In this episode, Dr. Nammy Patel of Green Dentistry in San Francisco discusses brain detox through the lens of oral health, sleep quality, and airway function. She shares her perspective on the glymphatic system, tongue position, sleep apnea screening, oral appliances, and bedtime oral care.
John Maher: Hi, I’m John Maher, I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health and author of the bestselling books, Age With Style: Guide to a Youthful Smile and Healthy Living and Total Wellness: Understanding the Link Between Your Teeth and Your Health. Today, we’re talking about brain detox and how it starts with sleep and the airway. Welcome, Dr. Nammy.
Dr. Nammy Patel: Thanks for having me, John.
Brain Fog, Oral Health, and the Airway Connection
John: Sure. Dr. Nammy, when patients talk about brain detox, how do you connect that conversation to sleep quality and airway health?
Dr. Nammy: One of the most important things that patients need to think about when they think about longevity for the brain neuroplasticity and staying sharp is the mouth. It is the integral part of the brain physiology and pathophysiology. The mouth is very close to the brain, and it’s really important that we look at it. The two most important things we start with as dentists is going to be the oral microbiome, really look at the specific bacteria that cause Alzheimer’s. So we really want to make sure there’s no snake-like bacteria that are found in gum disease go into the brain and are linked to Alzheimer’s. So that is a very important first step that we do as dentists.
Now, the second step that we look at is always going to be the functional airway because the tongue is really an integral part of the brain. The palatoglossus muscle, it’s a tongue muscle that connects the tongue to the roof of the palate, is connected to the vagus nerve, which is your rest and digest nerve. And we want that very active because it helps lower inflammation.
If we’re thinking about brain fog, if we’re thinking about not being really sharp when we wake up in the morning, it’s constant inflammation. Inflammation is what connects the entire body, the mouth in all of disease. It’s either a toxin which causes inflammation, which causes disease. So our focus as dentists is to make sure that we’re looking at the oral microbiome. We are looking at the tongue positions. We’re also looking for hidden infections like cavitations or CSRs as they’re called. Those are areas of wisdom teeth extraction or any tooth extraction that just didn’t heal really well. And they tend to harbor bacteria, viruses, parasites in those dense or low density bone areas.
Now, those are areas that are very connected because right here we have foramina basically where our cranial nerves from the brain come out and these bacteria viruses or parasites can have access to the brain and lead to a lot of brain fog, a lot of diseases and a lot of chronic conditions.
The other thing we also look at is failed root canals. Are there teeth that are dead that have an infection? We want to get rid of those infections because those are chronic low grade infections that over a period of time cause diseases. And one of the most common ones we hear about is brain fog, forgetfulness. The neurons don’t connect very well.
We’re also looking at mercury. Mercury is a neurotoxin. It has been documented, research has said so. Europe has banned silver fillings. They no longer are allowed in the mouth. So these silver fillings, what they do is they off gas as you’re chewing and grinding or if you’re having hot tea, that mercury vapor goes inside and binds to those nerve cells so it doesn’t allow them to grow and wire together. And what it actually does, it degrades them over time.
So a dentist is really important in your brain detox program because the conversation is very long and very deep. It starts with a simple thing like a cleaning, but it goes into deep things like cavitations, your sleep, your HRV, your vitamins, your sleep quality, and really looking at how can we help you stay smarter? How can we help you stay sharp? How can we avoid that brain fog? And most importantly, how can we give you that confidence in health so that you know when you’re 100, 120, you have your ability, which is to move, and your brain capability, which is to think and be in charge of your own body, your own health and your own life, which is so precious as we get older.
The Glymphatic System and Sleep Quality
John: And what is the glymphatic system in the body and why does deep sleep matter for the brain’s natural waste clearance process?
Dr. Nammy: So the glymphatic system is a beautiful system. We are all aware of the lymph system. So we have our blood flow, which are like highways, which help the blood flow. And alongside of that, we have a lymph system which takes out all the toxins and the waste and then we poop or pee or sweat it out. That’s where our lymph system is really helpful with.
In our brain, that specific system is called the glymph system, with a G, and we like the glymph system because it helps detox our brain. Our brain uses so much energy throughout the day because our brain dictates every autonomic and also things that we control. It controls all of the actions that we do on a daily basis. So it uses a lot of energy, there’s a lot of blood flow and there’s a lot of waste. And there’s two ways why it’s so important.
I mentioned the oral microbiome. We want to make sure that that’s super healthy because if there is bacteria in the brain, it’s going to make that glymph system leak. When that glymph system leaks, all those toxins accumulate in the brain and that is a problem.
The second thing is when you’re sleeping, we want good REM sleep, rapid eye movement. It’s not about deep sleep, it’s about REM sleep. I know everyone who has an Oura [ring] says, oh, my score is so great because I am tracking it and I have great deep sleep. Now it’s not about deep, it’s about REM. The reason we want REM is called rapid eye movement. That means that your entire body is paralyzed, only your eyes are rapidly moving. The reason why they’re doing that is because your entire body kind of shuts down. We want that to happen so that your body can repair itself.
That glymphatic system is taking all the toxins out of the brain. It’s taking all the toxins out of the body and working really hard to… Well, one is to pull the toxins out. Second is to regenerate, make sure it’s killing off the cancer cells, make sure if you have tissue damage, it’s going to go ahead and repair it. And that rapid eye movement is critical. And so if we’re waking up with brain fog, if we’re waking up feeling exhausted or tired, it’s most likely because our glymph system didn’t get a chance to clean it up. It is a vacuum cleaner. That vacuum cleaner kept getting interrupted. You could have been waking up in the middle of the night and not knowing it. When you wake up, it stops the glymphatic system from working. Or if you’re deficient in different vitamins and minerals, it’ll stop your glymphatic system from working at night.
