on the plane back to Australia and I devoured it in two hours front to back. This guy, in Camarillo in Southern California had 11 dental hygienists working for him. They were all working on the oral systemic aspect of oral health. so, Ron, I’m going to refer to the oral systemic quite a bit, but it’s where the mouth and the body come together and the complete impact that having really decent dental hygienists and a team that can have these conversations will
impact your business. And in that moment, I realized three things. Not only will understanding this and teaching this save our patients’ lives, it will also completely reignite the career of dental hygienists because suddenly we’re excited and we’re using our degrees and our brains for more than just picking stuff off teeth. And the third thing, which was quite unexpected, but which my dentists love, is it absolutely skyrocket their practices. So you imagine having an auxiliary working for you where they do most of the work and you’ve got 11 of them. Mike doesn’t do dentistry anymore. He’s become an airway doctor. He has other GPs, but he has two shifts of practitioners working across his practice. And he has had such a major influence on me. And he’s a real ACDC fan, by the way.
And we’ve had some fun in America. But he’s got his own podcast as well. He’s a brilliant human. And once I read that book, I went, you know what? I have just found and discovered everything I was searching for. And in that moment, my life changed.
Dr Ron Ehrlich (35:03)
Well, mean, there he is in Southern California with 11 hygienists and the whole issue around oral microbiome systemic health. It may have been a moment for you, but for somebody who’s been observing the way the mouth impacts on general health for 45 years, I can tell you this is a conversation that’s been going on.
for a very long time. if you actually Google Scholar Periodontal Disease and Systemic Health, you’ll come up with tens of thousands of articles on this because this is a subject that has brought the dental profession into holistic health care, whether they like it or not. And many dentists aren’t particularly interested in it, but a lot are. And it’s those that are providing a service that’s great. Now, when you talk about, you’ve mentioned the oral microbiome, you’ve mentioned that there are 811, perhaps, species because 500 of them are good and 300 of them are bad and 11 of them are toxic. And you’ve mentioned porphyromas, gingivalis and PFNA and AA and all these other species. How do we detect that, the balance? How do we, Chair Side, do that?
Sue Rusalen (36:13)
That’s an absolutely great question. And it’s extremely difficult to. that was where I got exactly the same spot. So I reached out to Mike and said, I need to teach Australians this. The word holistic, everyone gets a bit scared of. They think it’s two fish slapping together. And it’s It’s just let’s look at the whole body. You you’ve heard that a times. But I think dentists are taught to look at the hard tissues. We take x-rays. We take photographs. We…
We palpate, we touch with our hands. Our eyes can’t see these little things. You can look at a mouth that relatively looks extremely healthy-ish, like mostly healthy, but their microbiome can be horrific. Now, it can be horrific and not impacting the mouth per se, but it can be impacting the entire body. So the mouth doesn’t always leave clues. So how do we test it?
What I found and Mike referred me to some people who actually taught the microbiome and microbiology in the US and I brought their program to Australia and I redesigned it, packaged it up and I now have it in 60 practices across Australia. We’ll get and more coming, but we’ll get to that. But it all started and the diagnosis, the assessment, the screening all starts with the use of a microscope. And
You mentioned the history of dentistry. And we’ve always had the engineers versus the healers. We’ve had the people. Dentistry has gone down a very strong engineering path. The healers, the gurus starting with the mayors and there was a Paul Kyes in there that was just absolutely astounding. He, he
He took the work of microbiologists from previously and he did a lot of work in decay and then he flipped over to Perio and he started all of this work. This is not new stuff. This has been hanging around for a very long time and all we’re doing is rejuvenating it. So we go into a patient’s mouth and included in less than 30 seconds in an appointment, I’ll take a very small sample from under the gum of a little bit of biofilm. For want of another word,
You might say plaque. It’s actually not plaque. It’s a little bit. It’s underneath the plaque. You scrape it off the tooth. We always go under the gum because that’s where the bad guys live. They love hanging out where there’s no oxygen. And those pathogens, the 300 nasty and the 11, including the 300, they live in areas where there’s no oxygen. the anaerobic bacteria is quite visible on a microscope slide if you know what you’re looking for.
So we use a special mounting medium. We plop the sample on it and honestly, it’s less than a pinhead, less than a pinhead. We seal it, we put it under a very specific microscope that we’ve had built just for this purpose. We use liquid that’s been built just for this purpose to keep it alive. It’s a phase contrast microscope and we teach our practitioners what to start searching for. And we search for different shapes of bacteria.
