The Oral Microbiome and Fertility with Dr Katie Lee

Dr Katie Lee is a dentist and author of 'Saved by the Mouth' 

Join Katie & myself to discuss:

• Fertility Facts: the connection between oral health and fertility, your oral health can be vital for fertility amongst other things
• Red Flags for Oral Health, signs and symptoms there maybe some work to be done!
• How to look after your Oral Health and testing for the Oral Microbiome

Katie is based in Colorado, USA and offers telehealth consultations and saliva testing for the oral microbiome, you can get in touch with Katie via her website or her instagram. 

Transcript

Unknown: 0:01

Hi, I'm Rachel Sherriff, and welcome to the fertility suite podcast. Our aim is to educate and empower couples who are struggling with all aspects of facility. By giving you the information to make informed decisions along the way. We've had a little rebrand since service one, we were formerly the fertility method podcast. But in this second series, rest assured, we still have the same high standard of fertility experts coming to share their knowledge and support you. So if you are struggling with fertility, miscarriage or you just want to arm yourself with the facts, then this podcast is for you. Hi, everyone. And welcome back to another episode of the fertility suite podcast and joining us today we have Dr. Katie Lee. And Katie is a dentist and the author of a book or saved by the mouse. And we're going to be talking all about the importance of the oral microbiome, and its links to fertility today. So welcome, Katie. Thanks for having me. I'm excited to be here. Thanks for joining us. Do you want to just introduce yourself a little bit more? tell our listeners. Yeah, so I'm based here in Denver, Colorado in the US. And I've been practising dentistry since 2010. My journey into dentistry and fertility is kind of a long one. So I'll be brief. But when I was 14 years old, I was involved in a really horrific ATV accident, where I broke nearly every bone in my face from my eyebrows down. And it took four years and nine reconstructive surgeries to kind of put me back together. And during that time I had my jaw was wired shut for about eight weeks. And I had lost many teeth and had many broken teeth when my jaws are wired shut. And essentially, I lived off of ice cream, box mashed potatoes, pudding, and jello, which is all the things you don't want to be living off of, especially when you can't care for your oral health. And so as you can imagine, my oral health deteriorated really quickly, I became emaciated, my liver enzymes spiked, my kidneys started shutting down. And so I learned at a very young age, just how important your oral health as to your overall health. And so that's really what got me into oral systemic health and dentistry. And then fast forward my own personal journey when I was practising, I, too was the fertility patient. And I was going through the whole process, I did it six rounds of IVF over six years. Lots of obstacles that I faced and never once did. I have reproductive endocrinologist asked me about my oral health and the research out there is unequivocal, that oral health really does impact fertility health. And I was just kind of appalled that I was spending hundreds of 1000s of dollars in the US it's very expensive on fertility care. But yet no one was looking at me as a whole person, they were only really looking at my reproductive system. And so I started diving into the research and learned about the oral microbiome and how it impacts fertility. And so I started offering saliva testing. And I had this couple that came into my practice. And I was brand new, using this technology. And I said, you know, what can I do to help you today? And they said, Well, we've been trying to conceive for over a year, they were in their 20s, very healthy, couldn't figure out why they couldn't conceive. And their OBGYN said, Maybe you should go see a dentist. Now that is the one and only time I've ever been referred a fertility patient. And they weren't even referred specifically to me, they just said go see a dentist and it happened to be me. And I performed the saliva tests on both her and her husband. And they came back with sky high numbers of bacteria that negatively impact fertility. So we treated both her and her husband and they were pregnant within three months. So that just really solidified that, you know, I could help a lot of patients out there along their fertility journey. So that's kind of how I got into this whole thing. Wow, I am even more excited to hear what you've got to say now, because I often will look at the vaginal microbiome. At giants. And as a Chinese medicine practitioner, we look at people's tongues all the time. So amazing. off like how important the tongue is it gives us an idea of the internal environment. But I've never looked at the mouse from the microbiome environment. And I'm really, really interested to learn a bit more about the links and the evidence. So like, it's going to be fascinating. So yeah, start with the basics then. So what is the connection between the oral microbiome and fertility? What does the evidence tell us? Yeah, so there's a couple different ways. You know, the first thing that people need to understand is that when we are born, we're essentially sterile or