78. Bone Health And Gum Disease Solutions with Dr. Alex Volchinuk

Gum disease can look quiet while it drives loud inflammation throughout the body. We sit down with Dr. Alex Volchinuk, Biologic Board Certified Periodontist & Oral Implantologist, to unpack what’s really behind bleeding gums, gum recession and bone loss and why the story isn’t just “brush and floss.” We talk about the oral microbiome, genetic susceptibility and the immune response that can turn everyday bacteria into a chronic, bone-resorbing problem. 

From there, we get practical about regeneration. Dr Volchinuk explains modern periodontal treatments designed to rebuild support around teeth, including minimally invasive pinhole gum rejuvenation for recession and laser-assisted new attachment approaches that aim to remove toxic burden and help the body heal with its own clot and biology. We also tackle the part most people miss: biofilm. If you’ve tried oil pulling, ozone or rinses and still feel stuck, you’ll hear why hardened biofilm can block penetration and why professional disruption plus the right home routine matters. 

Finally, we dive into dental implants, peri-implantitis and how to stack the odds in your favour. We compare titanium vs zirconia ceramic (zirconia) implants, including plaque resistance, aesthetics and concerns around corrosion and titanium particle release in an acidic, inflamed environment. We also cover smart pre-implant prep: controlling periodontal disease first, checking inflammation, blood sugar and vitamin D, and using better diagnostics like salivary testing and CBCT 3D imaging to catch hidden infections early. If you want implant longevity, better bone health and fewer surprises, this conversation gives you a clear roadmap. Subscribe, share with a friend who’s considering implants and leave a review with your biggest takeaway.

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Practice Name:
My Tetra Health

Website:
www.mytetrahealth.com

Phone:
929-293-0200

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Office Locations:
• Upper East Side, New York City
• Greenwich, Connecticut

Consultations Offered:
• In-person consultations
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Join the 6-Week Gum Disease Course: https://reversegumdiseaseinsixweeks.info/optinpage

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Disclaimer: This podcast is for educational purposes only.  Information discussed is not intended for diagnosis, curing, or prevention of any disease and is not intended to replace advice given by a licensed healthcare practitioner.  Before using any products mentioned or attempting methods discussed, please speak with a licensed healthcare provider.  This podcast disclaims responsibility from any possible adverse reactions associated with products or methods discussed.    Opinions from guests are their own, and this podcast does not condone or endorse opinions made by guests.  We do not provide guarantees about the guests' qualifications or credibility. This podcast and its guests may have direct or indirect financial interests associated with products mentioned.

Transcript

Welcome And Guest Background

Dr. Rachaele Carver 0:00

Hello, everybody. Welcome back to another episode of The Root of the Matter. I am your host, Dr. Rachaele Carver, and I'm very excited to bring you one of my colleagues, Dr. Alex Volchinuk, who is a periodontist in New York City. And we've met at various meetings. We are both of the biologic dentistry mindset. So I really wanted to bring Dr. Alex on today to talk to us about bone health, talk to us about implants, the difference between titanium and ceramic, how we might prepare our bone to take those implants, other kinds of procedures that we can do to maintain bone health. And the the studies predict that 80% of us have some form of gum disease. So I really wanted to get a periodonist on here and somebody who I really respect and trust to give us kind of the lowdown. So thank you for joining us, Alex. And uh maybe tell us a little bit of a story about how you kind of came into the more biological philosophy.

Dr. Alex Volchinuk 0:57

Yeah, yeah. Well, thank you so much, Dr. Carver. It's a pleasure to be uh to be with you here. And and I think this is such a great topic to talk about because it's all about the foundation, it's the health of the bone and the gum that supports teeth and implants and and everything connected with the mouth and the body. Um so so yeah, so you know, my my background, I um I did my dental school at the University of Pennsylvania, and that school is particularly focused on specialty education and most importantly periodontics. It's uh one of the kind of the founding principals for for that school. So I've always got very drawn to the periodontal health and periodontal sciences as a result of that. I then went on to Columbia University in New York City to do my actual training, periodontics. And one of the things that I really appreciated about Columbia was that it was a very international program. So half of my class was students from the US, and half was students from all over the world, from Europe, from Asia. And what that offered was a very unique perspective on the way that we approach patients. And one of the key takeaways I realized was that there is so much more to our knowledge base than just what we kind of get taught in school or taught through our contrastal education. Um, so that sent me on some travels while I was in school, and then actually even onward uh when I uh graduated in my early years, and I was spending time with doctors in Europe, and I was getting very uh interested in the way that we would approach certain things. And one of the key things that I really, really liked was that in in European uh dental uh philosophies, it's very integrative in the care amongst dentistry as a whole, meaning all the different specialties work very closely together, all the providers work very closely together, um, you know, accounting for all the steps and what the patient needs from start to finish. And also it's very closely seen as a link with medicine and overall health and wellness, especially in Switzerland. I saw that concept a lot. In Germany, I saw a lot. And I got very hooked in that. I thought it was really, really interesting to see that. And so that kind of really got me started integrating those concepts into my periodontal practice. So kind of first and foremost, it evolved to become a biologic periodontal practice. And I was the first biologic periodontist in uh in New York City, and probably one of you could probably count on one hand how many there are in the entire US. There's been so much more to learn in the field, especially as biologic dentistry has been evolving. You know, now there's a lot of educate about this and even a new residency program at Tufts University under Professor Gannati that focuses specifically on biologic dental surgery, which I was really happy to be a part of. So yeah, it's been a continuous journey and I've really loved it. And I feel like it's the true way to practice not just periodonics, but but dentistry as a whole.