Cocci, rods, gliding rods, spinning rods. We look for white blood cells. We don’t want white blood cells because they’re only there if they’re fighting infection. We look for spirochetes. Spirochetes are the curly ones. Spirochetes, there’s 57 nasty different types of spirochetes. Some are Lyme disease, some are sexually transmitted disease. They’re not the ones that live in the mouth, but we don’t want spirochetes, they’re nasty.
They’re the inflammatory and infection-creating ones. So we can see them on a slide and we look for parasites, so single-cell protozoa. They’re all big fancy names and we see red blood cells and we see skin cells and we see plaque and all that stuff. But if I can…
Dr Ron Ehrlich (40:33)
This is all from the sample that’s been taken. Yep. Right. Right. Okay. I love this. This is good.
Sue Rusalen (40:35)
Less than a pinhead. So we look for morphology, which is shape. So I’m looking for the straight ones, the short ones, the squiggly ones. I can tell what they are at a hundred heartbeats. All sorts of cool stuff going on in there. Then we look for motility. So morphology is shape. Motility is how fast are they moving? the nastier, except for the amoeba, they’re slow. And we look for load.
If we just have one lonely little spirochete floating around, not good. We don’t even want them there. But sometimes I see them in clusters and they’re like radiating like sun rays and they’re munching on a white blood cell and they’re just coming out. And you can see this in real time. Now, the really nasty stuff we see, which has been long forgotten and not discussed in dental school at all, are parasites. And there’s amoebic parasites.
And then there’s something called trichomonas. Now, trichomonas are tiny little things with a tail on them and they wiggle around really fast. And they come from cats. And the other trichomonas, I have to be careful how I say this on a podcast, the name for the trichomonas is Trichomonas vaginalis. And it comes from down there. Or it loves hanging out down there.
Dr Ron Ehrlich (42:08)
Well you can say vagina on this program. can we pray? we can. Don’t worry. My listeners are really, they’re pretty good about that I’m pretty sure.
Sue Rusalen (42:18)
Have a little bit a meltdown sometimes when I’m talking about it.
Dr Ron Ehrlich (42:19)
Okay, okay. Wow, that’s so interesting. know all of this. Now this is so fascinating because I’m presuming this is all happening chair side on a screen and the hygienist is sharing this information and their knowledge with the patient. it’s also always so abstract, isn’t it? What goes on in the mouth? yes. can’t see. And I know in our practice, we do use high definition photos and people suddenly get an understanding of what is actually going on in there. But this is taking it to a whole new level, really where the rubber meets the road to say this is where disease is actually happening.
Sue Rusalen (42:59)
So this is intra oral camera photography on steroids because you’re going on a visual aspect and you’re going 100x on that. So there was a Dr. Bob Barclay that had a movement and over 10,000 members in the US who was the preventive king of dentistry in the 1970s. He passed away in an airline crash. But Bob coined something called co-diagnosis.
And we adopt that theory and I have all along so I sit with a little card I sit alongside my patient we look at this big screen together I don’t put it on a screen that big I blow it up to king-size television size, right and I will Allow them to feel a little bit uncomfortable because I want this to land Because when you get a patient engaged and they truly understand what’s going on there
You’ve got a patient for life and you’ve got a partner who will work with you to get their disease back to zero. If we don’t get that engagement and that message across, we can’t do it on our own.
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Dr Ron Ehrlich (45:24)
Yeah, because I’m assuming that image is taken stored as a slide, literally as a photo. that when the patient come, a video, even better, a video. And so when the patient comes back a few weeks later, I’ve been really good with my hygiene. I’ve been terrific. And you do that again and they can visualize the difference. That is a learning experience that is worth their weight in gold.
Sue Rusalen (45:33)
We saw the video.
Sue Rusalen (45:34)
So anything we teach them, anything they do, anything we do, anything we do together needs to have an impact. So we can actually bring this back to not a despotic slide. It’s completely visceral when they see it. But I need everyone to understand, dentists, and I’ve got a few people out there that think this is all crazy. It is not just, aren’t we crazy? It is not just a patient motivator.
It’s a screening and assessment. And then people will say, but don’t you do just the same treatment? No, we don’t. But we tailor it to what we’re finding. That’s the first thing. And more so because if it’s a parasite involved, we have to go down a very different pathway of therapy than if it’s just dysbiosis. So you have to know that.
Dr Ron Ehrlich (46:49)
Let’s go on, yeah. I want to ask you what that difference is.