almost sterile. You know, the first bacteria that we are introduced to is when we're coming through the birth canal. And so we're introduced to our mom's vaginal microbiome. So I'm really excited that you talked about that. Vaginal microbiome is not something that's very common here in the US. So that's really cool to know that that you're looking into that. And so when we're We're born, our mouths are essentially sterile. And so everything that we acquire, the bacteria that we acquire throughout, you know, when we're infants to babies to toddlers to adulthood is from the people around us. And so everything that we have is communicable. And so people need to understand that. It's also super important because we swallow 80 trillion bacteria a day. And so in the US, at least, the gut microbiome is in vogue. Everybody loves to talk about the gut microbiome and do things to improve the gut microbiome. But what they're not understanding is that the gut microbiome gets there through the mouth. And so you cannot have a healthy gut microbiome if you don't have a healthy oral microbiome. And so that tells us right there that the bacteria in the mouth do not stay in the mouth, you know, whether we're swallowing the 80 trillion a day, or the pathological ones are actually going through our gum tissue into our bloodstream and circulating throughout our body. So we know that the oral microbiome impacts fertility in two ways. One is the actual pathogens themselves, getting into the bloodstream and going to the reproductive system and causing all kinds of issues. And then the second is just by having these pathogens in the mouth or having, you know, a dysbiosis of the microbiome in the mouth, that will create a systemic inflammatory response. And we know that systemic inflammation is not good for fertility. That's when patients can end up with things like endometriosis, pelvic inflammatory disease, and PCOS. So those are the two ways there's a lot more detail there, which I'm happy to go into if if warranted. But yeah, that's how the mouth affects fertility. Yeah, that makes perfect sense. When you talk about like gut microbiome, right? Like, of course, the point of entry has to be the start of the study. So that when you think about it on a really basic level, that makes perfect sense. And then third of digestion is the mouth. Right? And a lot of people don't they forget that the mouth is connected to the rest of the body. Absolutely. I would be interested to know, and maybe this is a question for another time, it'd be interesting to know whether the sorts of bacterias that you're picking up like, overly are the same bacteria that you would find vaginally like patho bionic type bacterias that translocate from the gut? Yeah, I like I would definitely like to learn more about that. But if a patient was wondering whether this might be a problem for them, like how do you know whether your oral microbiome is healthy or not? That's a great question. Symptoms of something being Yeah, that's a really good question. So you know, our mouth, we have over seven different species of bacteria in our mouth. And it's okay to have bad pathogens in our mouth, as long as we have really good and you probably deal with this all the time in the vagina. As long as we have, you know, plentiful amount of good bacteria that can kind of keep all the bad bacteria at bay, then we're totally fine. What happens is, is when we get this dysbiosis, or this shift in bacteria in the mouth, where we shift from, you know, a high prevalence of good bacteria and then the bad bacteria start to take over. The pathogens in the mouth that we're really concerned about, especially for fertility are fusobacterium nucleatum I don't know if you've heard of that one in the vagina for fire Mona's ginger valus, or P ginger ballasts. And then the other one is TF Tanner, Ella Forsyth. Yeah. So those are the three that we're really concerned about, in terms of the bacteria causing direct effects on the reproductive system. But if we have a, you know, high amount of gramme, negative anaerobic bacteria, which are bacteria that don't like oxygen, so they live underneath our gum tissue that will cause a systemic inflammatory response, which is horrible for reproduce, for reproducing. And so some signs and symptoms that people will have is bleeding gums, that's probably the number one sign and symptom that people need to be aware of. If your gums are bleeding, or if you see pink in the sink, that is not a good thing, get to your dentist right away. That's never normal. receding gums can also be a sign of dysbiosis Bad breath is another sign of it, you know, and you're very familiar with the tongue. And so if people are having bad breath, that's sulphur coming out of the bacteria that's causing the bad breath. So we want to get that treated as well. And then something else that people need to be aware of is actually mouth breathing. mouth breathing is very dangerous for the microbiome. It lowers the pH in our mouth causes our mouth to dry out which allows the bad pathogens to stick to the teeth and proliferate it kind of creates like an ideal environment for them to grow. So mouth breathing is not good either. Any of those things, I would go see your dentist and get tested. And can it manifest symptomatically inflammatory responses