Dr. Mark Burhenne on How the Oral Microbiome Affects Overall Health

In this interview with Dr. Mark Burhenne, we talk about the oral microbiome, the dangers of fluoride, and why diet matters more than brushing. Dr. Burhenne also shares toothpaste recommendations and his approach to mouth breathing.

Dr. Mark Burhenne is a functional dentist, best selling author, and TedX speaker. At the core of his years of learning, practicing functional dentistry, and teaching is that the state of our oral microbiome directly affects our overall health. 

Our Interview with Dr. Mark Burhenne

Known by his patients (and much of the internet) as Dr. B, Mark is also extremely caring, kind, and refreshingly optimistic about how our everyday actions can reclaim our health.

The topic on everyone’s minds lately is immune health. What is the relationship between the mouth and the immune system?

The immune system is very active in the mouth. It turns out that one of the great risk factors in COVID-19 infection rate (and even fatality) is oral health. The mouth has its own biome, just like the gut has its own biome.

The mouth has a variety of micro-environments that host different bacterial populations: the tongue, the hard palate, the teeth, the area around the tooth surfaces, above the gums, and below the gums.

There’s a lot of permeability in the mouth. Oral pathogens are involved in almost every chronic disease. The mouth is the only place in the body that a biofilm exists by design. The oral microbiome is a unique system that is integral to your health, yet it has been largely ignored by the medical community for years.

How we breathe (nasal breathing as opposed to mouth breathing) has an effect on the immune system. What happens in the mouth – happens in the body.

Which toothpaste and products are necessary for a healthy oral microbiome? Many of our readers live low-waste and want to know what’s essential so they’re not creating waste.

I applaud them, and I try and do the same. There’s a lot of waste in the oral health category. Think about all the floss, toothbrushes, and tubes of toothpaste in our landfills. It’s part of the single use plastic floating in the Pacific Ocean, and it doesn’t break down.

The good news is that a lot of the smaller companies are providing better solutions. I use a recycled toothbrush handle and replace the head because I really like the toothbrush. There are also wooden-handled toothbrushes so you can avoid plastic. You can also find biodegradable floss, made from silk.

Some toothpaste tablets are available in recyclable glass jars. Bite Toothpaste Bits contain hydroxyapatite, which is a safe alternative to fluoride, and it doesn’t contain emulsifiers. You can also find toothpaste tablets at most refill stores.

The toothpaste I generally recommend is by Boka.

Editor’s note: Since the time of this interview, Dr. Burhenne and holistic pediatric dentist Dr. Staci Whitman have created their own toothpaste. FYGG, it stands for Feed Your Good Guys, is a hydroxyapatite-based toothpaste that is free from fluoride, emulsifiers, surfactants, essential oils and every other harsh, unnecessary ingredient.

They created this toothpaste with the goal of using natural, supportive ingredients that nourish the oral microbiome. You can find Dr. Burhenne’s toothpaste here.

However, toothpaste is only 10% of the equation. If you had a perfect diet and weren’t mouth-breathing, you could get away without using toothpaste.

And forget mouthwash. You don’t need it, so that saves one product and one container from the landfill.

Beyond toothpaste, what is the rest of the equation?

Most modern diseases, which were nearly unknown to our paleolithic ancestors, are the result of a “mismatch” between the environments we evolved in for the last two-million years (Homo habilis) and the new environments we have created for ourselves and live in now.

This is the premise Harvard evolutionary biologist Dan Lieberman puts forth in his book, The Story of the Human Body: Evolution, Health, And Disease. In other words, our bodies are matched to the environment we’ve had for most of our evolutionary history — not to the environment which we just recently created for ourselves. Natural selection has not been able to keep up with the rate of human innovations like farming, sugar, and processed foods.

The recent changes in our lifestyle create a “mismatch” for the mouth, which evolved under vastly different environments than what our mouths are exposed to these days. Our mouths evolved to be chewing tough meats and fibrous vegetables.

Sugar-laden fruit was a rare and special treat for our paleolithic ancestors. Now, our diets are filled with heavily processed foods that take hardly any energy to chew — smoothies, coffees, and sodas high in sugar, white bread, and crackers to name just a few.

You said before to forget mouthwash. Why?

There are a lot of chemicals (alcohol, detergents, pesticides) in mouthwash. In dental school I was told that the mouth is a dirty place and you have to disinfect it. But it’s actually a place that needs to be nourished.

There are good and bad bacteria in your mouth, and as long as the population ratio is commensal, you’re fine. Even natural mouthwashes with essential oils are bactericidal. One health influencer burned his mouth on a homeopathic mouthwash and lost his voice. Another study found that if you use too much mouthwash, it actually elevates your blood pressure.

It kills off a bacterium that produces nitric oxide. Again, this super organism – the combination of human bacteria and other nonhuman bacteria and viruses and E cells, fungi – is present in your mouth for a reason just like it is in the gut. Using mouthwash every day is like using an antibiotic on your gut every day.

What is your professional opinion on the safety of fluoride?