Why Gum Disease Happens

Dr. Rachaele Carver 3:59

Well, of course I agree with you. One of that philosophy, it's it's amazing. But like you said, there, you know, as a dentist, so many of us biological dentists are learning this extra surgical technique, right? Because now that we know these things, we don't want to just send our patients to the general oral surgeon or the general periodonist because we want them to use ozone and we want them to understand nutrition, you know, because we want our patients to have the best of everything. So that's why I really appreciate you. And I would like knowing that I have you to refer to because I'm I don't love to do a lot of different surgeries. You know, I love extractions, but I'm not doing the implants and stuff like that. So um, so again, it's wonderful. Um, and thank you for doing what you do. So I really like what you said at the beginning about bone health, right? That's the foundation, right? Just like a house, you're not gonna have a good, steady house if the foundation is shaky and super, super important. Can we live without teeth? Sure, but it's not optimal living, right? And can we live with gum disease? Sure, but it's not great. We know that periodonal or gum disease is a major contributor to almost every other chronic disease on the planet, right? Every time we chew, every time we swallow, all of that bacteria is getting into circulation, getting into the gut, causing all sorts of problems. So talk to me a little bit about what what do you think is the cause, or what are your theories maybe about the cause of periodonal or gum disease?

Dr. Alex Volchinuk 5:20

Yeah, yes. You know, so periodonal disease, gum disease is a condition that is mediated by a buildup of CERN bacteria, you know, what we call pathogenic bacteria. So this is not like a foreign infection, this is not something that you contract, but it's actually the natural bacteria in your mouth that is kind of becomes out of balance. Almost kind of like uh, you know, a good neighborhood that kind of goes bad, you know, so to speak, right? But our individual genotypes, our genes actually play a very, very important role in how that disease is expressed. So really what happens is that the bacteria in and of itself just kind of activates the immune system. The question is, how does our immune system respond to it? Does it respond to it in a very aggressive, hyperinflammatory way? Um, and then in those cases, you'll see patients with very severe periodal disease. Maybe early onset happens in as early as third or fourth decade of life, um, and usually leads to early loss of teeth, you know, amongst many systemic health things, which I'm sure we'll talk about. But also there are some patients that have a more protective genotype, right? They're going to be less inclined to have it. Um, and so they can maybe deal with more of these bacteria. So, you know, it really is kind of an interesting balance between the patient's oral microbiome that we now can actually study and get great salivary diagnostics to look at what's going on for patients, but also your genes, right? And the way that you're kind of coded, predisposed. And I'll probably even add a third factor that I think is really important, which is, you know, nutrition, sleep, stress, right? All these other factors, what we'll call like environmental factors, right? You know, we know a great example that is, for example, smoking. Patients who smoke have very, very, very severe forms of periodal disease and much higher prevalence to it, right? Completely modifiable factor there. But yeah, those three things play a big role in in the manifestation of gum disease and the severity of it.

Genetics Nutrition Stress And Risk

Dr. Rachaele Carver 7:26

Yeah, I think that's that's a really important point that you make. That, and and that is why, again, I I love this concept of biological um dentistry because we're looking at the person as an individual, right? It's, you know, not everybody, even though maybe this person and this person both have gum disease, it can be from different things, different species. So we really have to consider the whole body, right? You know, in traditional periodontal disease, we just, you know, throw antibiotics at you and, you know, scrape your teeth every few months and we're done with it, right? But again, everybody's comes from a different thing. Some people, you know, maybe they inherited those genes where they don't detox very well. I think that's that's a pretty prominent one. People hear of this MTHFR, right? You don't methylate very well, so therefore you don't detox very well. So that's kind of, you know, people will say, you know, well, my mom had gum disease and I had gum disease. And and, you know, maybe there's a transfer of the bacteria, but I think part of the genetics is is that immune system, right? How well because that's what people don't really r think about, really their immune system affecting the teeth and the gums. So, like even for cavities, for instance, when I'm seeing all these like young kids from holistic households with all these cavities, I'm thinking, what's going on with the immune system? It's not the hygiene, right? There's something, and and I've always thought of gut disease as an autoimmune condition, right? It's like your own body is eating away your own bone, which is kind of, you know, the absolute definition of autoimmunity. And we know that that stems from the gut, right? And um in the immune system, you know, it's not going awry, you know. I think we tend to think of autoimmunity as such a bad thing that your body is going haywire, but in fact, your body is responding to a pathogen. And in order to get rid of that pathogen, right, that is in the bone, the bone is kind of a, you know, as a consequence, the bone gets eaten away, right? It's not the body's goal isn't to get rid of the bone, but to get rid of the toxins that are in the bone. So when we think about it, when think about that context, having to think about all of the environmental factors, like you said, kind of so many people out there are biohackers, whatever you want to call them, like they have the pillars of health, right? And it's always diet, nutrition, sleep, exercise, you know, those are the big ones that are important for all of us. But then, like you said, you got to dial in. Do you need extra immune support here? Do you need to change this habit here? You know, do you need to change your? I think diet nutritious is the most confusing, right? Because you know this is yes, you need to eat, you know, 10 pounds of vegetables every day, but you know, maybe not for me genetically. I don't I don't absorb the brassica vegetables very well, which is all the broccoli, the cauliflower, the cabbage, all those sulfur rich that are supposed to be the healthiest thing for you. Really interesting. I did a gut microbiome test and it said you cannot process those. You don't have the bacteria to process the molecules in those foods. Once I took that out of the diet, holy cow, did my gut health get better. Right. So I think that's the tricky thing, is right, is that individualizing of what's what's good. And we're lucky. We have so many different tests that we can do this depending on you know how how many roads you kind of want to go down to. But having a biologic dentist, periodontist in your team is really helpful to guide you along those those right paths, right? So when we have, you know, we think a lot of times when we if we break a bone, boom, we can grow that bone back, not a problem, right? So telling me a little bit about protocols that you use to try to um kind of grow back. Those people who come to you and they have pocketing, right? That's who most people refer to. They have starting having some bone loss. So tell me a little bit about what we can do about that.