outside of the mouth as well. So for example, can you link you know like conditions I don't know like picking a couple off the top of my head like psoriasis, you know, inflammatory. Can you link that back? Back to the oral microbiome as well, we know we can link that to the gut. So it makes sense that like, yeah, 100%, I love that you hit that on the head, because what we know is that kind of the root of all disease now is not genetic. So, at least in the US, we spent billions of dollars trying to sequence DNA and trying to figure out if all these diseases were genetic, and what we found out is they're actually not, of course, there's very few diseases that are based in genes, but most of them, it's based on inflammation. So whether you have inflammation in your mouth, which is going to manifest as bleeding gums, Gingivitis, or periodontal disease, or you have systemic inflammation in the body, you know, if it's going to be in the gut, you're going to have leaky gut, IBS, colitis, things like that. If you have it in the skin, you're going to have psoriasis, eczema, a lot of people will start to have joint issues. So arthritis, rheumatoid arthritis, those are all systemic inflammatory diseases. It's all the same process. It's just manifesting or showing up in other places. And so you always want to look at the mouth, because oftentimes, at least in the US, everything is siloed. And so if you go to your doctor, say for or your dermatologist say for eczema or psoriasis, they're gonna give you a cream or a steroid or something to lower. And that's what steroids do. A lot of people will say, Oh, I'm taking steroids, well, steroids are lowering your inflammatory response, which is good, because it alleviates symptoms, but it's horrible, because you're just allowing whatever is causing that inflammation in the first place to continue and proliferate. So you always want to try and get to the root cause. And a lot of people overlook the mouth. And that's why it's so important to have a good relationship with a practitioner or a dentist that can help you kind of lower the bacteria that are causing inflammation. So how do you know whether these bacteria there if you say, for example, you didn't have any of those signs and symptoms, it's maybe still possible, you've got the bacteria? You actually check? Is it like we use vaginally? We use a vaginal swab like and then you culture it like, is it the same or do I know vaginally? We now use PCR and also NGS next generation sequencing? So how are you testing the oral microbiome? Great question. So we just take saliva samples. So there are several different tests on the market. And they all pretty much use PCR. There are some that use RNA as well, to test but you can get just a saliva test, you swish and spit into a tube and send it in. And the reports that come back are really fascinating, because it'll tell you what bacteria are present, we're really most, you know, some of the reports differ. But we're only concerned about a handful of pathogens in the mouth that will cause periodontal disease and systemic issues. And so it'll tell us if those pathogens are present, the level that they're present, and then it'll actually tell us what systemic organ systems those pathogens are affecting. And so that's really great for patients. Because, you know, if you come in and you say, I have a history of, you know, eczema, I have heart disease in my family will, I'll be able to tell you specifically if your oral microbiome is directly affecting those conditions. And then the other thing that's really great about the test is traditionally in dentistry, we've treated kind of the mouth is or periodontal disease or gingivitis is kind of like a one size fits all approach, meaning someone comes in with infected gums, we give them you know, scaling and root planing or periodontal cleaning, and send them on their way. But you've I'm sure you've probably heard of those patients that say, Well, my gums are bleeding, and they've always bled, this is the way it's always been. And I still go see my dentist twice a year. Well, that's because we're not rendering the right treatment for the bacteria that are present. And so when you go to your physician, you know, when they run a strep culture in your throat, if you have a sore throat, or they run some blood work, they're doing that because they want to try and give you the appropriate antibiotics or the appropriate treatment for what you have. Well, now we have that in dentistry. So if someone has, you know, if their microbiome test comes back and showing us that they have, you know, FN or PG, well, that treatment is gonna look a lot different than if they have other bacteria that are present. So very important that we know this. Is the treatment always antibiotics, then are you saying there's other types of treatment? Yeah, so we try and avoid antibiotics if we can. However, if someone has a rampant infection, and the levels are sky high, they already have some chronic conditions. You know, when they're having symptoms, then sometimes we do need to also render antibiotics to kind of wipe out everything and then rebuild the microbiome. And this is the part that's really important. And you know, this too, you have to rebuild the microbiome after you wipe it out. But we try and avoid antibiotics if we can. A