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The Connections Between Dental Health and Chronic Disease with Lewis Ehrlich

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The Connections Between Dental Health and Chronic Disease with Dr Lewis Ehrlich

Did you know that suboptimal dental health can affect athletic performance, heart health and even cancer risk? This is the knowledge that holistic dentist Dr Lewis Ehrlich wishes everyone would learn. In today's podcast, we delve into the many factors which may have drastic impact on health, as well as some simple, and some complicated solutions, which can correct long-standing dental, sleep and performance issues. Listen as we uncover just a few of the reasons why a healthy bite can have a dramatic impact on your health. 

Covered in this episode

[00:52] Welcoming back Dr Lewis Ehrlich
[01:44] Preventing systemic disease through dental health
[03:14] The dangers of compartmentalisation of health
[06:23] Sleep apnoea signs and symptoms
[10:45] Dental treatments for sleep apnoea
[16:44] Preventing sleep apnoea in kids
[18:35] The importance of eating a “hard” diet
[20:55] Dental health and cancer
[23:56] How to maintain good bacterial diversity in the mouth
[25:23] Oral health and athletic performance
[28:55] Periodontitis and retinal degeneration
[31:38] The importance of brushing and flossing
[34:39] Best sleeping positions to avoid sleep apnoea


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line again today is Dr Lewis Ehrlich, a dentist who is passionate about the many links between oral and general health. His mission, to educate people to take control of their own health and prevent oral health disease and in turn overall health diseases. Lewis is a highly sought-after holistic dentist who graduated from James Cook University, that's JCU, with the academic medal. Before studying dentistry, he completed a bachelor of science at Northeastern University in Boston, U.S.A. Lewis practices along with his father and uncle at Sydney Holistic Dental Centre. Lewis is also a bone marrow donor and this, he says, is his proudest achievement. Welcome back to FX Medicine, Lewis. How are you going?

Lewis: Okay, thanks. Thanks for having me back on.

Andrew: So, let's first start out, dental health preventing systemic disease, one would ostensibly be thinking of things like rheumatic fever, but I think it goes further than this, correct?

Lewis: Yeah. Well, I mean, the health of your mouth can impact on so many things, and what's pretty amazing is the amount of research that just keeps coming out. They did months on months and there's links between gum disease and things like pancreatic cancer, stomach cancer, breast cancer. 

Andrew: Wow.

Lewis: A whole range of new stuff's coming out all the time and, you know, with all these things, it goes back to, you know, the presence of chronic inflammation in the body and we all know that acute inflammation is a beneficial thing, but it's that chronic inflammation that causes a lot of dramas in the body and one of the most common places for that is obviously in the mouth with about, you know, 25% to 50% of Australians have gum disease.

Andrew: So, that's amazing. So, just gum disease is driving this sort of smouldering inflammation, which is having systemic effects on the body, not just from an infective nature but from an inflammatory nature.

Lewis: Correct, yeah. Yeah.

Andrew: Fifty-percent of Australians have got poor gum health, some sort of gum disease. What's happening with the health system? Why aren't people waking up to visiting dentists regularly?

Lewis: I think it's a range of factors. One is that there's kind of this compartmentalisation of our health system, and I know that that has to happen to an extent in the sense that we need specialists to do specialised procedures. But in many ways, I think, in our training, it's perhaps gone a little bit too far and we can lose track of, you know, the bigger picture and how it all connects. So, you know, you've got, obviously, dentists that look after the mouth. You've got cardiologists that look after the heart, etc. 

And I think that in doing that, I think we kind of lose track of, like I said, the bigger picture and then you end up getting poorer health outcomes for patients. So, I think there needs to be a greater awareness of, you know, other people's areas of expertise to see, you know, how else we can help one another. Because, you know, for example, I asked a cardiologist friend of mine the other day and she didn't have any clue whatsoever about some of this new research coming out showing that there's links between gum disease and heart disease. She was kind only aware of the infective endocarditis stuff. 

Andrew: Yeah, yeah.

Lewis: And you just think, wow, like, you know, they've been hammering us about this for years and yet it's not, sort of, you know, penetrating into other areas of health, which is a little bit disappointing, so I think that's one factor.

