Dental Myths & EDS Truths with Dr. Audrey Kershaw (Ep 161)

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Dr. Audrey Kershaw: [00:00:00] When you know what periodontal EDS is, when I saw this man, it was like, why has this not been picked up before? Because when you know what you're looking for, it's obvious When you don't know about it and you don't know that it is a a thing very hard to pick up.

Dr. Linda Bluestein: Welcome back every bendy body to the Bendy Bodies podcast with your host and founder, Dr. Linda Bluestein, the Hypermobility md. Be sure to also check out my bendy bulletin on substack. You can subscribe@hypermobilitymd.substack.com. I'm so excited to chat with Dr. Audrey Kershaw again today. I've gotten so many questions from listeners like you who have EDS or HSD, and they have teeth and gum problems, and they wonder if they're connected or not.

So this is going to be a very important conversation. Dr. Audrey Kershaw [00:01:00] is the founder of Oral Surgery Scotland. Her career has taken her all over the uk, gaining experience at nationally recognized centers for oral and maxillofacial surgery before settling into an associate specialist post at Dundee Dental Hospital and School in 1998, where she practiced and taught until 2017.

Through this, she has been involved in the education of well over a thousand of Scotland's dentists. Audrey works with the Scottish Government's focus group on rare diseases and the Aler Danlos Society. She has reached over 1000 clinicians and healthcare professionals with her teaching sessions on hereditary disorders of connective tissue and EDS.

I'm super excited about this conversation and can't wait to get started. As always, this information is for educational purposes only. As not a substitute for personalized medical advice, stick around until the very end so you don't miss any of our special hypermobility hacks. Here we go.

Okay. I am so excited to be back with Dr. [00:02:00] Kershaw. We have had so many great conversations over email and things, but this is going to be the second time that we've gotten to chat this way. So thank you so much for coming back. Thank you for having me, Linda. Thank you. Yes, yes. Um, one of the things that comes up so often that I feel like a lot of people have questions about, and so it's really important to chat about, especially as it pertains to hereditary disorders of connective tissue, EDS, HSD, et cetera.

Is wisdom teeth extraction? Are we extracting them appropriately? Are some people perhaps over extracting? Um, how do we know if wisdom teeth actually need to be removed? Um, what can you tell us about wisdom teeth extraction? 

Dr. Audrey Kershaw: Yes. Um, this is a question that comes up a lot, especially in in chat groups when we have patience in and with parents.

Wisdom. Teeth do not always need to be removed. Sometimes they'll come into position, sometimes they won't come through at all. Sometimes they won't give [00:03:00] any trouble. Mm-hmm. Um. When I first qualified Linda in 1987, uh, we were removing many, many more wisdom teeth than we were now. So I'll, I'll, I'll just give you a little bit of a potted history of it, of what it was.

From 87 to 2000, we were quite happy here in Britain. We were removing whatever wisdom teeth we wanted, it seemed about right. We then got some nice guidelines out and that was in the year 2000. And we were really only told we could remove wisdom teeth if they had given problems. And, um, this went on until about 2012 and we weren't really all that happy.

I wasn't very happy as an oral surgeon 'cause I could see we were going to have issues. So in 2012 we had a paper come out by Tara Renton, who I've discussed with you before, a professor of oral surgery in London and a, a colleague. I qualified with Louis m Cardo. And this paper was great 'cause what it basically said was after the guidelines came [00:04:00] out.

We were now removing more wisdom teeth than we were before the guidelines came out. Oh, they were trying to stop us removing so many, and what we were doing was removing wisdom teeth. I think on average about seven or eight years later when we had decay in the tooth in front or gum disease. And so this wasn't very sensible.

So this sort, this paper was great. It opened up the whole debate and, um, we're now back to somewhere a little bit better after everybody has sort of argued it out. And we've now got new guidelines. 20, 20 20. They're all College of surgeons guidelines that we're all maybe a little bit happier with. Mm. And that's what's happening in Britain, uh, over with yourself in the states.

What we in Britain believe is, uh, and I've spoken to colleagues, and this is true, that for many, many decades everyone seemed to have their wisdom teeth out when they were in their late teens or their early [00:05:00] twenties before they went off to university. And we now all seem to agree a little bit more. A lot of USA, um, guidance has come out on it.