Sue Rusalen (46:50)
Yeah, I will. I’ll you that second. The second step is if we’re not getting health or we’re dealing with someone who’s very high risk, I prefer then to actually take a another sample, either a saliva sample spit in a tube, or we use little paper like points to poke under the gum send them off to the laboratory and I get back a report which tells me exactly what bugs we’re dealing with. And we can see how many PG per mole there are how much FN there is, how much, and I know exactly what bacteria we’re dealing with. And the amount of times that I see families that have got the whole lot or identical patterns, parents, petners, partners, parents, partners, pets, mothers, lovers, dogs. These are communicable.
They transfer from your pet to your mouth. They transfer from your new boyfriend into yours and then onto his new girlfriend and whoever he’s, you know, whatever. This is how it lands. It doesn’t mean don’t kiss anyone ever again. What it means is, what it means is you’re going to come across, we’re human, we’re going to come across this. But what we need to learn is when those bacteria come in, the bad guys,
We have to learn to keep them at very, low levels of dysbiosis in order to remain healthy. And all we’re aiming for is not zero bacteria. That’s impossible. We just want to get the bad guys down and so that we get balance.
Dr Ron Ehrlich (48:28)
Yeah, so you mentioned a couple of things there that I want to just backtrack a little bit on, because you’ve mentioned and people may have missed it, the importance or the virulence of anaerobic bacteria or microorganisms, organisms that don’t need oxygen. And this gets to the very point about the difference between early colonizers and late colonizers, isn’t it? And how late is the late colonizer where we start to get the 11 really toxic bacteria, know, microbes that are causing damage. So when we brush our teeth, as soon as we finish brushing our teeth, the early colonizers start forming again. I mean, it’s a it’s a process that goes on pretty quickly. Because we brush our teeth twice a day, not such a big deal. But if we miss a part of we have a deep pocket that we can’t get to then we get late colonizers. is late? Where do we draw the line between early and late?
Sue Rusalen (49:32)
You’re asking beautiful questions, but I have to backtrack all the time, Okay, so I’m going to use a metaphor. If you’ve got a garbage, like a green garbage can out in the sun, and it’s got some food scraps in the bottom, and the garbos have been, and they’ve collected it then put it back on it, and they’ve left the lid open, that bit of filth in the bottom is going to feed probably
probably some flies will come and lay maggots. Then cockroaches might turn up or worms. Then the birds might come in because they want to eat. The lid’s still open. The birds come in, they go, we like it in there because we’ve got some food down there. And then, I don’t know, a local raccoon might come along, like this is if you’re in America, like using the raccoon. But it builds and builds and builds till you’ve got big species that are then interested. It’s like that old, the old mother, you know, the little.
There was an old lady who lived in it and it gets eaten by a bigger species all along. Eventually you’ve got a garbage can that is full of really big animals. It’s the same thing with our gum pockets, okay? So the early colonizers on their own don’t do a lot of damage, but they act as a bridge species and they create like a structure that the other species can build onto. So at about day 90.
Dr Ron Ehrlich (51:05)
You’ve got three months.
Sue Rusalen (51:07)
Yep, three months. You’ve got the bad guys there. And then if you’re not disrupting frequently enough, it can happen faster. And so there’s a really, it’s really important that we tailor whatever we do to you, because if you’re a great oral health cleaner and you’ve got a good immune system and you don’t have a lot of stress and you’re not a smoker and blah, blah, we can, can mitre or tide it or stretch your appointments out because you don’t get that building up as quickly. So if you’re the person that has their little rubbish bin and it’s a free for all, within 30, 40, 60, 80, 90 days, it’s chockers and we’re back to the start again. So colonizing the bacteria happens like it’s the growth of a city. You know, the little buildings and the big buildings and the skyscrapers are coming and all of sudden we’ve got this structure. If it’s not disrupted properly at that point, it will just fumigate and that’s when all of the periodontal collagen breakdown or the gum disease, the bone, because each of these species eats the byproduct of the previous species or it eats and is very interested in the whole environment. the body sends along the white blood cells because the white blood cells are going, we’re out to fight these people.
But spirochetes, amoeba, they love white blood cells and they go in and suck out the nucleus. It’s their food source. And so as this builds, the byproduct of all of the previous ones and the body’s natural first line of defense come along to help, but they become the food source. Then it starts to break down the collagen fibers in the gum. And this is when it starts to cause damage elsewhere in the body. So how are we going so far?