lot of time not a lot. I would say about half the time we can't just depending on how bad the infection is, but the basic treatment is going to be a periodontal cleaning, and then on top of that we can use other treatment modalities such as different and irrigation types so we can irrigate out the pockets with some medicaments. Lasers are fantastic for treating tissue invasive bacteria and kind of eliminating that granulation tissue. And ozone therapy is really fantastic too. And that doesn't do anything with antibiotic resistance. So we like ozone, and then addressing, you know, the patient holistically. So what are you eating? What is your lifestyle? Like? What is your sleep? So your sleep patterns? Are you a mouth breather? So we try and look at the patient holistically as well. It does the bacteria literally sit like just in the gums between the teeth and the gums. Yeah, yeah. So there's all kinds of different bacteria in the mouth. And depending on what area of the mouth, you'll find different bacteria. So our cheeks are going to have different bacteria than our gum tissue, our gum tissue is going to be different than our tongue. And so quick little call out here. So that's why we always say, you know, get a tongue scraper, don't use your toothbrush to scrape your tongue. So you don't want to be moving things around. But the bacteria that we're really concerned about in terms of getting into the bloodstream are going to be the ones that are sitting underneath the gum tissue. So we have our teeth that are above the gums. And then we have these pathogens that lie underneath the gum tissue, and they attach to the roots of the teeth. Once they've attached, there's no way that a patient can get under those gums to clean out that bacteria. And over time, as they sit there, they proliferate. They form these really tight kind of matrices to help them stick and stay on the roots of the teeth, and then the gums will get inflamed. Excuse me, that's when we'll start to see the gum tissue start to bleed. And what that tells us is the bacteria then are leaving the tooth structure going into the gum tissue and circulating the rest of the body. Wow. Would you give probiotics then is there like an overall approach? Because we would use like vaginal probiotics or God? Is it the same? Like do you apply that differently? Or is it a tablet programme? Or how does that work? There's all different types of things on the market. I would say oral prebiotics are probably more effective than oral probiotics. But I certainly would encourage people after they get the treatment to take pre and probiotics, because the whole idea is we want to try and replenish the good bacteria in the mouth. Because we want the mouth microbiome or the oral microbiome, to do its job, which is to make the or maintain the mouth as a healthy state. So I always tell people be very careful about what products you're using. Because you know, a lot of people are really wanting to kill 99.9% of bacteria that's really on the products that's really popular marketing here in the US is, you know, use something with alcohol, make sure it burns, if it's burning, it's cleaning, or if it's foaming, it's cleaning, that's actually not true. Those are actually you know, chemical base, and they're horrible for the microbiome. Alcohol kills. It's non selective, so it's going to kill all the good and the bad bacteria. And the point 1% of bacteria that's going to be left are going to be the super, you know, strong, Stingy zombie like pathogens that we don't want to be surviving. But now we're giving them an environment to proliferate. And so I always tell people make sure you're using very gentle products. The oral microbiome is very sensitive. And so we don't want to disrupt it. And we don't want to wipe it out completely. So alcohol free is always key. And then try and use products, you know, that don't have harmful chemicals in them. But the best thing people can do is just use an electric toothbrush for at least two minutes twice a day, make sure they're flossing twice a day. And that's a non negotiable because our teeth have five surfaces. So if you don't floss, you're missing two out of the five surfaces. And in between the teeth is where all of the pathogens like to hide. So if you're not cleaning that you're really setting yourself up for oral infection. And then mouthwash this key tongue scraping is key and then of course ensuring you're not breathing through your mouth at night. With mouth mouthwash then would you use because a lot of mouth washes are quite alcoholic, aren't they? Like they've got that? Like what mouthwash would you recommend? Is there like a more natural sort of pre probiotic based one or yeah, there's a lot of really good ones. I actually know in the UK, there's a company called invivo that is really good. Do you know in vivo? I use in vivo all the time for that too. Yes. microbiome testing? Yeah, yeah. So in vivo is great. Um, it comes with like a powder and you mix it with some water and you can swish swish that way. And some other products that we really love our you know Tom's of Maine is really good. tooth and gum tonic, biocide in Fig, primal health, those are all really good products to use just something that is alcohol free. I was recently introduced to another one called perio guard. That