The Brits and the Americans are actually agreeing on the guidance. They're, and they're endorsing each other's guidelines. So we're, we're getting a bit more nearer, they're trying to be a bit more sensible about what we're doing, but I feel in the states it takes a long time to change how people work.

And I think generally still more people are getting their wisdom teeth out younger than in Britain. Um, so we have to think, um, what are the good reasons for taking out wisdom teeth? Yep. And this is all in the 2020 Royal College of Surgeons Guidance, which Tara Renton was part of. I've sent you the link to that, Linda, and you might be able to share that with your mm-hmm.

Um. Uh, with, uh, the people listening. So [00:06:00] it, it's just really obvious if you've got decay in a tooth in front, if you've got a decay of the wisdom tooth, if you've got a gum problem. Um, we've now got in there medical issues. If you've got medical issues, say if you might be needing to go on a transplant list or if you might be having chemotherapy for some blood cancer, sensible to get those teeth out.

One interesting thing, the Royal College of Surgeons guidance did say was, um, on average 85% of the people with wisdom teeth do end up having them out eventually. We've got, remember that it's much easier as the guidances, which is all based in peer reviewed publications. Wisdom teeth are much easier to take out under the age of 25.

The bone is much softer and everything else. So, uh, we need to be sensible. We need to see each case on its own merits. And decide from there. But it's definitely not, if you have wisdom teeth, you'd [00:07:00] definitely have them out. Mm-hmm. Um, so I think N of D who's interested in it, go and read the Royal College of Surgeons Guidance and also the, uh, American Public Health Association guidance and the other American guidance, which I've given you as well to put on your website there.

But we've gotta have good reasons for taking them out, but we've gotta think forward as well. Mm-hmm. To whether they might need these out in the future. 

Dr. Linda Bluestein: Oh, that's such great information. So, so not everyone has wisdom teeth though. 

Dr. Audrey Kershaw: Um, not everybody has them. I'm not sure what the, the figures are at them. I think it's maybe 85% of people.

Uh, sorry. Have them, uh, a certain place, I think in South America where most of the population don't have them, so I'm not going to be going there as a oral surgeon to work. Right. But most people, I think in the states and in Britain have them. 

Dr. Linda Bluestein: I know that you often first recognize connective tissue disorders.

When you are doing a consultation [00:08:00] for somebody for wisdom teeth extraction, what are the things that you are seeing that makes you suspect a connective tissue disorder? 

Dr. Audrey Kershaw: So I think as we said in the previous podcast, we did, Linda, I, I had my eyes open to this in about 2017. Until then, I didn't see LERs Danlos, but now I see it in one, one in eight of my patients, regardless of what they come to see me for.

Whether that's wisdom teeth, T MDs, or oral facial pain. So I see it in a lot of my patients. I now have it. So my nurses, the managers, reception staff quite often pick them up before I do. We can pick it up from a referral letter. The patient's anxious, local anesthetic hasn't worked. Um, things along those lines.

Yep. Um, so, you know, when I go out to get my patient from the waiting room, they're looking anxious. Uh, we know what to do to get this patient less anxious. Yeah. Um. [00:09:00] I now have a question in my medical history, does local anesthetic work for you? I ask every single patient I see and I ask them three times.

Um, if, and if they say, well, yes it does. I say, well, does it really, do you still feel any pain? 'cause we really need to know. And that is a big indication that they could have a connective tissue disorder. I, I would quite often look down at them sitting in the chair. Linda and I can actually see their fingers are very, very bendy because they're stressed and they're playing with their fingers.

I can see their fingers are bendy when we, if we've not picked the case up before we started, which would be rare, sometimes discover during taking the tooth out. And that could be the local anesthetic could fail then, because more of our patients are younger, their teeth are better, so they haven't had fillings or any.

Dental work done before, so this might be the first time they're having, uh, to be numbed up. And so we find the local anesthetics not working. [00:10:00] Sometimes they can bleed a lot, sometimes they can bruise, but that would obviously be a, uh, several days afterwards. As you know, with any surgery, Linda, we also see poor wound healing and infection more in these cases.