Dr Ron Ehrlich (52:58)
Well, we’re going well. And I think this is a good point in which to remind people why a comprehensive oral exam, which measures the crevice around a tooth and which can’t be done in a 15 minute checkup and click quick clean, which is exactly where we started from, which says why hygienists are so important because they measure points around each tooth to see whether you’ve got a deep garbage bin there or a shallow gut to take this metaphor a little bit further. If if if the bin you’ve got there is just the depth of a lid, the lid itself, then you haven’t got a real problem because it’s so easy to keep that clean. But if you’ve got a really a wheelie bin there around every tooth, then you’ve got a problem. Then you’ve got a problem. So this is again why comprehensive oral exams are important.
And I think also worth reminding our listener that pain is not involved, very rarely involved in any of this. So keep going. Yeah, we’ve got we’ve got this these early and late colonizers and these kind of destructions. And I love this microbiome screen that you’re doing involving in co-diagnosis. You know, when you say co-diagnosis, you’re meaning you and the patient are looking at things, educating themselves understanding what is actually going on around each pocket. I can see now, Sue, why my good friend, Dr. Jalal Khan, who’s been a guest on my podcast on several occasions, was so keen for me to talk to you because I do like this. This is a very important aspect of modern dentistry. Go on.
Sue Rusalen (54:46)
It is an important aspect and it does go, I will tell a bit of a personal story here before we go back to the comprehensive exam. And I tell these stories because they really make things land. So, so, so how, so how we actually, as a dental hygienist, tell if our patients have a gum disease, we look for inflamed gums. We looked for a little bit of bleeding when we poke them. And there’s always a bit of a joke, well, no wonder they bleed, you just poke them.
but healthy tissues in the mouth shouldn’t bleed if you just gently poke them. If you’ve got those little quicks around your finger and you notice how inflamed they get when you peel off of it, that’s really painful. But gums get inflamed and infected too, but a healthy gum is so tight and it forms a cuff around the tooth, a very tight cuff, and there’s a little space between the tooth and the gum of about one to three millimeters, which is considered acceptable.
That is very easy to keep clean. So when you have a healthy mouth, it’s easier to keep healthy. Now, little pathogens will burrow down in there and they will start to do all of the magic that we were just in the destruction that we were just talking about. And it goes through a bit of a process where we get some inflammation and then there’s some bleeding and then we have some collagen breakdown in the gum fibers. And then we have something called clinical attachment loss where we can actually see it.
Prior to that, we can’t see it. Clinical attachment loss and then bone loss and then gum pockets or the big garbage bins where the bone is actually in a way is quite late in the process. And so we’re trained as dental clinicians not to find gum disease and still it’s very, very late. And I get quite upset about that because if I can show someone right at the start that there’s a problem, I have a huge chance of stopping it down the track.
Because once you’ve got those big garbage bins around your teeth, we’re going to do a little bit of work to get you healthy again and get you back to the tight pockets. And that’s where gum therapy comes in. But the preventive therapy, we can step in and turn things around really fast. Now, the story I wanted to tell is there’s plenty of mouths. I can hold them side by side. One will be completely dysbiotic and the other one will be healthy. So I’m one of four girls.
And when I say girls, I know I’m 58, but I’m a full woman. I still call myself a girl when I’m around my sisters. And my younger sister, Alison, in 2023, she had been my patient as a dental hygienist since the age that she was 19. So we’re only a year and a half apart. And I had been her dental hygienist. She was a nurse, a high-end nurse. She didn’t drink alcohol. But at the age, and she had come to the the dentist her entire life and had seen me regularly and I was always maintaining her teeth. But what I wasn’t doing and I didn’t pay attention to was the fact that she had a very dysbiotic bifurmino mouth. And I didn’t know that until quite late. So in 2023, she was diagnosed with colorectal cancer. that’s, sorry, it was actually something called cholangiocarcinoma, which is a disease of cancer of the bile duct.
And that’s what we were talking about with that FN, Fusobacterium nucleonin before. He’s the little bugger that actually exacerbates cancer. So she’s in full-blown cancer therapy. was terminal by the time, stage four terminal by the time she was actually diagnosed. Again, no pain until the very end, right? And certainly nothing wrong with her teeth. But because I’m knee deep or neck deep in all of this, said, hey, Ali, can I just take a saliva sample and see what’s hanging around in your mouth? And there it was. PG and FN were off the chart. And the amount of clinical science that’s actually proven and shown that this little nasty bacteria is responsible for a lot of this, there it was sitting right there. And so I sent this to her oncologist, who knew exactly what to do, but it was too late.
