Welcome to Beyond Topical, a series of interviews with experts in a variety of fields that extends the discussion of skincare to explore some of the multitude of other factors that affect skin health. Because while supporting skin with well-formulated and strategic products such as the ones we make at Marie Veronique is imperative, there’s more to the equation.
Intro from Marie Veronique Nadeau:
One area that cries out for further scientific investigation is the role of the oral microbiome in determining overall health. For those of us involved in skincare the implications of the role of the skin-oral microbiome connection are fascinating.
In this interview with Kristina Holey, Dr. Gerry Curatola, a biologic restorative dentist, suggests that oral microbiome balance is a major determinant of health that is not just confined to the mouth, but is intimately connected to the health of other microbiomes such as the skin. Microbiome balance leads to healthy teeth and gums, which contributes to healthy and beautiful skin and a well-functioning gut, which in turn leads to a healthy immune system, which in turn leads to a healthy individual. From this point of view processes as well as microbiomes are all interconnected in the great web of life.
Another way to look at it is that all of us biological creatures are merely walking (flying, crawling, slithering, etc.) microbe containers. Keeping microbes happy keeps us macrobes healthy. Hence comes Dr. Curatola’s wise advice to us and our biological brethren: “Make peace with your microbes.”
From a skin care point of view I want to paraphrase this a bit, both because the use of crappy products that utterly destroy skin microbiome balance is rampant and because I am a hippie from the classic age of Hippiedom, when we were all SO cool, and so I say, “Make love, not war, on your microbes.”
KH: We did an interesting study a couple years ago to investigate relationships we’ve observed between the bacteria in the mouth (oral) and the bacteria around the mouth (perioral). We swabbed a lot of symptomatic clients and discovered that strains of bacteria that should only exist in the mouth were all over the skin!
GC: Exactly. You know, mask wearing has exploded outbreaks around the mouth of acne and dermatitis, and so many different problems from the virulent bacteria that were being created from a high concentration of carbon dioxide in the mouth. I saw people wearing masks with filters. What they didn't understand is that within the oral microbiome, we have 6-10 billion bacteria. And when you concentrate carbon dioxide, it creates a more acidic environment, throwing off the homeostasis. And so now you have this imbalance causing the production of pathogens. The same bacteria that cause tooth decay and gum disease are benign and beneficial when the environment is balanced.
So, as you know — and I know I'm preaching to the choir here — in terms of how these amazing ecologies work, it's all about balance.
I always tell my patients, make peace with your microbes. They keep you alive. They make you healthy. They make you look beautiful. But if you piss them off, conversely you will have the production of pathogens that are linked to serious chronic inflammation and systemic disease.
Amen. For years, the skincare industry has targeted the acne causing bacteria, P acnes. If it's out of balance and excess, then it can cause problems, but the skincare industry has just been like, “let's get rid of it entirely.” And that causes a spiral of additional problems leading to unhealthy skin.
Well, I was excited to speak with you because my daughter has been following you, and she's like ‘Marie Veronique, they're all about promoting a healthy balance of the microbiome of the skin.’
I was like, wow, OK! We are moving in the same direction of understanding the root causes of problems that were traditionally mistreated with what I like to call the scorched earth policy of healthcare, right?
Like, oh, it's a bacteria, kill it, kill it. You know, the Louis Pasteur story.
We are big fans of the Louis Pasteur story — terrain!
It's not about the seed and individual bacteria. It's about the soil. It's about the terrain. So you hear terrain being spoken about a lot right now, which helps people understand.
And I often thank the yogurt companies for making bacteria palatable in the mouth. The reality is that we're a bunch of walking bacteria containers, and these bacteria do everything from make neurotransmitters for our brain to determine who we're going to marry, etc.
Everybody laughs when I say that, but I'm like, no, no, no bacteria manufacture pheromones, which determine sexual attraction. Sometimes they make the wrong choice, you know, but indirectly, they may be responsible for who you're attracted to and who you may marry. So everybody laughs, but I try to create an understanding of the fact that these bacteria run us.
They do everything for us in the mouth. They actually remineralize your teeth. They transport ionic minerals from saliva to remineralize the teeth, and they transport molecular oxygen to the gums to keep the gums healthy.