So it’s really important that you sleep and you sleep and have the rapid eye movement. Now you’re wondering as a dentist, what does this matter? So what I see in my patients is patients who have sleep apnea do not sleep really well. They do not get good REM sleep. They don’t get good REM sleep. They’re using a CPAP, they’re sleeping eight hours a night and still waking up dreadful. They’re tired, they’re exhausted, they don’t dream and they have brain fog and are still not feeling optimal. We want to feel optimal. Now, the second thing I see is those are my sleep apnea patients. I also find the same thing in my patients who don’t have enough space for their tongue, either this way or this way. So if the tongue is not resting at the roof of the palate, we’re not activating that vagus nerve.
We’re not activating the “rest and digest”. We’re not activating that glymphatic system to be active and be the vacuum cleaner and clean all the toxins and disease away. And so one of the things I see in my patients and I always look out for in their cone beam scan, we actually look at a cone beam scan to make sure we can see the tongue position, make sure that the tongue has enough space, making sure it’s at the roof of the palate.
We’re also checking the patient’s sinus to make sure that the sinus is not filled with bacteria, viruses or fungus. Many times patients have been exposed to black mold and that mold harbors in the sinus and when that happens, they’re not able to breathe really well and they’re not able to sleep really well. So that’s a huge concern. So as dentists, we’re really deep diving in to make sure that the glymphatic system works really well or making sure that there’s no bacteria getting into the brain.
We’re also making sure the tongue position is proper so you’re getting proper airflow through the night so that you can sleep really well, have dreams, and your body vacuum cleaner can go and suck up all the toxins and make sure that it is repaired when you wake up with joy.
Sleep Apnea Screening and Oral Appliance Options
John: How do oral appliances help with sleep apnea and, like you said, with that tongue position and the airway?
Dr. Nammy: There’s so many different appliances that exist for sleep apnea or oral appliances, whether you have sleep apnea or something we call upper airway resistance, and we want to treat both. I prefer to treat upper airway resistance before it turns into sleep apnea. The reason being is that when we can catch it early, you’re able to get better return on investment of time, effort, energy and money. So I prefer to get things earlier than sleep apnea. Now, when we’re checking things out, I’m screening my patients through a CBCT scan for their sinuses, their tongue position, their windpipe, and also their jaw joint.
Secondly, I work with a medical practitioner to make sure that we are screening our patients. We’re looking at a sleep study. And when we’re looking at a sleep study, we’re looking at how many times does a body drop in oxygenation levels below 3% or at 97% or at 96%.
Also, what’s the heart rate like at night? Also, what’s the RDI like? Are we wheezing for air? Are we snoring? What are we really doing at this restorative time that we’re supposed to have to regenerate? Is our body under constant stress or is it really resting, digesting and fixing itself? And that is our main focus. So we do that through a CBCT scan, through posture analysis, and also partnering with a medical doctor to be able to do screenings for sleep. And we really deep dive in to see how can we help our patients sleep better. And then we select appliances. The appliances we select are very different depending on where the problem is. If the problem’s only on the upper jaw, we expand the upper jaw. If the problem’s on the upper jaw and the lower jaw, we expand both. Sometimes we even add in exercises for the tongue called myofunctional therapy, tongue training exercises in order to tone the muscle of the tongue.
Tongue Training and Airway Function
Yes, guys, we go to the gym for our bodies, but sometimes we have to go to the gym for our tongue too, and it makes a big difference when we can get our tongue to rest at the roof of the palate. And then sometimes we even need adult tongue ties. We’ve all heard about children having tongue ties, but sometimes adults need tongue ties too because they might have been okay when they were younger, but throughout their age, they’ve had braces, they’ve had some sort of situations where their tongue doesn’t have enough space and nor does it have mobility. And that tongue tie really helps with mobility of the tongue so that it can rest at the roof of the palate so that it can stay closed during the night and breathe really well.
Sleep Hygiene and Bedtime Oral Care
Now, we’re talking about appliances, which is great and all, but we also need to look at sleep hygiene. Sleep hygiene is a basic step and I want to give this to you because you can do this in the comfort of your own home and you can start today. I recommend this to all my patients. So my thing is you come home, we must shower. Let’s get all the toxins of the world cleaned out, shower first. That water also helps your nervous system relax and get ready for bed. Let’s clean out those sinuses to make sure that you’re going to be able to breathe really well through the night.
So shower, clean your boogers, floss your teeth, brush your teeth, scrape your tongue, put some coconut oil on your gums and mouth tape. I always say you can do something as simple as scotch tape in the comfort of your home. You just tape it like this and do some box breathing, four rounds of box breathing, breathing in for four seconds, holding for four seconds, exhaling for four seconds, holding for four seconds.
When you do that at least four times, it really starts setting your neurology into “rest and digest”. And we really want to do that so that you can go to sleep and stay asleep because those are two different things and we need to address them both because as we age, they become a bigger part of our daily lives. If we don’t sleep well, we don’t feel good. We’re cranky, we’re tired, we can’t focus and it’s a huge problem.
John: All right. Well, that’s really great information, Dr. Nammy. Thanks again for speaking with me today.
Dr. Nammy: My pleasure.
John: And for more information about Green Dentistry, you can visit the website at sfgreendentist.com or call 415-433-0119.