The thing is, even though as a dental hygienist, I had been trained to check for pockets, bone loss, calculus, all of those things. She had none of that. But I’m now who was packed with FUSA bacterium nucleatum. Furious me as a dental hygienist and an oral health care worker that we’re not trained to do this and check for. So as much as I’ve got my little instruments where I can go around and poke it, poke the gum and find out if there’s disease.
There you go, a periodontal probe with little lines on it that tell you how deep that little garbage bin has got. So archaic, I believe, when it comes, it’s just a confirmation you’ve got disease there. Yes. There’s lots of stuff going on, but we could have found this had I known about it 20 or 30 years ago. It has been brewing in her body for a very long time and a simple either antibiotics
Or a naturopathic process can get rid of Fusobactyum nucleatum. And maybe on another day, or I should get you to interview Professor Emily Stein from Stanford University. And she’s actually developed a prebiotic, which will kill off and stop FN and caries. It’s a huge conversation.
Dr Ron Ehrlich (1:00:21)
You know, yeah, go on. I mean, I what I was going to say, Sue was, mean, that’s a very personal story. And I can just imagine how you reflect on that now. But in this modern world where we are exposed to so much stress and that’s what this program is about, unstress health, we I have clinically, professionally, personally defined stress as anything that can promote chronic inflammation and compromise immune function.
That’s what I define a stress as. And there are many in our modern world areas of stress. And dental stress is a very common one, the most common one, I would argue. And you would agree, I know, I think. But it’s not the only one.
Sue Rusalen (1:01:08)
No, and I would, I would absolutely 100 % agree to that, but poor Alison passed away in January 24. And she had, thank you. And she had been under a huge amount of pressure and bullying at work. She was a very high nurse to the point where she said, I’m just not going to fight this. I’m going to go and work somewhere else. She had to have five mRNA vaccines to keep her job. She needed a job because she was a single mom.
Dr Ron Ehrlich (1:01:40)
Well, let’s not let’s let’s let’s not go down. Well, we could go down that path because.
Sue Rusalen (1:01:41)
We don’t have to, but the thing is the Fusobacterium Pliatum, she had the perfect storm. And she was going to the same doctor over and over and she said, I’ve got a bit of a pain here and I’ve got to be, and you know, we found it all by accident. By the time we found it, as you know, any pancreatic or bile duct just comes very late, but it was the perfect storm. The thing about the oral bacteria, A, we could have found it earlier had I been better trained, more proliferative, whatever or if our clinicians had been better trained and I’m on a mission to do that.
Secondly, the transference of the cancer cells into the liver are facilitated and really helped along by FN. So if we didn’t have the FN, so of course I went and tested myself and they’re swimming everywhere. I’ve got them everywhere. Mothers, lovers, dogs, parents, partners, pets, family units share these things. Do family units share?
The same diseases or do they share the same oral microbiome and do we all end up with these crazy diseases, not just because of our DNA, but because of the bacteria that we share. The end of the day, just find out what it is.
Dr Ron Ehrlich (1:02:49)
Well, Sue, I mean, the other thing to be said there, and we’ve done my program with one of my favorite, one of my mentors is Bruce Lipton, who wrote a wonderful book called The Biology of Belief. And thoughts are things. They are called neurotransmitters which attach on to cell membranes and cause our genes to express themselves in a positive or a negative thing. So when in a negative way. So when you say she was under huge emotional stress, bullying, etc, etc.
She was under those neurotransmitters were compromising her health. Then you mentioned she had five mRNA vaccines and this may shock some of my listeners. Others may be very familiar with it, but there is research which is emerging showing that mRNA vaccines, gene therapy, not vaccines really, gene therapies, turbocharged cancers. So you’ve got a perfect storm here of dental stress, of emotional stress, and of this turbocharged experimental gene therapy. So don’t be too hard on yourself, but I get your passion. I’m picking up on your passion.
Sue Rusalen (1:04:09)
I did, when Alison passed away, mean, poor girls, all born, know, very close family. You know, we’re not girls in each other’s pockets, but we’re certainly, you we don’t even share fingernail tips. not that, we’re kind of those practical women. But when she passed away, I dived under a doona, and probably for six to eight months, and I thought, I don’t want to do this anymore. But last October, I came out and I went, F it.
