Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Chair of the Department of Oral Health for Cook County Health, Dr. Jorelle R. Alexander, about bite-sized oral health tips. Thank you so much for being here today.

Jorelle R. Alexander, DMD: Oh, thank you so much for having me.

Host: I can't wait to hear more about this because, obviously, we all need to have good hygiene when it comes to our teeth. So, tooth decay is the most common health condition in the world. I did not know that for starters. But it's largely preventable, which is the good news. So, why is that?

Jorelle R. Alexander, DMD: So, a number of different reasons. So when we look at tooth decay as a whole, we look at people that don't have access to care. So, they don't have access to a regular dentist on a regular basis. They don't understand the importance of dentistry and oral health and are not going to the dentist. Even those that have insurance and have the ability to go, it's just not on their radar. There's large gaps in insurance. There's a disconnect between medical insurance and dental insurance. And what we know is that largely those that have medical insurance, some of them lack dental insurance. And you can only imagine if they don't have medical insurance, then we know for a fact that they don't have dental insurance. There's a disconnect from oral health from medicine. And in addition to that, just the education surrounding what we do and the importance of oral health and how it affects the rest of your body.

Host: Is oral health really treated as a public health priority, or does it sometimes feel like a luxury? Like you were saying, not everybody has access.

Jorelle R. Alexander, DMD: Absolutely, Maggie. So, one of the things is that when we look at oral health as a whole, I can honestly say that it is not always a public health priority. There are different things that have happened in my profession, and we get highlighted at that moment, at that time. And there's synergy around what it is that we do to try to push the envelope to make oral health better for all, but then that quickly dies down. And so, most people, because of their lack of education surrounding oral health, really only truly view oral health as a luxury. And so, they'll come to the dentist, "I want to have whitened teeth," but they may have never stepped foot in the door. But that's their priority, is the cosmetic piece of things.

Host: Wow. So, we often think of oral health as just about teeth and gums, but how does it actually affect conditions like diabetes or heart disease? And how is oral health connected to the rest of the body?

Jorelle R. Alexander, DMD: Well, I'll just put it simple for you, Maggie. The mouth is connected to the rest of the body. So when we look at the mouth and the head and neck, it's all connected. It's not separate. Yes, it's a separate area, a separate organ system, but it's all connected. Our mouth has nerves, it has lymphatics, it has blood vessels that run throughout our entire body. And so, we're not separated. So, those pathogens that grow in the mouth, that contribute to diseases like dental abscesses or periodontal disease, those same pathogens travel in the bloodstream to cause havoc in other places.

Host: What are some common oral health problems that people might overlook and how can they end up impacting overall health like you were talking about?

Jorelle R. Alexander, DMD: I'll give you a couple of different examples. One is dental caries, which is a cavity. And so, oftentimes, those are overlooked, particularly with children and sometimes adults. With children, parents are thought, "Oh, you know, these are baby teeth. We don't need to worry about them. They're going to fall out anyway." But those are infectious processes that are in the teeth and they can travel to other systems in the body. And so, we know that there are children that have been affected negatively by having dental caries that have then turned into a dental abscess, and that dental abscess has the spread to other points in their body.

And unfortunately, some have even lost their lives due to dental abscesses traveling to other places. We know that the pathogens that are connected to periodontal disease have an impact on one's ability to control their blood sugar, as we talked about with the diabetes. And we also know that those same pathogens affect the blood vessels surrounding the heart.

Host: So, how much of our oral health comes down to daily habits versus genetics?

Jorelle R. Alexander, DMD: A lot. So when we talk about prevention, we hold the key. And so, prevention at home, brushing three times a day, at a bare minimum of twice, making sure that we are being seen by a dentist on a regular basis. Those are all huge measures that make a large difference in the end that help us to be able to prevent dental disease that would eventually cause us problems.

Host: What does a simple, realistic, daily oral care routine look like for a child and for an adult?

Jorelle R. Alexander, DMD: Yeah. So for children, I always tell parents that they need to start early, even before there are teeth in the mouth. And so, parents should be wiping out those baby's mouth with a wet cloth after every meal, after the milk, the bottle, to clean those tissues from those sugars that are just sitting there. And the same applies to when those baby teeth show up as well. And at the first chance that we get to get a toothbrush in there, we should do that. We should start forming those positive oral habits early so that the children will continue that because they're used to that and they know that.