Regenerating Gums And Bone

Dr. Alex Volchinuk 10:55

Yeah, yeah. So, you know, I think the uh interesting shift that's happened in modern periodontics, right? And and I'll kind of it's a little bit of a shift from I would say classic or conventional periodontics, but modern periodontics is about regeneration, right? So the goal is to try to rebuild the structures that support the teeth. Or if a tooth is already lost, let's say it's an implant that's losing bone, to be able to regenerate the bone around that. Uh, or if a tooth has gung recession, to regenerate that gunk. So we have a lot of great techniques and a lot of great protocols that we can utilize to help make that happen. And I would say that probably the front runner, the things that I do in my practice with patients really kind of fall into like a couple, a couple categories. When it comes to gum recession, which we'll say is one of the versions of gum disease that we see, you know, the patient's not necessarily losing bone, but the gum is starting to pull away from the tooth. Well, we start to take a look what factors, what local factors can be affecting it. Maybe it has something to do with the patient's bite. Maybe it's orthodontic, the tooth is extruded or pushed too far outside of the bone. Maybe it has something to do with hygiene techniques or certain diet habits, things like that. But if we can modify that, we'll always give the body a chance to self-heal, right? So we always want to kind of correct anything that's obvious. But if we find that there is nothing that we can really modify or the response to that is isn't as ideal as we'd like naturally, well, then we have techniques we can do to improve it. And really we have some really minimally invasive, amazing things we can do. One of my favorite things to do for patients is something called pinhole gum rejuvenation, which is a procedure where we respect the fact that we want to keep the gum intact. We don't want to make cuts, we don't want to make big openings, but we can work through these small little orifices, literally the size of a pinhole, and we can work with the elasticity of the gum to correct the area of recession. And why I love to really talk about this and share it is that, you know, one thing we'll see with regeneration is that it always works better the earlier you catch it. Right. So sometimes if if a patient is walking around, they see one or two millimeters just of that recession, that root showing, that's actually the best time to treat it. Right. We don't want to wait for there to be extensive recession or bone loss that starts. But if we can regenerate it early, we can do a minimally basis technique that works really, really well. When it comes to teeth and I'll even say implants that are losing bone, then we really have another protocol in place that we work with patients to focus on regeneration. And it involves laser therapy. Specifically, there's a technique called LANAC, which stands for laser-assisted new attachment protocol. And new attachment essentially means regeneration. So we have studies from about 13 years ago at this point in time that have proven, meaning on the cellular and microscopic level, that we can treat and regenerate teeth that have lost bone and have diseased root surface back to health. And what's amazing about that is actually it really speaks to what the body wants to do. The body wants to restore a healthy situation if it can. And what do we need to do to make that happen? Well, one is we need to eliminate all the toxic burden that's happening in that site, right? Whether it's uh in that pocket around a tooth or in the mouth as a whole, this is the bacteria. We need to eliminate the toxic bacteria, but it doesn't mean we have to wipe everything out, right? We just need to get rid of the pathogens that that trigger that immune response in the body, which actually you mentioned before is kind of like signaling that autoimmune response to resorb the bone. Secondarily, we can work with techniques that will actually help to regenerate a clot, meaning like a blood clot, just like if you get a cut on your hand and the skin will bleed and then it'll form a clot and that creates healing. Well, blood is the key, and the clot is the key to healing for bone. And what's amazing is that if we create a clot between the tooth and the bone, and between the gum and the tooth, and the area stays clean, we actually can rebuild bone in that area. And that's really an amazing protocol. It's something that is minimally invasive. We don't need to, you know, use scalpels, we don't use sutures, we don't use bone graphs, we don't put anything foreign in there. It's actually working with the body's natural healing response and understanding the biology of how the body heals and taking advantage of that. And it's really truly, truly, truly incredible. You know, I've been very fortunate that when I was in my residency program, I got exposed to that. So I practiced my whole career with laser therapy, and I haven't really ever looked back. It's been quite amazing, you know, and at this point, thousands and thousands of teeth saved, and you know, and that's that's where I think we should really be.

Dr. Rachaele Carver 16:03

Yeah. I think my laser is my favorite tool, biflot is the the best thing I I ever invested in it because again, we were talking about that regeneration. You know, a lot of modern dentistry is like, you know, fixing, drilling, and filling, and and you know, it's not about regeneration. And that's again the exciting part of that whole idea of biological is remembering how the body works, right? Remember like your first year of dental school. You know, we in at UConn, we had the first two years with the medical students. So we did the first two years in med school. We learned about how the body worked the first year and never ever thought about it ever again after that, right? Year two and on was all about pathology, right? And so I had to go back, you know, when I had my own health and go back and learn, remember, oh yeah, the body is supposed to do, you know, X, Y, and Z. So how do we support the body to heal itself? Because we can. I mean, we hear all these stories and think they're miracles, right? When people heal from stage four cancer and all these kind of things, but they've removed the burden, right, and allowed the body to do what it's supposed to do. So I think that's what's really exciting. And and the fact that doing this amazing thing with something that's non-invasive is even better, right? I mean, I the lasers, the pinhole therapy, that's amazing. I did that training too, and I did a couple of them and I was like, you know, surgery is not really my my thing. I'll let my parents keep doing that. But it was but it was a very cool procedure because it is also minimally invasive. You don't have to, I mean, the traditional way of cutting the square away of your palate can be works, but it's pretty painful, right? And you know, and create some scars. Right. And we know in biological genetics we were trying, we want to minimize that kind of stuff, and that's where the laser comes in is so so amazing to be able to do these kind of things. So when you say you have to get rid of the toxic bacteria, are you using things like ozone, antibiotics? What kind of thing? And do you have the patient do something at home to help get rid of that bacteria?