One thing that even my nurses can point out now is when I've got the patient numbed up and I'm making a cut with my scalpel, they will see that this tissue is behaving differently. And that's because we've seen so many of these cases. Yep. The tissue can be fryable, it can be difficult to stitch it back over.

It's difficult, but we can still absolutely do it, but it's nice to be able to recognize these cases and what's going on there. Yep. Yeah. And one thing I would say, Linda, is it's really quite funny, uh, you know, with appearing on your podcasts and everything else in the past year, in the past six, six months, I've had people from Thailand, Italy, Spain, the States, Ireland and [00:11:00] Australia, wanting to come to see me in Britain, to have my wisdom to, to have their wisdom teeth out.

That is what the current state of affairs is like, that these people find it very hard to find dentists who know about ER's, Danlos. Mm-hmm. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Audrey Kershaw: Um, so. This is why we do these podcasts to 

Dr. Linda Bluestein: try and spread the word. Right. Right. That's so interesting. I actually had a listener when I shared that I was gonna be talking to you again, and she asked a question about the, the whole issue of the local anesthetic efficacy.

And she said that when she tried to talk to her oral surgeon about it, the oral surgeon said, there's only two cases in which that can be the case where you don't numb up. And one is because you are misinterpreting like a pressure sensation as pain. So, um, you're still getting numb, but you're misinterpreting the sensation.

And then the other had to do with like a nerve abnormality that, uh, that nerve variant that somebody might have. Yes. So that's really [00:12:00] interesting. Yes, Uhhuh. Yeah, 

Dr. Audrey Kershaw: just, uh, before I came on the podcast today, I had a lady called Jenna from the States message me this lovely email just to say she's had one wisdom tooth out.

She needs the others out, and she is struggling. An aesthetic doesn't work, sedation doesn't work, and she doesn't know what to do. So Jenna, I've got your email. I've replied, and I hope you managed to get the care that you need. Yeah. Mm-hmm. Mm-hmm. One other thing I should probably say is with wisdom teeth in younger people, and this is just what I personally have noted, we've not done a.

Trial on it or whatever. Sometimes the bone seems to be so much denser. 

Dr. Linda Bluestein: Yeah, that's fascinating. 'cause you wouldn't necessarily expect for the bone to be denser like that. So that's really, really an interesting finding. Yes, 

Dr. Audrey Kershaw: yes. 

Dr. Linda Bluestein: It's, yeah, but hopefully my colleagues can all take this further in the years to come.

Okay. And what should patients with EDS do if they know that they're going to go for [00:13:00] wisdom teeth extraction? What, what kind of things can they do to hopefully optimize the outcomes 

Dr. Audrey Kershaw: we need to get the dentist reading up on everything they can with this? What I always say, and we've said in previous podcasts, Linda, is we need the patient to help as much as they can because it's not the dentist's fault, it's not the doctor's fault that they dunno about this.

Um. I shouldn't say, but I will help and update. If they send me an email, I will send them links to send to their dentist. They can get all the links off your podcast, Linda? Basically. Yeah. Yes. But they need to help their dentist to understand what EDS is like. If the problems, and this happens a lot, the dentist can message me and I will speak to them.

They can watch the podcast I did with you back in December of last year, which I think is a great one, explaining the science and whatever behind it. So they need to help their dentist know about this. And there's people like myself, yourself, others that will help them if they're needing help. [00:14:00] So it's basically just, um, trying to help them learn about this.

Um, the patient. It, I think it also helps if the patient has faith in the dentist that is doing it. Um, I know in Scotland, I know in Britain we are really spreading the word on EDS now through the talks myself and my colleagues have done, and more and more dentists are getting to know about this, but we're still not by any means finish the work we need to 

Dr. Linda Bluestein: do.

Mm-hmm. For sure. And what if, what do you do differently if you suspect that a person has cranio cervical instability or CCI? 

Dr. Audrey Kershaw: Yeah, so, um, I have never had a patient come to me and say they have CCI. Mm-hmm. I think in every EDS patient I would suspect, and so I very, very gentle in the notes.