Fluoride is a byproduct of the phosphate fertilizer industry. They take this product which they would have to pay to get rid of because it is a toxin when it comes out of the smokestack, and filter it. Then they truck it to a municipal water supply and sell it, and then it goes into the water.

It’s been linked to health issues and lower IQ. When we raised our three daughters, my wife and I went to distilled water right away. They didn’t get fluoride supplements, and they don’t have any cavities.

Your at home care – brushing with the proper toothpaste and flossing – should be enough. The goal is not really a removal of biofilm, but a removal of stuff that sticks to the biofilm that can produce an immune response like inflammation of the gums.

Fluoride is a broad reaching kind of bandaid that has lots of implications for the health of our society.

We learned about mouth breathing from your Instagram. Tell our readers more.

When you breathe with your mouth open, you are a different person because your blood pH is different. Your heart rate is higher. Your sympathetic tone is greater. Your respiratory rate is higher.

Using mouth tape forces you to breathe out of your nose (instead of your mouth). This is a simple way to reap the benefits of better sleep and improved oral health.

The big factor from a dental perspective is if you are mouth breathing, your oral posture is altered. It’s in a state of dysfunction because you can’t breathe through your nose. And the tongue is in a different position, causing the lower face to develop in a different way.

This lower face develops from birth to age six. If you are mouth breathing, you’re going to have a narrow face. If you have a narrow face, that means your airway has been made smaller.

Essentially, there are three boxes in the lower face – the mouth box, the nose box, and the airway box. If the mouth box grows to its proper width, the airway and nose boxes also form properly, meaning we can breathe better. But if the mouth stays narrow with a vaulted arch, the tongue sits low in the mouth or back up against the airway. These are things we see in mouth breathers that determine breathing issues later in life.

How can you help your child stop mouth breathing?

Let’s say your child is a mouth breather, and what do you do? I have one and two-year-olds mouth taping. There’s a product called Myotape that was patented by Patrick McKeown, a breathing expert and author of The Oxygen Advantage. It’s a tape that doesn’t actually seal up over the lips.

It’s more like a frame. It’s essentially what Native American women would do with their kids when they came off the breast. If the baby’s mouth was still open after breastfeeding, they would pinch the lips shut.

You don’t want your child sleeping with their mouth open all night long, so this tape pinches the lips closed. If they want to open, they can. There’s nothing blocking the airway. That means the nose will come online eventually.

Now, if there’s severe anatomical issues and they can’t breathe through their nose, it’s something beyond allergies and lack of using the nose over time, then you’d need to see a pediatric ear, nose, and throat specialist.

Is it possible to heal or remineralize a cavity?

Yes. I think a lot of people are shocked by that, but you probably will remineralize a small cavity in your mouth at some point today. Now, if you have a dry mouth and you’re eating a lot of carbs, then the process of demineralizing will have too much emphasis where the remineralization can’t catch up. It’s happening to our bones as we speak. The more exercise you do, your bones get stronger. It’s the same thing.

But yes, teeth can remineralize. You have to give your teeth a chance to remineralize, and intermittent fasting is great for that. Instead of snacking constantly where your teeth are always demineralizing, try eating two meals a day that are six hours apart, and the rest of the time you’re remineralizing your teeth.

If you’re developing cavities, I recommend intermittent fasting, and of course, modify your diet and eat whole foods and grass-fed foods. Make sure you’re supplementing with K2, Vitamin A, D3, and getting enough sunshine

Do you recommend oil pulling?

Oil pulling can reduce pathogenic bacteria, like the ones that cause cavities and gum disease, in the mouth. Rebalancing the oral microbiome is one of the key benefits of oil pulling. Scientific studies show it also reduces gum inflammation, among other benefits.

Once when I was congested (which doesn’t happen as often since I started mouth taping) and my mouth was dry because I couldn’t tape, I would oil pull for three days for about three minutes maybe once or twice a day. That was enough to thin that biofilm without scrubbing it away and using caustic mouthwashes and preserving the oral microbiome because it’s not that strong of an emulsifier and it doesn’t have chemicals in it.

Oil pulling is simple. Floss and brush your teeth, then place a tablespoon of oil (coconut is the most popular) in your mouth. Swish the oil around for about three minutes, and then spit it out in the trash can (not down a drain because it can clog when it hardens), then rinse your mouth with water. If your oral health is good, oil pulling once or twice a week is enough to get all the benefits.

You can find a full list of Dr. Mark Burhenne’s toothpaste and other product recommendations in his functional dentistry online store.

More About the Oral Microbiome and Dental Health

Holistic Pediatric Dentist Q and A with Dr. Staci Whitman
Mouth Breathing vs. Nose Breathing
How to Boost Your Child’s Microbiome
Fluoride in Drinking Water and Your Child’s IQ
Sippy Cups and Kids’ Facial, Dental, and Jaw Growth
How to Curb Thumb Sucking

I interviewed Dr. Burhenne in September 2020 and updated his recommendations in January 2024.