Lasers Ozone And Biofilm Reality

Dr. Alex Volchinuk 17:50

Yeah, yeah. So I think the way that analogy I like patients to think about, it's a little bit kind of like gardening, right? You know, so if you come out to the garden and you have a bunch of weeds and you have, you know, some flowers, you know, you don't want to use something that just, you know, scorches the whole earth and everything dies, right? I think that's not the goal, right? You know, we want to propagate things that help the healthy plants grow and get rid of the weeds, right? And that's kind of the idea with the mouth, too. So, you know, we'll use certain therapies, for example, like laser treatment, is very, very targeted to inflammatory bacteria, right? And the way that it does that is that it works through infrared um energy and bacteria that live off of inflammation, blood is red, right? It will kind of build up in the in the heme of the bacteria, and the laser will be targeted to that. So it's almost like a homing missile, right, at that bacteria. Whereas most healthy bacteria is water-based, will go right through it, right? Which is really kind of quite amazing. Ozone therapy is fantastic. It's a really, really great way to help bring oxygenation to the area, blood vessel formation, and it's a very, very potent antimicrobial. So it's a great way to keep those areas clean. But it's also important something about the biofilm. And that's something that patients don't always understand. So bacteria is kind of smart, right? Because what it realizes is that if it's kind of free-floating out there in the gum by itself, it's very vulnerable. The laser can get to it, the ozone can get to it. So what it does is it forms a colony, right? It forms a biofilm, right? And that biofilm over time, if not cleaned properly, will actually start to harden. And sometimes patients can see this on their teeth in the form of calculus or tartar, right? It's a really hard buildup. And this actually prevents the penetration of ovazone and even laser energy, right? So bacteria is smart, it's trying to protect itself too. So it's important for you to work with the dentist that's that's at disrupting that biofilm too. So it's not that we just use a technology like a laser or ozone, but we also need techniques that effectively and gently remove that biofilm layer. One of the things that I really advocate for is to shy away from using aggressive metal scalers and instruments on teeth that damage healthy tooth structure and focus more on using piezo or ultrasonic instruments that are really, really great at breaking up the biofilms. And you can even use some hydrogen peroxide or ozonated water in that so that when you're cleaning it, it's now also penetrating further and detoxifying the bacteria. But you need to do both, right? You know, we need to use technology to help target the tough-to-reach spots and the and the really resistant pathogens, but we also have to rely on some of the things that we know as as dentists are important is to get in there and clean it out. I can tell you probably almost on a weekly basis, I have a patient that comes to me and says, Oh, you know, I've been, you know, doing a coconut oil pull or I I uh do an ozone, I have an ozone machine and I put it in my mouth and you know, and you know, why is it not working? Why is it not working for me? And and it actually comes back to that point, right? That sometimes if the disease process gets more advanced, right, you know, it's deep in the pockets, it's not gonna penetrate there. If the bacteria is forming an advanced biofilm, it's not gonna penetrate there. That's a perfect opportunity to work with with biologic dentists to kind of help effectively, you know, treat that. So, you know, it's kind of it's you know, let's say even say it's smart gardening, right? It's uh getting the right environment together, but using the best tools to make that happen.

Dr. Rachaele Carver 21:33

Absolutely. So at home, what do you recommend? Is there something that a patient can use at home that will help with the biofilm?

Dr. Alex Volchinuk 21:41

Yeah, one of the tools that I I really like patients to do is use a water pick. So, water pick is a device that's kind of like an oral power washer, and it's capable to clean further and more effectively underneath the gum line. Um, I'll instruct patients to either use like a little bit of Food grid hydrogen peroxide kind of mixed in in a one to three ratio with distilled water, regular tap water, if that's easier to clean. And um also to utilize electric toothbrush and a rubber tip. And these three tools I think work together very well because you're disrupting the biofilm on the teeth with the toothbrush, the biofilm in the gums with the water pick. And then you're creating a tight packing of the collagen fibers that make up the gum. So the seal of the gum to the teeth can be enhanced by using a gum massager, like a rubber tip. And I find that that trif, that's like the trifecta I call it, right? The three things that if you can incorporate this into your daily routine, you're gonna really make a big dance at either preventing gum disease or really managing it.

Dr. Rachaele Carver 22:48

Awesome. So do you do any saliva testing to like to look for those, you know, pathogenic, more toxic bacteria? How do you how do you know? I mean, sometimes we know just because we've been doing this forever.

Dr. Alex Volchinuk 23:00

Yeah.

Dr. Rachaele Carver 23:00

But do you ever like to do any of those more diagnostic tests for any reason?