Gentle three, three times in my [00:15:00] notes overemphasize, you've got be gentle. So when patients have wisdom teeth out and have it done under. They can be numbed up, they can have sedation or they can go off to sleep. To me, the much more gentle way of having it done is to be numbed up, to still be with it, to know what's going on.

Then they can protect their neck, they can get into the position I want them in. Really, I think it's selfish because I much prefer one working when they're just numbed up. Yes. Mm-hmm. Um, because it's easier for the patient. Yep. I can talk to them. They can put their head where we need it and they can do exactly as we want.

There are, you know, uh, peer reviewed papers out that say the complication rate under at least ga and I think sedation as well is higher 'cause the patient cannot do what we want them to do. And that goes for nerve damage as well. So, um, have a good chat with your dentist. I know you had a podcast or something recently and you were saying if you're going for dental work, put on a [00:16:00] collar, that would be a great idea As long as the dentist is able to work around the collar.

When I take out wisdom teeth, Linda, patients are worried that they're not going to be able to open their mouth wide enough. They're not gonna be able to get into the positions we want. What I always say to them is, I don't need them to do anything. What, what I need them to do is just to let their mouth drop, and that is the best position for me.

If I'm taking out a wisdom tooth, we take it out from the side, we're inside the mouth, but we're on the side. If they open really wide, the cheeks are in the way. We can't get into it. So the ones that really try hard for is they're making it harder and have to say, thank you so much for trying hard. Would you just let your jaw go to where it feels comfortable?

Mm-hmm. Yeah. And that makes it so much easier. So I don't have them, I would very rarely have them with their heads in uncomfortable positions. Yes, every so often with a difficult tooth, but it's not that often. Very, very rarely I have to do that. So [00:17:00] I think we've just got to be so aware of the spine. Now, the other thing I would say about this is Linda.

Are so underdiagnosed. So I think we have to be assuming every could have these neck issues. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Audrey Kershaw: And just treat every. What they do. 

Dr. Linda Bluestein: Yeah, yeah. I agree that, I know that the guest who made that comment about wearing the collar I was as, as an anesthesiologist who's spent over two decades in the or. I'm thinking there's downsides to that.

There's downsides to everybody suddenly showing up at a collar. And instead, I think that everyone who's managing an airway doing surgeries, like you just said, I think that was brilliant. We all need to be aware that there are people, way more people out there than we think who might have a connective tissue disorder and might have issues with their neck stability.

And therefore we should be, like you said, gentle, gentle, gentle. And if somebody can understand this concept that, uh, procedures that can [00:18:00] be done, 'cause of course there's many more besides wisdom, teeth extraction procedures that can be done under local anesthesia instead of under general anesthesia. Then you can, as the patient, you can let the surgeon know.

Hey, that position's not comfortable for me, and you can protect your joints so much better than if you have a general anesthetic. I think oftentimes people think, oh, the general anesthetic is safer. Of course, it depends on the surgery. There isn't always that option, but I'm really, uh, grateful for your explanation of that.

Thank you, Linda. Thank you. So I wanna move on to another topic, if that's okay with you? Sure. Okay. Okay. So oral appliances, um, do they help with TMD? What are your thoughts about that? So Linda, uh, we could 

Dr. Audrey Kershaw: talk for at least three hours on this. At least three hours. Yeah, sure. Yes. And, and I would maybe suggest this would be a great other podcast if you've ever time in, in, uh, the future.

Um, appliances help for some TMD. 

Dr. Linda Bluestein: [00:19:00] Mm-hmm. 

Dr. Audrey Kershaw: I would direct you to the Royal College of Surgeons. Get it right first time. TMD. Guidance on this, and this again, Tara Renton, professor Tara Renton from Kings. She was one of the co-authors in this, and Emma and Justin, uh, from the northeast of England. That is what we need to look at.

It's an absolutely marvelous document that ev everything is researched to the health, peer reviewed journals, comparisons, and it really just breaks everything down. I've sent you the link for that as well, Linda. Mm-hmm. Yes. Yes. And I will have all those in the show notes. Yep. Perfect. That'd be absolutely brilliant.

So they will help for some, they won't help for others. They work in some hands and they don't work in others. Okay. So it's very much, again, on a case by case basis. But for some s done lost patients, these definitely do help. Okay. 