Dr Ron Ehrlich (1:04:32)
Yeah, yeah. Well, good on you because I, you know, I think you are actually putting something on the agenda, which I can really which which puts science to what is really happening in people’s mouths. And I love this code diagnosis model you’ve got. love this code diagnosis model you’ve got because patients need to be actively involved. They’re not passive. They’re not victims. They do have a great deal of they can do to empower them to better health. Listen, you’ve talked about, you know, patients are familiar with cleaning and flossing and brushing and good. What are some of the other lifestyle factors that can affect positively or negatively the, you know, the oral microbiome?
Sue Rusalen (1:05:19)
Great question. And I did, I did previously talk about parasites too. So they fall into a slightly different category than, so let’s talk about the mouth and just bacteria first. You need to disrupt the pathogens all the time, as often as possible. So brushing twice a day. Look, flossing has been shown, particularly in the hands of a inexperienced user not to be so good.
It has to be curled around the tooth, wrapped deeply into that garbage tin. Or you could call them like, they’re like a gum gutter. So you imagine the gutters on your house and some people they have a shallow gutter, good. Deep gutters, really hard to get down there. So people when they floss, they just ping it in and out and they don’t. So flossing. So there’s something, we use water picks. So a water pick or a water flosser is something that you can use, please use it in the shower because it makes a terrible mess. Put it in your mouth, close your lips together and squirt all around those little gum gutters in between. So when I’m showering and I’ve just got the water rolling down my back, that’s what I use.
Dr Ron Ehrlich (1:06:22)
There are some really neat, there are some really neat little mobile ones now. They used to be very bulky and they used to be very awkward. And you’re right. If you don’t close your mouth, you can make a terrible mess of the bathroom and the mirror. But but the mobile little handheld ones, a bit like electric toothbrush are really good on. Yeah, I like that. Use that in the shower. I mentioned that to my wife.
Sue Rusalen (1:06:44)
So absolutely, yes, and it’s great for cleaning grout. So if you’re in there and you’re really bored, you’re gonna get in there. And I always say to my friends, just be careful where you point it because you could do yourself an injury. So just make sure it stays in, because it’s quite powerful. It’s amazing. Tongue scrapers, people, tongue scrapers. The tongue is like this squishy velour thing that bacteria just loves consoles, they hang around that. And I’m not suggesting you should, you know your tonsils that’ll make an even bigger mess of your body.
Yeah, but tonsil stones and bacteria like they just hang out there and then you, don’t know if you’ve ever smelt someone with really bad, you know, tonsil stones or whatever. It’s not pretty. So tongue scraping every day. It’s like, it’s like a lot of third world countries have this like Indians tongue scraper. It’s part of the Ayurvedic way of doing things. People in Fiji do, but I don’t know what happened in our society. We just don’t do it. Get yourself a tongue scraper. The copper ones are really good.
You stick your tongue out, you scrape it down, and the stuff that comes off is amazing. So tongue scrapers, water picks, electric toothbrushes are far better than a manual toothbrush simply because they’re in the hands of people that aren’t trained most of the time. If I’m brushing your teeth, it’s going to be amazing. But sorry, guys, I haven’t got time every morning to come and brush everyone’s teeth, let alone my own. So they’re three of the big things. Interproximal brushes little tiny little brushes that look like a toothpick or toothpicks, but the ones with the little bottle brush on the end are brilliant. If they fit, if they don’t fit, you’re going to have to use like a floss, but learn how to use the floss. And then the very next question becomes what mouthwash do I use? And I am look, very, simply hydrogen peroxide in water. And I’m talking home bleach in a little bit of, you know, water is brilliant, but people get a bit funny about that. Don’t over concentrate it cause you end up with like, you’ve got to balance the good and bad bacteria. So can actually do some sodium bicarbonate and salt is amazing.
And I’ll get to that parasites cause that actually works super, super well. So mouthwash, my favorite mouthwash is ozonated water. Now ozonated water, H2O3 is 99.99 % bactericidal, virucidal, fungicidal. You can’t buy it at a chemist anywhere because it only has a 20 to 40 minute lifespan once you generate it. So I have a little flask at home where I press a button. The flasks aren’t cheap, but you can use them to clean your fruit and your chopping board and they’ve just been approved to use in childcare centres to you know instead of those horrible wipes we I think every household should have one so you’ve got your own oscillator.