At Home Tools For Biofilm Control

Dr. Alex Volchinuk 23:05

Yeah, I'd love to do it. So what what we're talking about is using these new diagnostic aids that can help identify the levels um and the types of gum pathogens, right? Like kind of what are the bad bugs that we're finding in the mouth and and how much are there in terms of level. And we could do this from a very simple spit test, right? So it takes, you know, 30 seconds to do it, and we get this really unique data, right? And uh one of the things that I've and we've been incorporating this in our practice now for about eight years. And one of the things that got me really excited about it and why we do it with our patients is that, you know, it gives me a little bit of this forecasting ability, you know, to kind of take a look at patients and let them know what's to come. Right. So, you know, the as a paradigmist, we'll measure the pockets, we'll take a look at the x-rays, and you know, we can tell you if you've had gum disease, we can tell you if you've had bone loss or if there's an active infection or problem right now. But what's our tools to predict what's to come? And honestly, aside from our inference, there isn't much. Salivary testing makes it makes a big change in that, right? Because prior to the bone loss and prior to the pocket, there's an increase in pathogenic bacteria. And if we can see that trend starting to happen, well, then we can intercept it. We can treat it before that actually becomes true bone loss or or gum recession or whatever. Um, and that's a that's a big deal, right? And you know, here in the in the northeast, you know, we just had this blizzard come through, right? And you you can kind of imagine it's like what if what if you went into Sunday night, Monday morning, and you had no idea that was coming and you were just planning to go outside and think it was gonna be a normal day. Well, you're gonna get, you know, you're gonna get quite a bit of a surprise, right? And using that salary test is a little bit like getting that forecast ahead of time. You can prepare properly, you can make changes before there's a disease process that you have to deal with. So it's a big thing to use.

Dr. Rachaele Carver 25:12

Yeah. And we know, I mean, prevention is a lot less expensive, a lot more conservative, right? If we can catch these. And again, I I'm really loving the the diagnostic test too, because the one that I've been using shows some of them just show, you know, the bad ones, right? But I like to see, well, what's the balance? Because we all may have bad ones, right, in health, because like you said, right? There's all there's weeds in every garden, you know, no matter how good of a gardener you are.

Dr. Alex Volchinuk 25:39

Right.

Dr. Rachaele Carver 25:40

But it's it's when they get out of balance, right? So it's not so you may have some of these pathogenic bacteria, but what's the balance? How does that compare to the amount of good? How does that compare to the ones that make nitric oxide, right? We want to look look at those things. Um, and like you said, that helps us decide, okay, what might what's the best treatment for you? Maybe we need to, you know, switch the environment here or there, or or maybe if the bad bacteria is so out of control, maybe we do need to like just vomit for a sec, you know, and then you know, we gotta start over. We gotta raise the whole garden sometimes to start it over. So um, you know, I don't really use antibiotics anymore because I think, you know, between ozone and laser, these these tools are effective without any of the side effects. Um, but and that's why I originally got away from the first salivary diagnostic testing I was using because every recommended didn't matter what the results were, it was always antibiotics, antibiotics. And I just thought, but no, we gotta be a little we can do something different and better. So I like that too, especially because we know oral bacteria, right, they um are found in plaques, right? In our arteries. We know they're, you know, they um can activate the the plaques in the brain, the beta amyloid plaques. We know that they become more active because of oral bacteria, right? So if we catch those things early, we can I think that's what's the cool part about our job. Like we can have such a major systemic impact in a positive way by catching these things at their earliest. I mean, people generally, you know, go to the dentist, maybe twice a year, once a year, every few years, who knows what it is, but sometimes more than they go to the physician. And we're looking, you know, and we can see the progression and x-rays. You take x-rays, you can see when bone levels start going down and uh, you know, something's happening here. You know, when I was in my most inflamed, my eczema was crazy. You could see on my bite wings, I was starting to lose the cortication in the bone. I was like leaching, so I wasn't absorbing any minerals, I was using them up, and that was evidenced there on the bite wings, right? We don't think about those things. And had I not caught it and improved my health, you know, maybe by the next decade I would have osteoporosis. And yes, we can see that early um when we're looking at those things. So yeah, it's a lot of cool things we could do. So, what about um let's talk about implants and tell me kind of your take on titanium versus ceramic?