one is really good as well. Closest is is really good. So yeah, just make sure that chemicals are limited and make sure it's alcohol free and you should Be good to go. What about foods? And the oral microbiome? Is it the same as gut microbiome where we'd want to encourage people to eat fermented foods, you know, good prebiotic based foods? Absolutely. So the the main thing that we want to stay away from is sugar. Sugar is so inflammatory. It literally is like shards of glass running through our blood vessels. And so it goes through our blood vessels and causes this kind of mechanical damage to our blood vessels, which just elicits systemic inflammatory response. So we want to stay away from sugar in the mouth, not only to sugar cause inflammation, but it also attributes to cavities, because the, there's a type of bacteria in the mouth that is responsible for causing cavities. And the food that that bacteria lives off of is sugar. So if you're feeding it sugar or processed foods, it's going to break down those carbohydrates into acid and excrete acid on the teeth. And that's what causes cavities. So we want to stay away from sugar, processed foods. And fibre is like the best thing we can do. So prebiotic fibre, any kind of fibrous foods are going to be great for the oral microbiome. I would love to know like more, and it's something that we don't have the answer to right now, maybe but like more about the links with the organ and the vaginal microbiome, because they're the two opposite ends, right of the gut? Yeah, yeah. I spent so much time learning about the vaginal microbiome, that I'm finding this fascinating that this is, you know, the other end of the of the tract, the I'm gonna have to look into that too, because I'm not well versed on the vaginal microbiome. And so I wonder if there's any relation there. Because bacteria I mentioned earlier, have you heard of those before in the in the vaginal microbiome, or I haven't heard of them in the vaginal microbiome, we tend to find often patho biomes, that translocate from the gut. And they can be your real sort of nasties. And then obviously, you've got the ones that live in that environment anyway, but only proliferate when you don't have enough lactobacillus. And they tend to be the ones that are kind of related to bacterial vaginosis in the No, no. And then you have things like mycoplasma slight ureaplasma that often can can be found in the vagina. So yeah, they they tend to be the most common ones. I mean, obviously, there's a huge list. But yeah, I wonder, I wonder whether that crossover. Yeah, lactobacillus is really important in oral health for maintaining oral health. And I assume it's important for maintaining vaginal microbiome health as well. Yeah, we look at really lacto, lactobacillus crispatus is the dominant lactobacillus in the vagina, there's a couple of others that we have, but that's the one you really want to see dominant for, like a healthy environment. Yeah, well, we know about Fn and PG and tf. I'm just abbreviating those, because the bacteria names are so long. You know, we know Fn, for example, is present in everybody. But it's really only pathologic when it's in conjunction with other bad bacteria, especially PG, PG, and fn are kind of like these buddies that go around and wreak havoc on the body. F and I also talk about Fn is kind of like the Uber or the taxi of the body. It's really good at binding to cells and tissues and crossing over and making those cells and tissues permeable to other things crossing over. So PG will kind of latch on to fn Fn, we'll take it around the body, and then help it cross over into areas that it shouldn't be. But we know for example, that if someone has an infection with Fn, their risk of infertility goes up by three times. We also know that Fn is responsible for stillbirths. So the toxic metabolites of fn in the reproductive system are toxic to the foetus and will actually cause the foetus to pass away, and will cause stillbirth. And so Fn is really highly associated with adverse pregnancy outcomes. It also will cause the rupture premature rupture of the amniotic membranes leading to premature birth and low birth weight. And so we really want to make sure that the patients don't have fn. P G is really it causes kind of like adverse pregnancy outcomes. So it's really linked to gestational diabetes to preeclampsia for the moms. It also impairs ovulation and implantation of the embryo into the uterine lining. So we always want to make sure our patients are free of PG. And what a lot of people don't understand is that infertility is a 5050 issue. You know, a lot of people think of, oh, you know, we can't get pregnant, it must be the woman's fault. Well, what we know from research is it's half the man and half the woman. And so that's why as I mentioned before, when when that couple came to see me, they did both have oral infections, but regardless if someone comes for fertility consultation with me, I always test the partner, because number one, their microbiome could be contributing to infertility. Or if they have an infection, and the woman doesn't, you know, it takes two to tango. And so they're going to transmit all the bacteria that they have to the woman. And what we know with the the bacteria for a man is it will reduce the sperm count, it'll reduce