Andrew: From a dentist professional aspect, how do you dialogue with other health professionals, even in the orthodox arena, let alone the complementary arena?

Lewis: Look, to be honest with you, I think there's massive room for improvement there. I mean, in our practice, because we're, you know, thinking about things a bit more globally, a bit more holistically, we're kind of trying to always research up on the ways that the mouth can affect other areas of the body and quite frankly we don't have time nor the expertise in some of those areas to go through and treat people for say, you know, if I pick up a problem with someone's gut or if I pick up a problem potentially with someone's heart, you know, I'm not going to go through and do that treatment, but I feel like it's my responsibility to recognise that and then communicate with our network of referrers to go through and treat that patient. The problem is is that when it comes to oral health, there's kind of a lack of understanding in the reverse, you know, when they potentially could be doing a little bit more to get patients' oral health into top shape as well. So, I think, you know, the way we practice, we're in constant communication with other health practitioners. 

Like, for example, the other day I saw a patient who...I saw him in the waiting room. He was overweight. He had a huge neck circumference, so already I’m thinking…it's screaming "Sleep apnea" at me. He got a really set back small jaw but huge amount of weight around his neck. And then, he comes in, he's got a history of heart disease in the family. And then, I took a panoramic X-ray. I'm not sure if you...you've probably had one of those done, they’re those ones that get your whole jaw.

Andrew: The OPG?

Lewis: The OPG.

Andrew: Yep.

Lewis: Yeah, correct, yeah. And there's actually a few studies showing that you can pick up carotid calcifications in a certain area on an OPG…

Andrew: Ah.

Lewis: Given the fact that he was, you know, kind of screaming that he had sleep apnea from the way he looked and the way he was answering his sleep questions that we give our patients, throw in the fact that he had a history of heart disease in his family, you know, on his OPG, it actually showed there's carotid calcifications. Now, I picked that up and I've referred him on to an integrative GP who's done some tests and then it's actually come back that he had carotid calcifications and then he's gone through and now seeing a cardiologist. And then, you know, I've also referred him on to a sleep physician because all signs sort of point to sleep apnea. So, I think that from the way we practice at least, that, you know, we're constantly on the lookout for some of these issues and then refer on, but I'm not always so sure that it's reciprocated because people just don't, one, know or, you know, haven't read enough about the impact of the mouth on overall health.

Andrew: What symptoms might somebody have if they have sleep apnea? What should somebody be alert for?

Lewis: If you're snoring a lot, that can be sign of sleep apnea. Waking up really tired after, you know, a good long sleep. Waking up gasping for air, so you kind of doing this, "Agh."

Andrew: Okay.

Lewis: That can be a sign. Waking up really, really wired and energised in the middle of the night is a classic sign of sleep apnea. Falling asleep or needing to have a snooze after lunch without alcohol is another one. You know, falling asleep, watching TV in the middle of the day or even, you know, you hear some people nodding off even at a red light, you know, these are all classic signs. 

Andrew: Whoa.

Lewis: I mean, we should really be sleeping our required hours, you know, sort of your seven, eight, nine hours depending, you know, for adults, and we should be able to go throughout our day without needing to have a snooze. And if you're tired, it can be a sign that you're not breathing well while you're sleeping. A lot of people just think sleep is about putting your head on the pillow and that's it, but it's actually the way you're breathing when you're sleeping, which is, you know, in my opinion, the most important.

Andrew: And, obviously, you know, the best assessment of how you're breathing when you're sleeping is your partner, and if you haven't got a partner, you're in trouble.

Lewis: Well, there's apps now. It's amazing, but, you know, a lot of patients are actually, you know, they're single. They don't have a partner, but there's...I don't even tell them to do this. Like, a lot of them have just intuitively done it. They've actually recorded themselves on their phone and they've come in and said, "Listen to my snoring. This is insane. And listen to me stop breathing here." They're almost, like, diagnosing themselves and then you, you know, give them the whole range of sleep-related questions that we do at our practice and then you're just, like, "Well, okay, this is seriously stacking up."