Dr. Linda Bluestein: Okay. And then I think we probably, uh, well, not probably, we definitely need to have a conversation [00:20:00] about TMD and really focusing on those, uh, those guidelines, which I think are, are really, really great.

I've looked at them myself because as you know, TMD is something that I have been struggling with for quite a while. Yes. Doing knock on wood, doing pretty well nowadays. But, um, so we're gonna talk about that in a future conversation. And I think we also, in a future conversation should talk about oral appliances for obstructive sleep apnea and how those may or may not affect, uh, TMD as well, or temporomandibular dysfunction.

Dr. Audrey Kershaw: Absolutely. And the only thing I can say to you about that is Tara Renton. Okay, we need Tara. Perfect. We need Tara. Tara is, sorry Tara. You're one of my heroes. Tara and I don't have many heroes in the world. And Ta Tara is absolutely brilliant. 

Dr. Linda Bluestein: Okay, well, we'll definitely be be having her on to, to cover that.

Okay, great. So let's talk about some must do habits for oral health because part of why I wanted to have this conversation with you is because there have [00:21:00] been some. You know, like maybe more offhand comments made about dentistry and problems that people with EDS might face. And I feel like it's really important to understand that these things are very nuanced.

Um, there's that saying, if you've seen one EDS patient, you've seen one EDS patient, right? So you're in there dealing with people's teeth all the time, and Absolutely, of course this is, yeah. This is a population now that you are seeing a lot of, because you're, the word is getting out that this is what you, this is what you do.

So can you give us some top habits for oral health in particular for people with hereditary disorders of connective tissue, EDS, HSD, et. 

Dr. Audrey Kershaw: Yeah, so I, I think Linda, um, it's important to say that most of the oral and dental issues patients with EDS have, are not specific to the EDS. Uh, the general population have these issues as well, and I can understand how people have EDS, they can think everything is related to the EDS.

Most of [00:22:00] it with the dental and oral stuff is not. And so this is just good general oral health advice that we are giving here. Okay. So, um, the important things we need to remember for oral health are diet, cleaning your teeth, and reducing sugar. Okay. Now I think we need to divide up as well what oral health is, and that would be, you can have decay teeth or you can have gum disease.

That, that's a, just very briefly. It's, it's simply broken up. Okay? Mm-hmm. So, um, let's talk about gum health a little bit there. Okay. For the general population, um, I'm not sure if you're aware gum health has a really big bearing on the rest of your general health. Multiple peer reviewed papers to see with diabetes.

If you can sort your gum health, your periodontal health, you can [00:23:00] reverse your diabetes. Wow. Now I know people are gonna be listening to us and thinking, is she talking? Is she talking sense? We're absolutely talking sense. Go away and do a Google search on it. You can make your diabetes much, much better, your type two diabetes, and you can come off, uh, a lot of your medication, if not all of them.

Um, it also goes the other way around as well. So that would be if you get your diabetes under control. If you're more sensible with your diet and everything else, you can sort your gum disease. So I think that's something a lot of people are not aware of, Linda, but I think it's a very, very important point now, gum health, that's also tied in with things like heart disease, premature labor, and Alzheimer's disease.

Now, to me, when this all came out, I don't know, 5, 10, 15 years ago, these are massive, massive things from spending two minutes night and morning, cleaning your teeth. [00:24:00] We can have such a big impact on the general health of the nation. Mm-hmm. And yeah, just very, very important. 

Dr. Linda Bluestein: Yeah. Yeah. That, that sounds so important.

And one thing I really wanted to ask you about, because I have this habit of sipping my coffee and there is sugar in here 'cause there's chocolate milk in here, I have to confess. So how bad is that? And you know, uh, you know, of course you don't wanna hear that you're doing something bad, but at the same time, if you are, it gives you something that you can change that will maybe make a big difference in your health.

So what should I know about that? 

Dr. Audrey Kershaw: So Linda, that's a really good point to bring up with me saying to reduce the sugar in your diet, it's the number of times a day you have sugar. That's important for, uh, having the dec teeth. So I, I, the current advice is sugar no more than four times a day. So that, that, that means if you have one sweet now, one sweet in 20 minutes, that would be counted as [00:25:00] two sugar episodes.