Saliva Testing To Predict Disease

Dental Implants Explained Simply

Dr. Alex Volchinuk 28:01

Yeah, yeah. So, you know, when when it comes to replacing a tooth, we have a couple options, I would say, kind of in the dental world. You know, you can have something removable, you know, like a denture or a flipper or something like that. Um, you can have a bridge, uh, which involves filing down the adjacent teeth and uh replacing the missing tooth. Uh, or there's really been some great novel technology to be able to replace just the missing tooth itself. And we we call that a dental implant. And essentially it's a screw that's placed into the jawbone. And once it heals to the bone, a tooth can be attached to that. Um and historically, actually, there were two materials that were kind of front runners for this, right? So there was actually ceramics, you know, ceramic implants that were early generation ceramic implants and and commercially pure titanium implants, right? And both of these kind of were actually developed in in Europe and in in Germany and in um in Switzerland. And one of the things that we were finding um was that the uh they were panning out very, very successfully for helping patients maintain, replace a tooth and maintain it for a long period of time. It really started to become like the primary option for for replacement. But like all things in life, people want things faster, cheaper, better, all this kind of stuff. And it and it's led to developing the marketplace where, you know, today the control, the quality of these things really kind of vary. And so, you know, I think the last I checked, it's close to 400 different dental implant companies on the market. You know, the the process to develop a new dental implant doesn't involve really any kind of novel testing or really a standard of care other than kind of showing that you're similar to another product. Um, and so I kind of I I say that because I think there's there's really an issue that I see as a periodonist a lot, which we call perimplantitis. So periimplantitis is essentially gum disease on an implant. And in the 90s and probably even like very early, early 2000s, this was not like a condition that people would see, right? This was not, first of all, it's not very well understood, but it wasn't happening as often as it happens today. Today we have patients who will have an implant placed, and as quickly as three to five years later, they're already losing major bone on this implant, right? Sometimes as much as 50 to 75% of the bone within such a short period of time. And this kind of got our periodontal world scratching our head, right? Because what's going on with this and what's really changed? And one of the big things that we saw to change was that, you know, in order for implants to integrate faster or to be stronger or to have more versatility in terms of being able to be very skinny or very short, you know, there was all these modifications that would happen to the surface that would get the bone to heal better to it initially, but it also would create a surface that is more corrosive, more inflammatory if it gets exposed. And if bacteria does get onto it, we start to get this very significant inflammation, something that we would not even see around teeth. It'd be like a moat. 360 degrees or on the implant, we'd lose this bone. Today we understand the process a lot more. We really understand that what's happening is that if that bacterial surface becomes, sorry, if that implant surface becomes exposed to bacteria, then now the biofilm can really actively propagate on the surface in a much more aggressive manner. And that creates a more aggressive autoimmune inflammation, right? And that leads to severe and rapid bone loss. When we kind of think about it, it's almost like we're coming full circle on our understanding because we want to start coming back to more pure materials, right? Because that actually really matters. May mean the integration is slower, but that long term, the lifelong outcome is much better. And so we kind of come back to ceramic implants. I would say there's definitely been some early adopters, but you know, I'm saying the last, you know, 10 to 15 years, the materials and the development of zirconia material specifically, you know, to be used to replace teeth and even to create dental implants has become so good that it's dependable, it's reliable. We're not worried that, you know, it's gonna break. And that's what I hear a lot from my dental colleagues who don't know about ceramic implants. They feel it's like those old generation implants. Oh, that's just gonna break. It's like glass. It's not, right? And they use zirconia for teeth replacement all the time. Right. Right. But they feel like, oh, no, okay. You so you're trusting it to be chomped on with, you know, you know, with 300, 400 megapascals of bite force, you know, but you're worried that it's not gonna connect to the bone, you know. So, you know, zirconia really offers a lot of key advantages. And when I say ceramic implants today, what I want to kind of clarify is that I'm specific uh specifically talking about zirconia implants, right? And zirconia implants have been proven to be durable, strong, not gonna fracture, they're not gonna break, um, and they're extremely, extremely biocompatible. And they offer a few advantages that that titanium implants don't have. One, most obviously, is the aesthetic aspect of the color, right? It's a white implant compared to a gray one. So if we're replacing a front tooth, it's much better from a cosmetic perspective to have something that's more tooth-colored. But biologically, there's some bigger advantages. And this is as a periodonist why I really love it. One is that the zirconium material is more plaque resistant. Bacteria doesn't want to grow on that surface as rapidly as it would grow onto a titanium surface. So it's not immune, but what it's a lot more resilient. So if you're on top of your hygiene, you're cleaning, you're using the water picks, the rubber tips, the toothbrush like we're talking about, and coming in for routine cleanings, we don't see that rapid pattern of bone loss like we would find with some titanium implants. And the second advantage that I find biologically is the corrosion effect. When titanium implants are exposed to an infectious environment, it's exposed to acids. And if you take a meta and put it in acid, it starts to corrode. And you start to see titanium particles leach from the implant into the gum, but also into the bloodstream and into the body. And we will find titanium particles in the spleen or in other organ systems, especially the kidneys, organ systems that filter the body. And this is a very reactive molecule, right? Titanium is going to try to form an oxide, it's going to form a connection with other cells and other oxidative species. And that can create systemic inflammation. And that's not something that we see happen with the zirconia implants because it's a more biologically inert material. So, you know, it's been an interesting paradigm shift. And sometimes I kind of feel like you almost have to re find yourself in order to know where you're where you really want to go. And I kind of feel like this has been the loop that's happened is that we've kind of come back to understanding that although it is great for things to heal so fast and and you know, to have something that's so easy that everybody can do it, what we're really finding is that if we want long-term outcomes, we want an implant that's gonna last you for your lifetime. We got to go back to the original principles and understand how the biology works.

Dr. Rachaele Carver 35:39

Absolutely. So speaking of, you know, acidic mouth, right, causing all the corrosion, are there other patients maybe, or do you do you do any prep work? Before a person's gonna have an implant, right? You you ideally want their the pH in their mouth to be neutral, right? This is, you know, one of the reasons when we we get periodonal disease, we typically have acidic mouth. Or do you notice that people with periimplantitis do they have more, you know, core comorbidities? Are they more inflamed in general, right? Maybe they have chronic itis in all different kinds of itis.

Dr. Alex Volchinuk 36:11

Yeah.

Dr. Rachaele Carver 36:12

Um, so tell me a little bit about that. Who do you think would be more prone to have the perimplantitis?