And the other really fascinating thing is that, if they're got mild or moderate sleep apnea, one of the things that we treat them with is actually a dental appliance that holds the lower jaw forward. The tongue is obviously connected to the lower jaw and what happens is, when you start snoring or when you got sleep apnea, the tongue drops back into the airway and you make an audible noise. And then, basically, the nightguard that we make hold the jaw forward, so it stops it dropping back at night. And we're able to titrate those, so we can bring the jaw further forward over time. And one of the great ways that we do decide whether or not to put a patient forward is to get them to record themselves, because if they're still snoring, they're still choking. They're still doing those sorts of things, then we know that we have to bring them forward. If they're quiet, then, job done.

Andrew: Okay. So, if you're bringing the jaw forward and they're in a supposedly relaxed state, could you be, like, stressing the jaw forward or is it because the jaw is over-relaxing backward? What's happening there? Is it purely their tongue or is it more to do with the weight that they're carrying in their neck is closing off their airway to some degree?

Lewis: Yeah, it's multifactorial. You have these, it's called a class II bite, so your jaw is set back. So, if you imagine the opposite of that is when, you know, those really prominent jaws where you see they've almost got an underbite, so they're in a way less likely to have sleep apnea than most small jaws that are kind of set back. 

Andrew: Yeah.

Lewis: Like, if you look at someone from the side, you know, they'll look like they don't have a very prominent chin, so there's that. But then, there's also, you know, weight issues. So, if you're carrying a lot of weight around the neck, then there's going to be a high chance of sleep apnea. But yeah, it's an interesting point you raise and this is one of the reasons why we have to balance the amount of snoring and symptoms with jaw position because if you actually bring the jaw too far forward too quickly, you can actually get some TMJ issues, that's one. But two, you can also lose contact on your back teeth. 

Andrew: Ah.

Lewis: So, see, we have some patients that have just been moved too far forward, too quickly or, you know, they're just a little bit more susceptible than others. And they go, "I can't chew on my back teeth," and you have to build their bite up or you have to, you know, change appliances and see if that jaw can recapture into that previous position. But the thing that you have to realise there is that that risk is very low, so we always say that there is a small chance. I think it's somewhere between 2% and 5% will get some sort of bite change. But then, you have to think, am I more concerned about a dental problem or am I more concerned about a medical problem that is going to reduce the length of my life? 

Andrew: Yeah.

Lewis: And most people will say, "I'll, you know, well, if it happens, I'll deal with the dental issue that can be fixed anyway and I want to make sure that I'm actually dealing with my medical problem."

Andrew: Indeed. It was a colleague who alerted me to the fact that her very young husband died of sleep apnea. This is something that affects not just that stereotypical person, but it affects many others and we really need to be aware of what's happening while we're asleep. So, I love that tip of recording yourself while you're asleep.

Lewis: Yeah, we sleep for a third of our lives. So, if you're not doing it well over and over and over again year in, year out, then you're just not going to have a strong immune system. It builds resilience. You can't be healthy without good sleep. I mean, you think about what one bad night's sleep does, see how cranky you are, how sluggish you are when you're at work, or what have you. You know, some people aren't breathing, you know, for years and years and years on end. And you're right, it doesn't discriminate. I’ve diagnosed…I’ve suspected sleep apnea, which has been diagnosed in, you know, a 3-year-old.

Andrew: Oh, my God.

Lewis: And then, I've also had...and then I've had another patient who's a fitness instructor, bodybuilder…

Andrew: Wow.

Lewis: …super, super, super-fit guy and I sent him for a sleep study because he was waking up really tired, didn't think he was getting, you know, much bang for his buck when he was sleeping, and he had an AHI index, which is basically apnoeas or hypopnoeas per hour of sleep and they have to go through that 10 seconds or more. 

Andrew: Yep.

Lewis: That’s when you either stop breathing or partially stop breathing. So, an apnoea is when you completely stop breathing. Hypopnoea is when you partially or there's a partial blockage of the airway or decreased oxygenation, etc. And he had a AHI of 57 an hour.

Andrew: Wow.