their ability to swim, their motility, and it changes the morphology of the sperm. And so oral bacteria is directly linked to male infertility. Wow, I never knew that we'd like we now when we have vaginal microbiome testing, if something comes back, we will always then go to the male partner on a semen culture. Like that's kind of pretty standard now, you know, I think we've moved so quickly in this area over a short space of time, right. And there's still a lot we don't know, and a lot we're learning. And, you know, fertility generally is a really fast moving area of medicine. We are still learning a lot. But yeah, we're definitely looking at people more as a whole couple now like, oh, yeah, rather than than just always looking at the woman when it comes to fertility problems. So yeah, I did have a man come to me. Well, he was he was already my patient for a long time. But he had disclosed that him and his wife were, they had been trying to have a kid and they went and saw a reproductive endocrinologist. They did a bunch of testing. And it turns out he had back sperm or bacteria in his sperm. And they also found out that he had slow swimmers is what we call them here. His his sperm are just not very mo tile. And so they were undergoing lots of rounds of IUI, but had been really unsuccessful. He also had horrible oral hygiene. And he knew that he had horrible oral hygiene. He was always in our chair every three months, his gums were always bleeding. And so I really sat down. And I was really happy that he shared this information with me. And we did a microbiome test, of course, is PG Fn and tf were super high, educated him on how those bacteria directly affect his sperm and put them on a an eight week recall. So he was coming into my office every eight weeks. I put them on some medication that it's not, it's an anti inflammatory medication that he was on for about three months to lower systemic inflammation, and they were able to get pregnant. So whether it's causation or correlation, I don't know. But he was definitely, you know, the infertility was on his side. And I knew for a fact that the bacteria in his mouth were affecting the health of his sperm. So and you probably see that too, when you culture, the semen that they can have bacteria in their sperm. Yeah, all the time. And then you treat normally we normally treat with antibiotics for sperm. Sometimes it needs second course or different totally. But once we get to it, we often see a big improvement in sperm house, right? And if you take it back to basics, like bacteria creates inflammation. Inflammation is bad for fertility. So naturally, if we treat the bacteria, look at the microbiome, improve the lactobacillus we're gonna see an improvement, genuine 100% 100%. And then I, you know, I'd encourage you know, one step further, make sure they go to the dentist and make sure that bacteria is not coming from their mouth, because otherwise they're just gonna get reinfected. Which is not good. And I don't know if if this is a thing I, I assume it is. But now I need to go look at this. You know, let's say, We do treat the sperm and the woman is able to get pregnant. You know, they're obviously going to have intercourse during the pregnancy. I wonder if there's any kind of damage that can be done if the man sperm becomes reinfected? I wonder if that could cause any kind of localised inflammation to the baby while they're in utero? I don't know. I don't know the answer to that. Interesting the links between causing the amniotic sac to rupture I had on the podcast a few weeks ago, a lady called Gold new school sorority, and she's from the UK. She sets up her microbiome testing company called Screen me, and we talked a lot about the links between preterm birth, stillbirth, second trimester miscarriages and bacterial infection. And yet, we still don't have all the answers yet. But there are lots of signs that this is an area that we need to learn more about. Yeah. One thing that we know is there's an enzyme I just wrote that down, I'm gonna, I'm gonna look her up. That's awesome. There's an enzyme out there called MMPA matrix metalloprotease Eight. And what we know is it's released during when the body notices that there's an invasion of something that shouldn't be there like bacteria. And what happens is the body will release the immune cells to go attack the bacteria or virus or or fungi that's invading, it shouldn't be there. But in order for those white blood cells and those immune mediators to get to the source of infection, it has to also release this enzyme MMP eight MMP, it acts as a scissor to go through and cut through the tissues, the cell junctions to allow them mediators to get to the source of infection. So what we see is, and that enzyme is what's responsible for the tissue breakdown in the mouth. And what we have when we have periodontal disease, it's also the same enzyme that breaks down the gut lining that causes leaky gut. It's also the same enzyme that's responsible for rupturing the amniotic membranes and causing preterm birth. And so there's ways that we can measure this enzyme. Now there's a company out there called dentists, agnostics, they're actually from Germany. And it's a little saliva test that you can do chairside at the dental office, and they can measure your levels of MMP