So try and have all your sugar, uh, at once when we say that again. Um, we should be reducing our sugar to the world, world Health. Uh. Advice on sugar and I think that for an adult is about 35 grams a day. What I always say when I'm talking to patients about this is if you are looking after your general health, your dental health will naturally follow.

'cause if we're on no more than the world health say a day, it would be very hard to have that. So you were talking about your coffee with chocolate milk in it. That sounds a wonderful combination. But I think, I think would you drink this through most of the mornings? You would just have a sip every now and again.

Yeah. So we are very much on the same side as you Linda. We're not meaning to give you a hard time or make you feel bad about this, but that is very, very damaging. If you are having a, a coffee with chocolate milk in it, you should maybe try and drink it over, I dunno what would be reasonable. Four or five minutes.

Dr. Linda Bluestein: [00:26:00] Mm-hmm. 

Dr. Audrey Kershaw: And then that would be counted as one sugar attack, one acid attack with how you are having it. You're really going to be a big, big risk of a lot of decayed teeth. Mm-hmm. Um, I don't know if you're happy for me to ask more. Do you have much decay in your mouth? 

Dr. Linda Bluestein: Well, well, I am very paranoid about my teeth, which is ironic given that I've been having this habit.

But I, um, I go to the dentist very regularly and I always, you know, I use the, I use the electric toothbrush and I floss and all of those things, and I generally have been doing okay, but at the same time, I, um, I actually have a magnifying mirror and I do my own, like scraping of my teeth when I, when I, uh, when I see things on there.

So I. I think that if I were to stop drinking my coffee in this way, I do see how that could very likely improve my oral health. 

Dr. Audrey Kershaw: Okay, so lemme just say there, we're getting a few issues mixed up there. By you scraping your teeth, scaling your [00:27:00] teeth yourself, that has got nothing to do with decay teeth.

Okay? Oh, okay. The decay teeth is from the sugar. The, the scraping your teeth is going to improve your gum health, but it's not gonna do, it's not really gonna do anything about decay teeth. Oh. If you're having, if you're having these three, four hour sugar long attacks, we would call them acid attacks, sugar attacks, uhhuh brushing your teeth is, there's a limit to how much brushing your teeth is going to help that.

So what happens when you have a, a sugar attack is the bugs eat the sugar, they produce acid, and then the acid eats away little bits of your teeth. If you stop having. Having the sugar, your saliva has time to get the minerals from the saliva back into the teeth to re to re umhe the teeth. And we can stop the damage with you having sip after sip.

I can see you've gone for water now there, Linda, have you [00:28:00] I I'm feeling guilty enough that I switched to water. My goodness. We have, we have got you a completely changed character. So we need to keep sugar to meal times and one other episode in the day. And if you're having sugar, try and have it all at once, but remember to try and keep two within the 35 grams or no more.

Of sugar. So I, I think that's a really important point to get across to your listeners. Um, what I find, uh, Linda, is this is stuff we knew when I was a student 38 years ago, and we have still not got the message across to highly educated people. Where I live in Dundee and the people I mix with, I have had to explain to every doctor, uh, doctor, educated scientist in our neighborhood who my children have been friends with, this is what I want my children to do when they come to your house because this is what causes decay.

And they're all amazed that it's the number of sugar attacks a day doesn't matter if you're having three [00:29:00] kilograms at once, that's going to do no more damage than one gram. Mm, at once. Mm. So you can tell I feel quite passionately about it. You know, we are spending all this money on mouthwash and toothpaste and, and special things to try and protect your teeth.

If we could only get everybody to follow the rule of four episodes of sugar a day as maximum, we'd be so much better off. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Audrey Kershaw: Okay. That's, I've finished, I've finished the lecture to you on 

Dr. Linda Bluestein: that one, so I appreciate it because, you know, finding things that we can change and potentially improve our health because, you know, I, I worry about brain health, you know, there's a history of Alzheimer's in my family and so I definitely want to do everything that I can to help my own glucose tolerance and, you know, risk of heart disease and all those other things.