Lewis: So, potentially, he wasn't even breathing for half his sleep.

Andrew: It's amazing. Like, I had a similar experience where somebody was huge and just by using a BiPAP machine, so that we're talking about positive pressure in and positive pressure out sort of thing, they decreased it down to, I think it was 12 and it was a massive number, I can't remember what it was originally. 

Lewis: Yeah.

Andrew: So, decreasing it to 12 isn't perfect, but, jeepers, it made a difference to their life.

Lewis: Yeah. And then, you know, there's risk of heart disease, diabetes. There's, like, you know, insulin resistance, depression, anxiety, road accidents. It's a massive problem and can affect your systemic health greatly, and your mouth plays a huge role. You know, because if you've got tiny jaws, you're a mouth breather, you've got a small airway, big tongue, a little bit overweight, what have you, these things play a role. So, you know, I see a lot of kids and, you know, one of the key things that they can do is breathe through their nose, tongue at the roof of their mouth, sit up straight all the time. And then, you know, trying to reduce the amount of allergens in the room. You know, dust mite covers, I recommend, and vacuuming beds with...

Andrew: HEPA filters, yeah.

Lewis: HEPA f ilter vacuum, you know, decreasing that, because if they start mouth breathing, their jaws won't develop as broadly as they otherwise should and then they'll get tooth crowding, which means less space for their tongue. And then, if they mouth breath, they're more susceptible to sleep apnea, so that 3-year-old was a chronic mouth breather, had, like, you know, huge bags under his eyes and was just so stuffy. The back of his throat was all inflamed and had, you know, huge tonsils, adenoids, etc. And, you know, these are all things that are really important to parents to be aware of and to have analysed because, you know, at the end of the day, you can do huge amounts to prevent sleep apnea in a child.

Andrew: Notwithstanding, you know, obviously sleep apnoea, but what about hypopnoea and what about things with, you've mentioned it with T&As, tonsils and adenoids just before. What about the obvious scourge of the Western world, you know, the allergies? Like, is it as simple as just sleep or do you have to look at holistic management of this, like, all-encompassing management?

Lewis: Sleep's just one part of the picture. So, I mean, you know, if you're eating, you know, really inflammatory foods to that particular person...and this gets back to, you know, individualising your treatment. 

Andrew: Yeah.

Lewis: One food might be perfectly normal for, you know, one person, completely horrible for somebody else. There's definitely a nutrition component, breathing component, jaw size component. So, you know, kids and adults who are just eating mush all the time, we're not using our jaws. And, you know, everything's soft and convenience food's sticky, sugary, etc., and we don't have to use our jaws anymore. What we should be doing is actually eating really, really hard foods to put tension on the jaw, you know, through use of our muscles, which helps it to grow. 

Andrew: Yep. 

Lewis: And, you know, a lot of people don't realise that they not only have to eat nutrient-dense whole food but also, kids especially, but all people have to eat hard foods. We were designed to put our jaws under stress and that's actually showing up with a rise in the amount of jaw fractures that we're seeing in Australia in children.

Andrew: Oh, that's really interesting, in children?

Lewis: Yeah. So, incidences of jaw fractures, because we're just not eating a hard diet. I mean, it's obviously multifactorial again…

Andrew: Yeah, yeah.

Lewis: …but one of the factors is that we're just not putting our jaws under tension. Like, we were designed to rip and chew and, you know, chew and chew and chew and chew hard foods, but we...everything is, you know, mush and, you know, just soft everything. 

Andrew: Yeah. 

Lewis: Everything that you eat throughout the day is pretty much soft. It's just not meant to be that way and our jaws are shrinking, and it's a health epidemic because it affects our breathing.

Andrew: Something that you mentioned before regarding oral cancers, pancreatic cancer, stomach cancer, this is quite amazing. Just how important is the microbiota of the mouth to affect the gut lower down? And indeed, what about, I think you mentioned breast cancer as well. What's happening there?