eight. And the reason why that's important is because we know if it's high in the saliva, we know it's high in the rest of the body. And so we know that the patient's currently experiencing collagen breakdown from inflammation. And this tells us at the moment in time, which is really cool, because a lot of times in health, we don't see ramifications of inflammation until after diseases and destruction has occurred. So it takes you know, anywhere from six weeks to six months to start to see bone loss, or gum inflammation in the mouth, whereas we can test for MMP eight now and notice that tissue is being broken down before it's clinically visible, which is really cool. And it's preventative right going to the root cause so prevented. Yeah. Yeah, I'm not sure. Obviously, you have a different health system or see much more privatised in the States. But over here, yeah, like our generalised NHS system is very much based on treating acute or treating afterwards, rather than than sort of preventative. So I would say that's the same in the US, unfortunately, and all of these new modalities that are preventative, none of them are covered by insurance yet. And so but luckily, I mean, the tests are not that expensive. And there's so much research out there showing that if someone were to pay for these tests, which are, you know, a couple 100 bucks, the amount of money that they save, and overall health care expenditures is enormous, you know, pregnant women who get treated for gum infection during pregnancy will save $2,400 throughout their pregnancy, on health care on healthcare in general, not just oral care. So it's critically important that people get treated. Also, from a fertility perspective, if we're talking about IVF, you know, like you said, in the certainly in the US hundreds of 1000s of dollars, you know, whereas if you can treat your microbiome for a lot less then of money in the long run, if that. Totally, hopefully, it'll you know, help you get pregnant naturally. And if it doesn't, it'll make your fertility treatments that much more successful because we know fertility treatments, you know, when you're injecting all these hormones into you, oestrogen, progesterone, gonadotropin, all these other hormones that we take, that makes systemic inflammation worse, it all you know, it causes vasodilation, it causes leaky blood vessels that causes systemic inflammation. So all it's doing is is exasperating the issue that's already in your mouth. So it's making your gums more leaky, which means if you have bacteria in your mouth, even more of those bad pathogens are getting into your, into your system. So critically important to make sure that this is treated ahead of time. So talking about treatment, then how are like, how do you work? What do you do? And do you have anyone in the UK that you can recommend? Obviously, you're in Colorado, but a lot of people UK, like tell people kind of what you do and how you can help? Sure. So I'm in the middle of building my oral systemic clinic here in Denver, Colorado. So until it opens, you know, I did write the book, say, by the mouth, which I wrote it for patients. And it talks about how the mouth affects every system in the body, not just fertility. And it's written in a really cheeky fun way. Very high level, so it's easy to read. And so what I found was when I released the book, I had everyone reaching out to me on Instagram, and via my website saying, you know, I want these saliva tests, where can I get these tests, I can't find anyone. And so I do offer saliva testing. Now for patients, I can do it for patients in the UK. And so what we do is I ship a test to patients house, they'll take the test, and then we'll go over the results together and create a care plan, holistic care plan on how we can get them improved. And then I work with their current health care provider to render treatments needed to lower the bacteria. And then we always want to post tests, you want to make sure that your treatments are effective. And actually the person who wrote the foreword to my book, her name is Dr. Victoria Sampson. She is basically my counterpart in the UK. We were not partners or anything. I just I adore her. She's a genius in this space. And she has an office I believe it's in Mayfair in London, called the Health Society. So she does a lot of microbiome therapy in the Health Society in London. I'm going to put all those details in the episode Yeah. Anyone listening who like me is now thinking I need to make a dentist appointment ASAP. In Touch and also So I'll put Victoria has details in there so that if anyone does need to go and visit someone in parallel, yeah, she's fantastic. And she's very well educated in this area. Amazing. That's been fascinating. Thank you so much. I'm sure that's gonna help people. And as you know, with fertility, you just want to do as much as you can to help yourself. So, again, part of the reason why I wanted to come on and talk with you about this today is because it's something else that people can look into and take control of, and it might, people might be listening and go, Oh, that sounds like me. You know, I've got bleeding gums, what can I do about it, which is so important when you're trying to get pregnant, right, so, thanks. Thanks for having me. Thanks for coming on. We'll speak to you soon.