And they also take waste products away. Reactive oxidative stress and waste products in the mouth and the tissues are actually removed by this community of bacteria we call the oral microbiome.
And the interesting thing is the oral microbiome is connected to the skin microbiome. Which is connected to the respiratory microbiome and its big cousin called the gut. It's all connected!
Exactly. At Marie Veronique we think about the microbiome for everything we do and we work with hundreds of clients with symptomatic skin. One of the most common conditions is perioral dermatitis. Our approach is not to control skin function, but instead support it so it can do its own job of regulating. We make sure the building blocks of the skin are in place so that the microbiome can eventually find balance on its own, without us getting in its way. Similarly to how you might approach healing the gut.
When COVID came around, the masks happened and the stress happened. As a result there was so much bacterial movement from the mouth that was affecting the skin. Within the first few months we had a boost of new clients with eczema or dermatitis around their eyes, their nose, their mouth.
So we had to immediately shift our focus to, “How can we support the skin so that it's not so vulnerable to this spread when we have to wear masks?” What do you consider the best strategy for setting up the foundation for healthy mucosa and therefore healthy skin?
The first thing that is so important for everyone to understand is that this is a foundation.
I'm a biologic dentist, right? I've done a lot of microbiome research, but I'm rooted in biologic medicine, which originated in Europe: Switzerland, Germany; these places are the root of the principles of biologic medicine. And they are so important in understanding how we function in relationship to this important symbiotic relationship between man and microbe. That goes back many, many, many years; woman and microbe, man and microbe.
The foundational principle, as you just said, is that our bodies have this amazing, divine ability to self-regulate and heal. So that's a common root and principle. The microbiome on your skin and in your mouth will move to a place of balance; it wants to be in a place of microbial homeostasis or balance.
What keeps us from getting there is toxicity and even trauma. There are five types of heat of energies and healings. One is biochemical. One is biological. So there are biologic imbalances, and those are imbalances of the microbes themselves.
Of course, with our own human cells, you have biochemical imbalances. So hormone imbalances and things like that will affect our microbiome. And conversely, an imbalanced microbiome will affect biochemical pathways. It is really a two way street.
The third one is energetic. There's energetic balance that's needed for our bodies to be healthy.
And then the fourth is really important. So you know I am a dentist, and when I work with my patients the first thing I want to know is what else is going on. Yes, there's a microbiome imbalance. But disease in the mouth, for example gum disease, does not happen by a bacteria flying in the mouth and, like, setting up shop. It's an imbalance of this indigenous microflora, which we call the microbiome.
And it's really interesting because teeth actually have energetic connections to organ systems as well in the skin. So a disease in a tooth can energetically affect the rest of the body.
For example, the upper molars are connected to the breasts. A friend of mine in Austin, Texas, and other biologic dentists performed a meta analysis of over 450 women who had breast cancer. And they found that almost 90% had a root canal on one molar on one side or the other. And what they were trying to illustrate is the fact that root canal is a major source of endotoxin production and inflammation, and that inflammation can energetically affect the immune system. And that the immune system is connected energetically through meridians. We know through Chinese medicine and acupuncture, there are thousands and thousands of meridians throughout the body that connect from the mouth to the rest of the body. So we have that energetic component.
Finally the fourth one is psycho-emotional. You alluded to it by discussing people under stress; and what happens with stress in the mouth is really amazing. Under high stress you end up with a microbiome imbalance and then the saliva dries up. So that then puts you at risk of tooth decay and gum disease. So the entire microbiome shifts with stress and we see all of this havoc follow. For the skin of course there are so many impacts from stress that we see with oil production variations, etc. and all from psycho-emotional stress.
It’s very compelling hearing about these categories!
It's amazing. Stress and psycho-emotional factors should all be major considerations in regards to our wellness. When somebody's under a lot of stress they're going to break out on their face and also essentially in their mouth. There's a whole host of other things that are going on as well with that same imbalance of that essential ecology, which we call the microbiome.
So the fifth one, which is really interesting as well, is spiritual. We really never talk about the spiritual side of things in medicine; it’s essentially the opposite experience. But the reality is that we are all mind-body-spirit.