So thank you. I really appreciate that. And, and what about bleeding gums? What should we know about 

Dr. Audrey Kershaw: that? Okay, so let's talk about gum health then. Um, bleeding gums are a sign that your gums are [00:30:00] not healthy. So we quite often have patients in whether they've got Ehlers-Danlos Syndrome or not, and they complain their gums are bleeding and they don't want to brush them because they're bleeding while they're doing exactly the wrong thing.

The gums are bleeding because the gums are not healthy. So we need to get them to ignore the bleeding and brush more, floss, more clean in between their teeth more. If they can do that with a dental professional's help, if they can do this well, the bleeding would stop within four or five days. Okay? The bleeding is a really good early warning sign that there's something going on and we need to be cleaning better.

And we need, uh, the need the dentist, hygienist, therapist to be helping you to learn how to clean better. And again, a lot of people do not realize that when they find an area bleeding, they think they're damaging it and they stop bleeding it, they stop brushing it. Mm-hmm. So very, very important to, to brush and clean between the teeth until there is no [00:31:00] bleeding.

Dr. Linda Bluestein: Yes. And do we need to worry about brushing too hard 

Dr. Audrey Kershaw: in those instances 

Dr. Linda Bluestein: or just in general? 

Dr. Audrey Kershaw: Okay. Um, so yes, you can damage the teeth by brushing too hard. Um, and you know, it would take months or years to damage the. Teeth. But yes, we can wear away the, uh, teeth by brushing too hard. So I mean, that brings us down to the conversation of do we brush with a manual toothbrush or a powered toothbrush?

Um, the research would really say both are, both are fine if you are using them properly, but for most people, we're maybe not using them properly. And to go for a powered one is much, much better. Yep. Um, some of the co uh, the UpToDate electric toothbrushes, they have a built-in sensor to tell you if you're brushing too, too hard.

Linda, which is what you were just talking about, to tell you if you're going to be damaging the teeth. What I like about mine is it's got a timer. It's got a 32nd [00:32:00] timer in, in four segments. So you know when to move on to the next bit of your mouth and you know when your two minutes is up. I don't know if I would know with a manual one when two minutes was up.

Mm-hmm. Mm-hmm. So, uh, any toothbrush is fine, but I would go for, uh, a powered one. Yeah. Okay. Um, cleaning. Cleaning between your teeth, you can either use floss or the little bottle brushes that go between your teeth or I think you like your water pick Linda, whatever works for you, but do it and find a way of doing it with your dental professional that you're not getting any residual bleeding.

Yep. So whatever way you want 

Dr. Linda Bluestein: do it, anything works. Okay. Okay. And what about people with hypermobile EDS? Are they more prone to gum disease? 

Dr. Audrey Kershaw: So the very simple answer to that one is no. Nope. And we've got a very good paper, uh, by our colleagues in, uh, INNI and [00:33:00] Ika in, uh, Europe, and I've given you a link to that.

Uh, they are not anymore likely to get periodontal disease, which is gum disease, and that is a big, big myth we've gotta get rid of here again, Linda. Okay. It's a very simple one. And it's very straightforward. With most types of EDS, you do not get increased periodontal disease. Um, they have got the very good link that I'm sending, I've sent to you.

They've got the very good link about just generally looking after your chief with EDS. And there was also a colleague of mine, Mike in London, uh, Mike Harrison, and he has got a, a talk with EDS Support uk. I think it's 19 minutes long. I can only g give you a little snippet here. I would suggest you go to Mike's talk and you all have a really good look at that.

He is a really calm, lovely man having a chat. I can't remember the girl's name. He's having a chat with, uh, with, at the [00:34:00] Elder Danlos support uk, but a brilliant, a brilliant talk there as well. So, um, go to Linda's, uh, site and get those podcasts and listen to them. They're all very, very easy, um, to listen to there.

Yeah. 

Dr. Linda Bluestein: Yeah. And you gave us so many great links. Those will all be in the show notes so people can access all this wonderful additional information that you're sharing with us. So we're gonna take a quick break and when we come back, we are going to talk about, uh, toothpaste. Is that damaging to teeth or can it be damaging to teeth and other practical tips that people can use to improve their dental health?

So we will be right back.