Lewis: Yeah. So, I mean, stomach cancers are a really interesting one because what they're showing is that, if you've got an increase in, like, aggressive oral pathogens and a lack of bacterial diversity, they're actually showing in a recent study out of NYU that it's a predictor of precancerous lesions and stomach cancer. So, what that raises is a couple of things, one, the bacteria that live underneath the gums that live in the presence without oxygen, so they're anaerobes, they’re really aggressive. What they're actually doing is obviously tracking down into the stomach, but what I found fascinating about a lack of bacterial diversity is this kind of adversarial approach that we take to bacteria. 

Andrew: Yeah.

Lewis: And, you know, I think we're seeing that in other studies as well elsewhere in the body. I think there was a study that came out the other week about leukaemia being, you know, the risk of leukaemia, I should say, is decreased if a child is exposed to a lot of pathogens in their first year of life to prime the immune system to deal with infections that are now basically shown to trigger a certain type of leukaemia. 

Andrew: Wow.

Lewis: So, it's this idea that we have to obliterate all bacteria. All bacteria is bad. You know, and, like, these sterile homes and, you know, washing our hands all the time. You know, just seeing bacteria as the enemy. What we're now seeing with a lot of cancers is that that is not necessarily a good thing. So, you know, Listerine ads and blowing the mouth up and getting rid of all the bad bacteria and all this other stuff, all this collateral damage. And, you know, the mouth and the stomach's pretty intimately connected, and if you're getting rid of a lot of the good stuff and you don't have that diversity in your mouth, then that's showing to, you know, to leave you more susceptible to cancer in the same way that, you know, leukaemia is starting to be shown to be a result of that as well. So, scary stuff.

Andrew: I think it's amazing when you think that benzalkonium chloride, the active ingredient in a lot of these mouth washes, is the same benzalkonium chloride that is used to, A, clean the screens of our windows and, B, clean our floors.

Lewis: Yeah, it just makes no sense. Yeah, I mean, so how do we maintain good diversity in the mouth, and that's, you know, eating plenty of natural, whole foods and eating a range of vegetables and plenty of fibre and plenty of chewing and all that sort of stuff is really important, and not thinking that you can just eat whatever the hell you want and obliterate your nasty bacteria with all those chemicals, I think that's just the wrong way around.

Andrew: Have you found any foods in particular are better for oral health? You know, we talk about prebiotics and probiotics for our gut, but there are also prebiotics and probiotics that are more suited, I get diversity, I get individuality, but there are those foods that tend to be more suited for our mouth, is that right?

Lewis: Yeah. I mean, I think eating as naturally as possible is obviously important. But we actually need a whole range of different colours, a whole range of different vegetables. They're really important. You know, things to snack on like celery sticks, carrots, nuts, those sorts of things that actually stimulate saliva, are really important for your oral health and keeping some good bacteria in there. Nutrient-dense foods, vitamins A, D, E, and K, foods high in that are really important for diversity but also tooth and jaw strength.

Andrew: You mentioned before to me, athletic performance. This is really interesting to me. Oral health and athletic performance?

Lewis: I talk to people about this all the time because I'm so into my sports. I used to be a professional soccer player, and I'm still into my...I casually surf, but I'm into, like, my sprinting and I've competed in the State titles and things recently and any sort of athletic edge really gets me excited. And then, when you can, you know, combine that to oral health and what's happening in the mouth and, you know, they're my two favourite things, so I'm like a kid in a candy store when I read this. But yeah, essentially, the position of the jaw and the way the teeth meet, we're talking about a bite, can actually affect athletic performance.

So, basically, some research coming out of Italy, but also some with Australian rowers in Australia, have shown that the position of the jaw can actually reduce the time it takes for lactic acid to be produced, so it delays onset of lactic acid, decreases heart rate during work, during performance, during competition. And then, basically, they've also shown that it increases, strengthens muscles but also muscle balance from left side of the body to the right side of the body. So, we tend to be dominant on one side. 

Andrew: Yeah.

Lewis: So, you know, when you're lifting certain weights, you'll have a weak arm. You'll say, "Oh, my left arm is a little bit weaker than my right," or what have you. What they're finding is that with a particular mouthguard that is made, this is what I was kind of getting at, is that a mouthguard is made at a particular position, which decompresses the jaw joint, opens up the airway, decreases cortisol, and then the result of that is that there's a decrease in heart rate during performance, which is always a win. And then, there's also a delayed onset of lactic acid, which, you know, means better performance, better times, better strengths, etc., so it's fascinating stuff.