And for adults, like I said, three times a day is what we encourage everyone to do, adults and children. But morning and night will suffice, because we all are kind of busy and we may not get that midday one in. But if we can get it in, that's what we should be doing.

Host: Yeah. So, what about flossing?

Jorelle R. Alexander, DMD: When we talk about flossing, flossing actually helps to remove those pathogens from in between the teeth and from the gingival tissues there. And that's what we want to do. We want to remove those pathogens because they contribute to gum disease, periodontal disease that has systemic effects. So if we are incorporating floss in our daily regimen with brushing, we're helping to remove those pathogens out of the oral cavity, and we're protecting not only the teeth, but also the gums.

Host: Is it better to floss in the morning or night?

Jorelle R. Alexander, DMD: It doesn't really matter. We just need to make sure that we are adding the flossing technique in with the brushing technique, and that we're doing it simultaneously. One is not greater than the other. They kind of go hand in hand. So, we want to make sure that we're using both techniques to the best of our ability to make sure that we are encouraging and promoting good oral health.

Host: So, how does diet affect our teeth? And are there a few big culprits people should watch out for?

Jorelle R. Alexander, DMD: Of course there are. We want to make sure that we're watching out for those sugars. Sugars are not our friends. So, most common people think of is candy. The first thing they tell you is, "Oh, I don't even eat candy. I don't know why I have these cavities." And so then, you start asking other questions about what are some other indulgences? Are we drinking juices that are laden with sugar? Do we have a high carbohydrate diet? Carbohydrates turn to sugar. So, are we eating a lot of sticky foods and we're not brushing on a regular basis to remove that? Are we drinking sodas that have not only the sugar, but they also have the acid in it that helps to the breakdown of the enamel?

So, there are lots of culprit as it relates to the diet piece. And so, we want to make sure that we are engaging in a well-balanced nutritional meal. It doesn't mean that we can't engage in some of those things that we like the most on a limited basis. Like for a birthday party, we're not going to tell a kid that they can't have a birthday cake. But we are going to make sure that we limit that and we are watching that so that is not something that is consumed on a regular basis and in large quantities.

Host: Yeah, Doctor, my husband always says, "Sugar is the devil. Sugar is the devil." Talk about putting a damper on enjoying a dessert. But it's true. He is right. And, you know, sodas are my bad thing. But what causes bad breath?

Jorelle R. Alexander, DMD: There are multiple causes for bad breath, and they don't always originate in the oral cavity. So, I'll start in the oral cavity and then I'll go elsewhere. Poor oral hygiene is one of the biggest culprits of bad breath. You need to make sure, again, brushing and flossing that helps to remove those pathogens that are releasing those gases that help to produce that malodor in the mouth. We want to make sure that we're brushing the tongue. We can have infections that are attacking our oral cavity and our oropharynx. So sometimes, the flu or strep throat, those can produce a malodor in the mouth as well.

And then, those people that also have some GI disturbances. And so, when we look at the GI disturbances, those can also contribute to malodor that doesn't necessarily originate in the mouth, but it's coming through the mouth. And so, sometimes people can just think that it's something going on with their teeth and it really isn't.

Host: And should we be brushing our tongues?

Jorelle R. Alexander, DMD: Yes, absolutely. You want to remove that plaque and that bacteria off of the tongue on a regular basis.

Host: If listeners could start just two to three habits tomorrow to protect their oral health, what would they be?

Jorelle R. Alexander, DMD: Okay, I'll give you the top two. One, brushing on a regular basis and, two, at least seeing a dentist. I'll take at least once a year, if not more.

Host: Is twice a year to get your teeth clean preferable?

Jorelle R. Alexander, DMD: Twice a year absolutely is preferable. I'll take once.

Host: I hear you. Anything else in closing you'd like to add?

Jorelle R. Alexander, DMD: No, I just want to encourage people to really look at their oral health, to seek care when they need it, and also to consider making oral health a priority for their overall health.

Host: Absolutely. Well, thank you so much for sharing your expertise on something that affects all of us, our dental hygiene.

Jorelle R. Alexander, DMD: Thank you so much for having me today, Maggie.

Host: Absolutely. Again, that's Dr. Alexander. To learn more, please visit cookcountyhealth.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.