Or as I like to say mouth, body, spirit or mind, mouth, mind, body, spirit. The connections between the skin and the mouth and the gut and the respiratory, and genitourinary is one big microbiome.
Harmful oral care products, harmful personal hygiene products, harmful feminine hygiene products, harmful hair products, you know, all of which disturb and denature and destroy these essential communities we need to survive. So I will say it again: Make peace with your microbes.
In regards to the skin and oral hygiene products, everything has been owned by soap companies, right?
Oh, I'm so glad you said that. Yes, absolutely. Toothpaste was invented by soap makers a hundred years ago. In the 1970s, we decided to put bug killers in toothpaste because we started identifying specific strains that cause tooth decay and gum disease. We essentially took the pesticide approach, which was, kill it, kill it, kill it. But really that just made the problem even worse.
So in my practice I eventually said, it's time for doctors to get out of the pesticide business. What I'm really promoting now is organic gardening for your mouth. We do organic gardening in the environment around us. We need to do the work.
With the skin, it's easy for us to talk about inflammation because you can draw direct lines from it to signs of aging. But what I would love to hear you talk about is the immune system. We are curious about your experience with it and the connection to oral hygiene, as that is a primary source of infection in the body. In cases of autoimmune disease, how much of those are rooted in the mouth?
The oral microbiome is one of the most powerful microbial environments in the entire body, including the skin, because there are parts of the skin behind your ear, you know, where it's like the Sahara desert. The microbiome is like the Sahara desert behind your ear and conversely in your mouth, it's the Amazon! It is rich and robust and hosts 6-10 billion bacteria.
The most fascinating part of the research that I did was discovering that the same bacteria that cause tooth decay and gum disease are actually benign and beneficial when that rich robust environment is in balance! The second thing is that the microbial environment is very closely correlated to the regulation of your immune system.
The body's number one source of chronic low grade inflammation is gum disease, and gum disease remains an epidemic. By some estimates, 80 to 85% of the American adult population has some level of inflammation of their gums in their mouth.
Gum disease is linked to a 10 times greater chance of a heart attack or stroke. Kidney problems, pregnancy complications like preeclampsia and premature, lower birth weight babies, pancreatic cancer, breast cancer, esophageal cancer, stomach cancer. The number one bacteria found in colorectal tumors and colorectal cancer was fusobacteria, a common bacteria in the mouth.
You were speaking before about the fact that the swabs that you took showed periodontal pathogens and bacteria from the mouth on the skin wreaking havoc. The most common bacteria in the mouth is benign in a balanced environment. Not a problem. It’s when it's out of balance that it really causes problems.
What everyone should understand is that the microbiome is a community of organisms that doesn't behave differently than we do on a macro level as human beings. They actually behave well when they are treated well, and their environment is healthy. We call those “probiotics” and only say good bacteria. For example, take a community in Brooklyn with these beautiful brownstones and they are all clean and they're right next to each other and they're all beautiful. That's a healthy microbiome.
Then take Brooklyn back in the days where it had bad welfare policies and nobody took care of anything. And you had gangs out there, cars on fire and all, all the burnt-out brownstones boarded up, etc. So you go from a good community to a disaster when the environmental policies change. And when you don't have a healthy environment, you have gangs, and we call those pathogens. Pathogens are resident bacteria that are really upset.
So we went from the germ theory that all bacteria were bad to the bad guy theory, which was the probiotic theory that there are good bugs and bad bugs. And that also has been disproven because the same bacteria that are healthy and benign and beneficial go through a process of Pleomorphism, and they become really bad. They can become really nasty.
And one of those is what I was referencing, called fusobacteria. If it gets on your skin and it is out of balance as a pathogen, it has been shown to cross the blood brain barrier and carry other harmful bacteria.
I've always taken my oral hygiene very seriously, never have had a cavity. However, while being pregnant, I noticed a lot of inflammation in my gums. I’ve worked with a lot of pregnant women who have experienced the same thing. I know in puberty, you have a lot of inflammation in your gums also. I know the pH of the mucosa can change during these hormonal shifts, right? So my question is, what do we do about these kinds of inevitable stages of hormonal fluctuation? Because these phases that cause more inflammation in the mouth are potentially a problem, right?