Andrew: So, it's not just as simple as getting a mouthguard to protect your teeth, like, in a contact sport or something, it can actually be a functional thing that can improve your athletic performance.

Lewis: Yeah, so I've popped a little bit of this information on my social media and a lot people, they've replied to me just saying, "Oh, yeah, I've got a mouthguard at home." 

Andrew: Right.

Lewis: It’s not as simple as that at all. 

Andrew: Right.

Lewis: So, there's a particular, what we call a bite record that we have to take after doing a few tests. It's a little bit, sort of hard to explain over the phone without being visual, but essentially, it's not just a matter of getting your footy mouthguard and popping it in and expecting that you're going to be a better athlete. It's a very exact science on where to put the teeth into contact and, you know, what height to set the night guard at, etc. That's hugely important for people training, so not so much during the actual competition. But yeah, so training, it's been shown to really improve training and performance outcomes.

Andrew: What other systemic diseases can be affected by oral health?

Lewis: Oh, there's a lot. I mean, there was even a study the other week that came out showing that, you know, gingivitis, not gingivitis, periodontitis rather, was correlated to retinal degeneration as an example, so your eye health is actually compromised by poor gum health.

Andrew: Wow. Really?

Lewis: Yeah. So, what they actually found in the study is that a particular form, again, of aggressive bacteria associated with periodontitis, gum disease, so one of the main culprits was at play, which is P. gingivalis, which is, again, an anaerobic bacteria, and this has been shown to actually infiltrate the eye tissue and contribute to retinal degeneration, which is crazy.

Andrew: Oh, hell. Absolutely, crazy.

Lewis: Yeah. So, you just think, "Oh, well, I've got gum disease, it's only going to affect my gums." But again, we can't look at things in isolation because, you know, gum disease is linked to, like I said, things like stomach cancer, pancreatic cancer, and even these bacteria can, you know, travel through the bloodstream, attack the heart, and now we're even seeing them affecting, you know, vision. So, if you want to keep your vision throughout life, which is pretty important, then it just gives people added motivation to actually prioritise their oral health because, in Australia at least, it's not something that is at the forefront of people's minds when it comes to their health. And, you know, testament to that is that the Australian Dental Association relayed some statistics, I think "World Oral Health Day" the other month in March and showed that 55% of Australian adults only brush their teeth once a day, which is pretty crazy. So, I mean, if you think of it just, you know, as a chore that doesn't warrant anything, then you're mistaken. And if people knew how much this chronic inflammation and these bugs, you know, are causing so much havoc with people's systems elsewhere in the body, then I think that you'd get a lot more motivation, which, you know, sort of gets me out of bed in the morning.

Andrew: You know, we speak about brushing and that's obviously a human thing that we have to do because of, I'm going to say our evolutionary diet and high-sugar diet. Dogs don't brush their teeth, but then they're carnivores. And then, you talk about other animals that might be either omnivores or vegetarians, but that doesn't stop them from having dental disease and it can actually kill them. So, somewhere along the line, we've got to have this happy medium, if you like, of dental health. But do you think brushing or flossing or both is a must, or which one? How would you prioritise those?

Lewis: I think that you've got to be doing both of those things. The bacteria that live underneath the gums are those really aggressive ones that leave you more susceptible to systemic diseases, and what you're actually doing with your flossing is introducing oxygen into an area where there's no oxygen and that's where those really aggressive type of bacteria thrive. So, what you're actually doing when you're flossing is you're... People need to get this out of their head, that they're getting rid of all the bacteria. That's not the case. You're making the bacteria more friendly and less aggressive and in turn reducing your risk of these systemic diseases. But I would be doing both, really. I don't think that you can skip on that. And, like, you see patients' priorities and, you know, in our medical history at work one of the questions is, how many coffees do you drink a day? And, you know, you'll have patients that will stand in line for a takeaway cappuccino for, you know, four times during the day…

Andrew: Yep.