A little flask, I should have brought it over here. It’s a silver cylinder flask. It’s tiny. It’s got a little pyrolytic plate in the bottom. You pop water into it from the tap. You press the button. Three minutes later, you’ve got three parts per million fluoride. Fluoride, not fluoride. Let’s get that out of the conversation. You’ve got three parts per million ozonated water, H2O3. And it…creates tiny little bubbles, you smell it and it smells like a fresh rain, you rinse for it for less than a minute and it’s just amazing how it can clean out and freshen the mouth and then it reverts simply back to water. So fungicidal, varicidal, bactericidal.
Dr Ron Ehrlich (1:10:28)
Sue, what do you think of oil pulling? Coconut oil?
Sue Rusalen (1:10:31)
Look, coconut oil has, and this is not a study, this is more anecdotal for me. I do a lot of retreats in Bali and I love looking after myself and I’m not great, but I still love a wine and you know, whatever. But I think coconut pulling has some anti-inflammatory agents in it and anti-disinfectant agents in it, definitely. But good coconut pulling can take 10 to 20 minutes.
If you’ve got 10 to 20 minutes to do, my God, makes a lot of commitment. And if you’ve got time to do that, there’s just much easier ways to do it. There’s much, much easier ways to do it. so I wouldn’t say no to people, but swishing with ozinated water for a minute versus coconut pulling. If you can just poke in between your teeth with the interproximal brushes, scrape your tongue.
Dr Ron Ehrlich (1:11:28)
It’s quite a commitment. It’s quite a commitment.
Sue Rusalen (1:11:35))
Because it’s not just your teeth that need cleaning. It’s that little gum gutter that needs cleaning. It’s all those little spaces. It’s your tongue. It’s your, it’s everything because the biofilm will stick to everything. And all you’re doing is disrupting it and you’re breaking down the structure back to the early colonizers. And then you’re back to start. You’re going to miss stuff. And that’s what the dentist is for. I did touch on salt and bicarb soda. So when you’re dealing with a parasite,
Parasites do a lot of damage in people’s mouths and we never check from and hardly anyone was told about this at university.
Dr Ron Ehrlich (1:12:10)
That’s true.
Sue Rusalen (1:12:11)
They are nasty and they’re prevalent. And under the microscope, we’re finding maybe one in three people have a parasite living in their mouth. I don’t know what sort of parasite. cannot be found on this salivary diagnostic. just can’t. But you see them on the slide, coming across the slide. Now they get into your gut. They’re going to. They alter your microbiome. They then affect all of the really good stuff happening in your gut.
And I’ll have patients that have an amoebic infection that are also depressed, that also have gut issues that have, they don’t know why. And we’re doing a lot of, I can’t call it research, but we’re doing a lot of observation of our clients and how their health is improving when we get rid of the amoebic infection. The easiest way to get rid of an amoebic infection is to pulverize salt and bicarbonate of soda one part to seven and you pulverize
Dr Ron Ehrlich (1:13:19)
Salt to two, one part to seven, one part salt to seven parts bicarb.
Sue Rusalen (1:13:19)
I can actually drop, I’ll drop all the instructions here. So two weeks on a little bit of water and hydrogen peroxide, followed by, it’s called Torrens powder. Do you know, I’m a bit reluctant to tell you exactly which one’s which, because on the spot now, I I’m gonna tell you the wrong thing. I’ll drop it to you and you pulverize it in like a blender or a thermomix or something and you make this powder, right? It’s very fine.
That’s okay, that’s okay.
And you pack it into your gums every day. I sound like a nut when I say this because my dental hygiene colleagues would go, we never taught that at university. But the salt causes the amoeba to explode almost straight away. And I don’t want to treat a patient until they’ve done their home disinfection. If I find an amoeba, I send them home for a month to get their bacterial load down because otherwise, and you’ve probably heard of this Ron, you get something called the Herxheimer effect, which is where, which is where the body goes into almost a flu like state for between one and seven days because of the release of toxins that are coming out of their body as we’re killing them. But salt and bicarbicidal absolutely kill amoeba. then once that has settled, cause I don’t want to get in there with an instrument and start squirting it around and having aerosols and spray around the room.
because the patient’s going to get sick and we’re going to get sick. When I actually looked at my own microbiome and I’d been treating patients for 35 years and my gums were as healthy as I thought, my oral microbiome was horrific. still have. Yeah, it was. And I was actually screaming going, my God, what’s wrong? Am I dying? I couldn’t believe the spirochetes that I could see. I thought, how is it that I’ve lived a lifetime in this profession and my mouth looks like that?
Dr Ron Ehrlich (1:15:19)
been very confronting for you.