That is a fantastic, fantastic question because every woman of childbearing years should understand that during pregnancy, those hormonal changes you referenced cause a condition known as pregnancy gingivitis. And inflammation of the gums during pregnancy is natural and normal.
However, inflammation should be addressed and should be controlled. This is one of the reasons why I'm trying to bring the wall down between medicine and dentistry, because this part of the mouth is not divorced from the rest of your body. Any OBGYN should be encouraging their patients to get a dental cleaning once a trimester.
So once a trimester during your pregnancy you get a cleaning — what does the cleaning do? The cleaning helps to remove deposits that will naturally form because of the inflammation that's incurring, which is a natural part of this hormonal change that women go through during pregnancy. So controlling that inflammation becomes important. One of the ways you can do that is by getting a dental prophylaxis at a simple dental cleaning.
The second thing is what are you using? I developed a product called Revitin and it’s loaded with prebiotics and probiotics, Vitamin K, Vitamin C, Vitamin D, D3, C and Coenzyme Q10, which feeds the gums to help to reduce the inflammation.
There used to be an old wives tale that woman had all these problems with their teeth and gums after they gave birth. And they said, oh, the baby robbed the mother's calcium. And that's why the mother's teeth got weak and the gums got inflamed. That's a huge wives tale. The reality is it has to do with the control of inflammation, because if you don't control the natural inflammation that occurs during pregnancy, you will have many problems, including the onset of periodontal disease.
Gingivitis is inflammation of the gums. Periodontitis is really the irreversible stage where you start to destroy the periodontal ligament that is attached to the tooth and the bone. When the periodontal ligaments are inflamed and infected, you lose bone around teeth and your teeth can become loose, or you could even lose your teeth.
Gum disease can progress during pregnancy and postpartum as well, if you don't control the inflammation. Of course inflammation is a natural thing that occurs. It's just, you need to control it in a healthy, productive way so it doesn't become more advanced.
So then could you relate this to other periods of your life, like the importance of oral support during puberty or during periods of high stress?
Absolutely. And of course during the menstrual cycle — that's a perfect example. You become more retentive; there's more inflammation just prior to a woman's period than after. Believe it or not, men go through this during puberty too. So there's hormone change and you see these changes in the skin and the mouth.
There are different stages in the mouth and those different stages affect us differently. As you were talking about, for women, I would say childbearing years are most critical.
And then menopausal years, whether it's female menopause or male menopause, they both have changes in the characteristic of the dynamics of teeth and saliva and periodontal tissue.
This is fascinating because dermatology has tried to reduce symptomatic skin to these very simple definitions such as hormonal acne, as many women break out before their period. But really it's not just the estrogen fluctuation and the progesterone, but what's happening to the mouth right before and during the menses. Perhaps these breakouts around the mouth might have something to do with the oral microbiome and not just hormonal levels!
Right. I was starting to say that the microbiome in the mouth regulates your immune system. If your mouth is healthy, you are healthy.
The oral microbiome is essential for the healthy regulation of your immune system and your immune system and the health of your immune system also helps to stratify and keep the microbiome in balance.
So you have this two way street, you know, and it becomes a chicken or the egg discussion because the microbiome and the immune system are very closely connected.
If your immune system is compromised, you are at risk of various viral infections and symptoms. People will have to understand we are fighting deadly viruses and bacteria in and on our bodies every day.
I'm working on this practitioner reference series and I am writing the 10 sources of chronic inflammation and toxicity in the mouth.
Number one, gum disease. Number two, jaw habitation. These are areas of necrotic bone that often go unnoticed. Many of them form when you have your third molars extracted, and they are sources of chronic inflammation. They also can harbor all kinds of pathogens, including parasites, limestone, hierarchies, mold, candida, things like that. Mercury fillings, amalgam, mercury fillings. Those so-called silver fillings you see in people's teeth are actually more than 50% mercury and they're toxic. They off gas throughout time. They're in the mouth and they're a source of a heavy metal toxicity neurotoxicity.
They should really be replaced, right? If you have them, they need to be removed safely. The American Dental Association says you should only touch them if they're leaking and there's decay. But nine out of 10 times, the amalgams have decay under them, you just can't see it on an x-ray.