Lewis: …and that might take, you know, 20 minutes in total, but yet they can't find...

Andrew: Five minutes to floss.

Lewis: Five minutes to floss their teeth. I mean, it's funny, you know, some people's priorities, but this is part of the challenge, is getting...and an exciting challenge is to, you know, get some behaviour change out of people. The thing to note there is that, and this is one of important reasons why avoidance is really poor, if you take me as an example, I'm a dentist. Highly trained, know exactly how to brush and floss, and yet I'm like everybody else, I’m a creature of habit. I will miss the same spots over and over and over again… 

Andrew: Yeah.

Lewis: …for six months and then I need to go in and get my cleanings because I don't want that to progress into something more aggressive and sinister. And, you know, this idea that you can go years and years and years without seeing a dentist is just all wrong because, you know, I think about 95% of oral diseases don't present with pain and people just use the absence of pain as a barometer of oral health…

Andrew: Yeah. Yep.

Lewis: …which is not a good barometer at all.

Andrew: Lewis, I have to ask you, sleep position. You know, we all talk about the perfect sleep position, you know? And you see the lovely person lying on a mattress with their straight spine, but we move in our sleep. You know, what happens? How do we control an issue with breathing when we're sleeping?

Lewis: Yeah, so, I mean, there's something called, like, a postural sleep apnoea, so you can actually get people that have sleep apnoea only when they're in certain positions, which means that sleeping position's usually important for your breathing while you're sleeping. Ideally, you should be on your side. Back, you'll have a tendency to have the tongue dropping in the airway if you're a bit of a mouth breather. And then, stomach sleeping isn't great as well because it'll promote some mouth breathing, but also posturally puts a lot of strain on your neck and lower spine, a chiropractor's dream. But yeah, I mean, it's true, we do move, and one of the tips that I give my patients is to try and lock yourself into that side sleeping position, so you want a pillow at the right height, obviously, so your neck's not too high or too low…

Andrew: Yeah.

Lewis: …and then you want to put a pillow underneath your top leg, if that makes sense, so it's at a 90-degree angle when you're on the side. And then, you place a pillow underneath your top leg and then you also pop a pillow in behind your back so that you can't roll onto your stomach and you can't roll onto your back.

Andrew: Oh, okay.

Lewis: So, a pillow underneath your leg on one side and a pillow behind your back on the other side and that means that there ain't nowhere for you to go.

Andrew: So, lock yourself in is really the best sort of advice that you can give to sort of, to train ourselves, I'm going to assume, and then we start to learn that unconsciously, is it, over a period of time?

Lewis: Yeah, you're just trying to retrain yourself and it's really, really difficult for people because they feel uncomfortable breaking a habit that they've had for so many years, but you got to think of the health benefits and you just got to work your way through it, but it's amazing, the amount of stomach sleepers that we see with small jaws and they do a lot of mouth breathing, and they got crowded teeth, and there's certainly an influence of sleep position in that.

Andrew: Lewis, thank you so much for taking us through, this is, like, I can tell that we haven’t really touched the surface here, there’s so much more to investigate, just on this aspect, but I really look forward to another podcast in the future with you. And to me, it’s obvious, you know, you and your family, you’re really knowledgeable, you’re responsible, and you really have this expertise in holistic dentistry that just glows for, you know, individualised health and care that you give to your patients. Well done and thanks for coming onto FX Medicine.

Lewis: Pleasure. Thanks a lot for having me. 

Andrew: This is FX Medicine. I’m Andrew Whitfield Cook.

Other podcasts with Lewis


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Dr Lewis Ehrlich

Dr Lewis Ehrlich is passionate about the many links between oral and general health. His mission?: to educate people to take control of their own health and prevent oral health disease and in-turn overall health diseases. Lewis is a highly sought after holistic dentist who graduated from James Cook University (JCU) with the Academic Medal.  Before studying dentistry, he completed a Bachelor of Science at Northeastern University in Boston, USA. Lewis practices, along with his Father and Uncle at Sydney Holistic Dental Centre. Lewis is also a bone marrow donor and this is his proudest achievement.