Titanium Versus Zirconia Implants

Dr. Alex Volchinuk 36:19

Yeah, well, definitely patients that have a higher inflammatory index across other body systems and organ systems, for sure. We need to look really closely at this. You know, the the the mouth is is a gateway to the body, but it's a two-way street, right? So things that the mouth affects many, many downstream pathways within the body, but we see the same thing in reverse too, right? So if there is inflammation, is there elevated blood sugar? Like, for example, patients with diabetes is a perfect example, you know, of a population group where we don't see great healing response, right? You know, if if there's uncontrolled blood sugar, right, and uncontrolled diabetes. So, you know, it it goes both ways. And and we want to make sure that we understand prior to doing any dental implants, we have a comprehensive health history for our patient with updated laboratory results, right? We want to see inflammatory markers, but we also want to see some of the key building blocks for the bone. So, for example, we might want to take a look at things like vitamin D, which is very important for bone formation, right? In fact, we can look at it kind of like a hormone. It's a it's a regulating, regulating molecule for the way that bone is going to form. And if patients have deficiency there, well, and we go and put a dental implant, you know, we're asking the body to form bone, but maybe it can't, right? And that's a big thing. And to the way you're talking about patients with periodal disease, I think that's probably one of the biggest dental induced or dentist-induced problems for patients where, you know, the oral microbiome, the oral disease is not controlled before the placement of a dental implant. Right. And sometimes I I've seen certain dentists get kind of stuck in the idea of treating just the tooth or treating just an x-ray, but not seeing the whole picture. So, you know, a patient has, you know, a tooth that breaks or a tooth that gets infected, and they say, okay, well, you need a dental implant. And they take the tooth out and they put an implant in, but what's the environment like around it? What's the health of the teeth around it? What's the microbiome? What's the overall periodontal health of the mouth? What's the pH of the mouth? All those things really matter. And I think that's one of the beauties and one of the things I love about biologic dentistry, right, is that you're trained to think big picture, right? You're trained to think comprehensively and you look at all these things, right? And it's okay to tell a patient, listen, your body's not ready for this, right? But let me help you get it there, right? And then that's how you get successful results, long, long-term successful results, you know, and and those are some, I think, big, big keys to look for, right? So is there systemic inflammation or systemic disease that's uncontrolled? Are there any deficiencies, whether there's a nutritional deficiency, vitamin deficiency, right? Is there oral disease or oral inflammation, specifically gum disease, right? Is that those I think are three key things that should be looked at prior to, you know, considering the actual placement of a dental implant.

Preventing Peri Implantitis

Dr. Rachaele Carver 39:22

Yeah, excellent. And I think I think you're right. So many of us dentists were just like, oh, lots of yeah, just go go get an implant. And again, if you have a traditional periodontist or oral surgeon, right? Again, they're not trained to think about the whole body. So they're like, oh, it looks good. Yeah, we've got some bone, let's drill it in there, right? Um we, you know, blame it on the patient. Well, you didn't clean it, you know, enough. Right. But again, you know, it has to be a team effort, right? We as professionals do what we need to do, but the we have to inform the patient what they have to do at home, right? We they only see us a fraction of the time. So that home, they need to take the steps to get that inflammation under control, get that pH adjusted, right, to create more. And like you said, as biological dentists, we can help them and give them that information where conventional dentists just aren't trained in that. So, you know, that's why we do this podcast, right? To to teach everybody. I I think it was really illuminating what you said about how ceramic, you know, not just for the aesthetic component, but the biologic component too. And man, do those fuse? I think the other thing, right, is that a ceramic truly fuses to the bone, whereas the titanium you get more of a sclerotic type of bone. Is that correct in what I'm saying there? Right? So it's not even true, good bone around a titanium implant. It works, you know. We they can last a long time, but it's not the same as healthy good bone that you see around a ceramic.

Dr. Alex Volchinuk 40:43

Correct. Yeah, we see we see a greater blood supply, greater natural blood supply around the area. And so we kind of say that's a more vital um, you know, bone around it. Um, and that and that plays a that plays an important role, right? Because we want to we need to understand that when we place a dental implant, this is not a nail or a screw that we're putting into the wall, right? And an inert object going into another inert object, right? This is a a device that's being put into a living structure. And that structure, every single cell around that implant is going to change over the lifespan of that patient. And if that environment is conducive to health, then it's gonna create balance. Something we call homeostasis, right? So if a bone cell around that implant is aged out and it's going to atrophy and a new one's gonna come in, well, that's gonna look perfectly healthy and it's gonna be a normal balance. But if we start to lose bone cells faster than we are replacing them, well, that's gonna create bone loss, right? And that surface matters, right? And and what is put into the body really, really matters. You know, and that biocompatibility concept of biologic dentistry is is is such a great thing because you know, this is I don't think enough attention is paid to that on a daily basis. I I see patients all the time, you know, they you know, eat organic, they they read the label on every single food. You're like, you know, my body's a temple, I only want the best things in it, you know, but then they'll go in, they'll get a procedure and they don't know what materials are being put into their body for the next 20, 30, 40, 50 years, right? And the effects, the long-term effects that's gonna have. Right. And that's and that's an important, important factor here to consider.

Diagnostics CBCT And Better Questions

Dr. Rachaele Carver 42:30

Absolutely. And when you talked about corrosion on titanium, I think the other thing that we're taught in dental school, but maybe we don't really think about it afterwards is having two dissimilar metals next to each other also increases the the corrosion rate. So if you get an implant next to a gold crown or a porcelain fused metal crown, you know, and those metals are different, you've got this galvanic effect you've got, you know. So there's but I think the thing about the mouth is so much of it doesn't hurt, right? So you don't realize the damage or the inflammation that's happening. That's why I really like um one of the saliva tools we use is the the silha, which it's not diagnostic, it's um just kind of a screening tool, but it shows how many white blood cells, right? Like the level of white blood cells in your mouth. And even in a mouth that doesn't look too bad when you you look at it, it's amazing when you see that white blood cell count go high, like, whoa, there is some inflammation happening here, right? Is it bacteria? Is it, you know, the different metals? Is it P like there's all these different things to consider? And I think we're really fortunate to do dentistry in this day and age with all the cool technology and all these things that we have. You know, we just got a microscope, and I'm like, whoo, you know, I barely have to talk anymore because, you know, intraoral scanners and x-rays, and then you know, the microscope is like here's what's happening. Okay, you want do you want to fix that little squiggly guy? You know, going through the let's let's uh let's get you healthy here. So I think it is a really, really exciting time, and knowing that there are so many different options out there to. consider, like you said, when you're when you're missing a tooth. So well as we're kind of wrapping up, like is there anything else um that you think we need to know about bone health or implants or, you know, your best. I mean you've listed a lot of things.