Sue Rusalen (1:15:21)
And I had no gum disease, but I turned it around in less than two weeks. And it’s been healthy ever since. And then I found the Fusobactyum nucleatum. So I knocked that out with a bit of antibiotic. I could have gone the naturopathic way, but I was in a world of pain with my sister at that point. And I just went, I’ll just deal with her and I’ll deal with me later. But you do see this living in clusters. So the salt, the…
The mouthwash, the bi-carb, all of those things are so, useful. And we’re having such great, there’s a guy called Mark Bonner. He’s a dentist. He’s a French Canadian dentist who created something called the Bonner technique. And we’re incorporating that into all of our education these days. There’s multiple, what you call it? Scientific articles that he’s co-authored that show this. He’s a microscope user too.
So I don’t just send people off to the lab straight away and go and get a lab test because I wanna know if there’s single-cell amoebas or trichomonas there because they need, they absolutely need the salt therapy. You can get a product called Perio Mix, which you can buy online from Eric Davies, Davies Dental, and that is essentially Torrance powder. So.
Dr Ron Ehrlich (1:16:48)
Yes, I do know Eric and I’ve known him for many years. I’m not surprised to see him with something like that. But that’s really useful. Sue, Sue, you’ve given us so much to think about. And this is from somebody this is from somebody who’s been in the oral health, dental stress space for all of my professional career. And I love what you’re doing. I love your message. I love the fact that you can quantify it and include a patient in that journey.
Look, we will have links to your site and what you’re doing. And I congratulate you on it. I love your passion. I think that passion is important in taking things like this forward. So listen, thank you so much for joining us today and sharing your knowledge and wisdom and such thought provoking ideas. And you’ve given us so many things for patients, people, listeners to take.
This oral health thing a little more seriously than perhaps they have in the past. So thank you so much for joining us.
Sue Rusalen (1:17:52)
I am really glad that Dr. Jalal put my name forward to speak to about this. We’re getting some amazing results and really try and look everyone for a dentist that’s got a microscope. There’s only 60 in Australia and you know what we’re finding and the turnaround we’re having is amazing. The health that we’re achieving, the conversations we’re having. And I’ve just bought a dental practice in New South Wales and I’m building it as our flagship store practice. It’s in Nara of all places. So you’ll find me down there at Amazing Dental. I fly in and out every month because I live in South Australia, but I’m on an absolute mission to make this as accessible to the public as possible. So thank you.
Dr Ron Ehrlich (1:18:42)
Well kind of head spinning really even for me as a dentist who has been in practice, holistic dental practice for over 40 years. Having a microscope in the dental practice is really important. I know many years ago, over 20 years ago, we decided that we would take as a part of a comprehensive oral exam. And if you’re wondering what a comprehensive oral exam is, I would encourage you to do my Mastering Oral Health course, which if you’re an unstressed member, you get free. But looking at module one and understanding what a comprehensive oral exam is, is really important.
But this adds another aspect to that comprehensive oral exam. And now when we did comprehensive oral exams in our practice 20 years ago, we took high definition photos because when you lie back and open your mouth and your dentist or hygienist explain something to you, it’s very hard to visualize. But when you see it, a high definition photo of what is actually going on, you become part of the journey of discovery and diagnosis. You become an active member, well, an active part of the diagnosis and treatment, which I know you are because you’re there, but when you can see it, you can understand it and you know what is going on. Well, the oral microbiome, just as the gut microbiome,
You can’t really take photos of the gut microbiome quite as easily as you can in the mouth. But what Sue’s talking about is taking a very small sample, putting it on a little microscope slide, looking at it under a microscope and projecting that image onto a TV screen and recording, say, one, 30 seconds or one minute of your oral microbiome in action. And then off you go and you clean your teeth or your teeth are cleaned.
And you come back a week later and you see the difference. And when you realize through the reports that are available in this approach to the links between, as Sue pointed out, with her own sister and the tragic case of her dying through colorectal cancer, and she was a highly motivated patient, this takes holistic dentistry to another level. And if I was 10 or 15 years younger, and looking at my dental practice, this would be something that I would just incorporate into it as a matter of course, because what defines the difference in a practice? What makes you as a practitioner different from all the other practices around? Well, this is important and it’s a win-win, a win for the patient, a win for the profession and a win for public health. So we’ll have links to Sue’s website and some of the things that she’s talking about. I hope this finds you well.
Until next time, this is Dr Ron Ehrlich, be well. Visit unstresshealth.com today.
This podcast provides general information and discussion about medicine, health and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.
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