Another source of inflammation is non-precious PFM crowns. These are metal caps that have porcelain baked on top. They're known to have nickel, cadmium, all kinds of alloys that are not good for you. Another source of metal toxicity in the mouth is titanium, or metal implants. There are a lot of studies showing that they produce endotoxins and are a source of inflammation.
Root canals, highly controversial root canals, produce endotoxins. They also trigger an overactive immune response, and they're not as benign as we once thought. There are more and more studies showing that root canals continue to break down and can be a source of cavity production as well.
And then we have harmful oral care products, which we spoke about. Detergent toothpaste, the overuse of antimicrobials that kill, kill, kill. And even a lot of natural toothpaste uses antimicrobial essential oils. You may have natural toothpaste with tea tree oil, which kills everything, or clove oil or peppermint oil. That's why I make Revitin with a pleasant lemon citrus flavor, because peppermint is very disturbing to the oral microbiome because it's anti-microbial. You really want to promote, nourish, and support a healthy microbiome in the mouth just as you would on the skin.
So basically if anyone has any sort of internal imbalance, health, or skin issues, the second question should be “How is your oral hygiene?”
Yes. We need to promote the skin microbiome's ability to self regulate and heal, and the oral microbiome’s ability to self-regulate and heal. And we do that with intelligent approaches.
Nick Perricone is a great dermatologist and was one of the first to promote the connection between nutrition and the skin. He wrote a book called “The Wrinkle Cure” that became a New York Times bestseller. He also wrote the intro to my book because I was promoting the same thing about the four cornerstones of oral health. First, get the junk out of the trunk, you know, all the detergent, toothpaste and mouthwash, alcohol-based mouthwash, detergent toothpaste with antimicrobials, and even natural toothpaste like charcoal. I use charcoal when I remove heavy metals from the mouth, but you don't use it to brush every day.
Clay, another ingredient in natural toothpastes, binds to toxins. It binds to everything. It strips everything. Oil pulling is a great ayurvedic practice to clean the mouth, but used every day, it can constrict the microbiome and actually make it unhealthy.
What I find in the natural products industry is they take a good idea and bastardize it because they don't really understand the science behind it.
Exactly. Just because it's natural doesn't mean it's good for you or will help your skin.
It’s fun to talk to you because I feel like you're a skin expert by way of being an oral hygiene expert. I wish there was more of a natural flow between practitioners as I'm sure the amazing advice you give to your patients would translate well to supporting the skin.
Well, that's because I understand the microbiome. More doctors need to understand the microbiome because even in oral care, the major consumer product companies are still pushing old science that's been shown to be false that says you’ve got to kill everything. Kill, kill, kill harmful bacteria.
No, if you do that, you're killing all bacteria, OK? And the reality is that we're literally made of microbes. Even our human cells. There are estimates that say our microbial communities, the number of bacteria in and on our bodies, are 10 times greater than the amount of our own cells. And if you go in even deeper, there are a lot of theories about how our mitochondria may have been bacterial in origin.
We are thrilled to get a new perspective from Dr. Curatola on a different region of the body — our bio-systems are, after all, all connected. This interview discusses the complexities involved in keeping our mouths healthy, which are rooted in maintaining balance in the oral microbiome.
While we are not oral microbiome experts we can certainly appreciate the connection between oral and skin microbiomes. The same strategies for caring for a microbiome, be it skin or oral, apply — the crucial lesson we learn is that it is important to create an environment in which microbiota thrive. We can call it building the terrain, because as Louis Pasteur pointed out, “the terrain is everything.”
Two products that will help improve skin health can be found in Balancing HypoTonic and Barrier Restore Serum. Balancing Hypotonic helps to balance the skin microbiome by maintaining the proper pH at which commensal microbes thrive, known as the acid mantle. Barrier Restore Serum addresses skin care at its foundational level, that is, it works to rebuild the terrain. A healthy terrain leads to microbial balance and, inevitably from that point, beautiful skin. It should be a truism driven deep into our collective unconscious that returning the terrain of any microbiome to balance improves the health of any and all of the other microbiomes, as they are all interconnected.
Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.