Dr. Alex Volchinuk 44:13

I'll I'll tell I'll add a couple, like a couple pearls I think that just come across my, you know, you know, come across my my chair all the time. You know, I think one is um having really good diagnostics um to understand your oral health, right? I think that it's important the first time you meet a dentist, conventional biologic, I mean hopefully biologic, you know, anytime you meet a dentist, they should educate you on what's happening with your mouth, right? What's happening with your teeth, your gums, your soft tissue, your palate, your airway, your joints. There is so much stuff that's connected through the mouth. And it shouldn't feel if it feels like you took your car into a mechanic and they just gave you a list of things that are wrong with it and told you here are the parts you need to replace it. That should be a flag, right? You should be educated on what is keeping you healthy too, right? What is working? What should you do to kind of keep this going? Because the last thing you want to do is every time you come in to see a dentist, they tell you, oh well no, now you need a new cavity. Oh now this needs a new crown. Right. The question you got to ask is why? What's happening to do that? And I think if if someone was sit down with you and really educate you on on everything that's going on with your mouth, the technology makes it very, very palatable and very easy to understand. I think that's a big one. One key part of that is is taking a 3D scan. So 3D x-rays something called the C B C T scan or a cone beam scan is a really, really important diagnostic tool to identify hidden infections, right? And that's something that is missed a lot in conventional dentistry. To date the gold standard still is just taking a two-dimensional picture of patients' teeth, right? And you miss so much. First of all, you're only focusing on the tooth itself. And second of all you're only seeing a part of the picture. And a lot of times that means infections are missed. Sometimes serious situations like a failing root canal tooth can go because there's no nerve there. There's no way the patient feels it you can go months without detecting that properly and that can become a major major infection when it when it boils over and then you know I see again as a surgeon I get referred patients like that all the time and they always ask me they're like doc did like did this thing just happen? Did this just and I'm like the reality is no it didn't. You know this has probably been there for months and it could have been treated earlier. It could have been prevalented. So getting a CBCT scan I think is a really important baseline test to to do for all patients because it will help you identify certain things that that you can't see. And I think to what we talked about in this presentation and this conversation of the salvary testing, you know, looking at new technologies and ways to predict the future course of disease so that you can prevent it. Right. Because I think that that's the true role that a doctor should do right and it's it's the it's the heart of what a biologic dentist always think about doing. It's not about what procedure can we do to help you. It's what can we tell you about yourself and what can we do to help you live your healthiest life, right? And prevent disease from happening. You know, and so I think that that's an important and a really important aspect salvary testing is a great way to get a preview of some of the things that are happening and just kind of stay really educated and ask questions. You know I think you should always feel really empowered to talk with your dentist and and be educated on everything that's going on and just realize there are no dumb questions, right? You know, just people that don't ask them right that's the only room you know for that issues you know so I thank you so much for for taking the time to uh to have me here and and to talk about this. You know I'm really really passionate about sharing the world of of of periodontal health and periodontal wellness with patients. I think it's a field that's advancing tremendously in terms of what we can do to help patients save their teeth, save their implants, and most importantly save their health because it's so significantly connected with you know systemic health issues from cardiovascular disease to um even new research on Alzheimer's prevention and how important gum health is with that to you know to nursing mothers and and and babies low birth weight babies uh pregnancy issues like there's so many corollaries of what we see with this. So get get it checked out make sure make sure that you always can look for those things. And I always I always root for you know working with a biologic dentist because that you know that's the people that really are thinking about health in a comprehensive and complete way.

Where To Find Dr Volchinuk

Dr. Rachaele Carver 49:01

Absolutely I think it's it's absolutely true what you said about biological dentists. You know again we're we're not a specialty we're a philosophy really and I say it all my dream is to never have to pick up a drill ever again because I will have educated all the people and they'll know how to take care of you know their own health and everything will just you know that's the dream. So Dr. Alts tell us um if people want to find out more about you if they're in the New York area and want to look at your practice how can they learn more about your practice?

Dr. Alex Volchinuk 49:28

Yeah absolutely absolutely yeah so we have a two office locations in New York City on the Upper East Side as well as in Greenwich Connecticut. You can go to our website www.mytetrahealth.com you can also find us on social media on Instagram at uh my tetrahealth as well and uh probably best number to reach us at is 929-2930200. Uh we offer both in-person and virtual consultations and we're really trying to make this really easy um and my philosophy is all about educating and empowering you so I want you to take the opportunity and I look forward to to talking with you and one day meeting you fantastic well thank you for taking time at the end of your busy day and um always love seeing you and I'm sure we'll we'll be together again soon at some all the events coming up.

Consultation Offer And Closing

Dr. Rachaele Carver 50:23

So again thank you for your expertise and I hope everybody got some great pearls and some good tips here so that you can take care of that gum disease if it's starting if it's more moderate we're here to help you. So I hope everyone has a wonderful rest of your day and we'll see you on the next episode. Huge thanks to you our amazing listeners for helping us climb into the top five percent of podcasts in the oral health space with all the love and support we've been getting many requests for one on one consultations. So we made it happen. Are you ready to take your oral health to the next level click the link in the show notes to book your personalized consultation and let's kickstart your journey to a healthier brighter smile starting today. We'll see you then