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So we're back with Dr. Kershaw, and I'm so curious to ask you your thoughts on toothpaste and other, you mentioned already about electric toothbrushes and interdental cleaning, um, and things like that. But if you could just give us a little bit more information on your best and favorite, um, tools and products if you, if you happen to have any or, uh, what kind of things we should be avoiding, if any.

Dr. Audrey Kershaw: Okay. [00:36:00] So toothpaste, I have to thank a colleague of mine, Ray, for just letting me chat about this yesterday, making sure I was up to date with all of this. So. Toothpastes, they can be divided into a few different types. We have fluoride toothpastes, we have some people that prefer to avoid fluoride toothpaste, so they had the, we have the non fluoride toothpastes in the past few years.

We've also had High Roxy Appetite toothpaste come out. And then we've also had, which was mentioned in a previous podcast of yours, a collating agent toothpaste, I think it was called Live Fresh. Don't want to be giving free advertising here, but I think that was mentioned previously. So, um. Fluoride toothpaste has been around since about 1972 ish in the uk.

The reason why teeth are better after the 1970s is because, because of the fluoride in the toothpaste. And, you know, all through my career we could tell looking at somebody's x-ray or how many fillings somebody [00:37:00] had, whether they were before or after the fluoride becoming in toothpaste. So it's been out there a while.

Uh, there is lots of evidence in it. There is very little evidence to say it causes any harm whatsoever used in toothpaste. But there, there are the people that prefer to avoid fluoride, but it really does an awful lot of good. So what the, your teeth are made of something called hydroxy appetite. Yep. And when the.

When the bacteria and the bugs eat away, the tooth, the hydroxyl group is lost from this. So when you have the fluoride in your mouth, the flu, the fluoride in the tooth space joins with the other group and it makes fluoro appetite. Yep. Now this is, is actually what sharks teeth are made from. So this is much, much stronger fluoro appetite than hydroxy appetite.

So that is why toothpaste is so important to be strengthening [00:38:00] your teeth there. Mm-hmm. Now another thing that the having the fluoride incorporated into your teeth does is just to take a little step back. Again, your teeth will decay dissolve with the acid when they get to a pH of 5.5. If we have a lot of fluoride incorporated into your teeth, they will not decay until the acid level gets to pH 4.5.

So there are big, big benefits in having fluoride in your teeth. Yep. Mm-hmm. Um, so, you know, fluoride toothpaste pretty good. Yep. As I said, there is the new toothpastes coming out that have hydroxy appetite in them. Um, these are good, but they do not give you the added benefit of going to a lower pH before your teeth will begin to decay there.

Okay? Mm-hmm. Mm-hmm. Um, these are bit newer. Yes. There's loads of studies on them. [00:39:00] They're good, but we have, be aware of all the science in them. Yeah. Mm-hmm. So the other one that was mentioned on your podcast recently, Linda, was with a collating agent in it. And that's, uh, collating agent is called il. Yeah.

Now this, this is used for heavy metal poisoning. If somebody is systemically affected by heavy metal poisoning, that's what it's used for. Now that toothpaste very, very expensive. I think it's about 35 pounds for a tube rather than if you go to one of the cheap super supermarkets here, maybe 70, 80 pence, I dunno.

Um, but all that does is act as a collating agent. So it'll take the plaque off the teeth, prevent new plaque farming, but it won't do anything to put minerals back into the teeth. Okay, so we need either the fluoride or the hydroxy appetite to go back in there. So [00:40:00] I'm not an expert on that toothpaste, but very expensive.

Yes, some of the studies are looking good. It will help your gum disease, but we have to remember there was a reason for fluoride being there. Okay. So we just need to keep very much an open mind on a lot of this. And for most of us dentists, we're still using, for most of us, we're still using fluoride toothpaste.

Mm-hmm. 

Dr. Linda Bluestein: Yeah. And, and is there such a thing as like an abrasiveness scale for toothpaste? And are there some that are, yeah. Are some that are more abrasive? 

Dr. Audrey Kershaw: Yeah. So, um, sorry, can I just say also about the collating agents? That was one toothpaste that's got that specific collating agent. And in other toothpaste we also have collating agents in them.

And some of those collating agents you'll see on your toothpaste are things like citric acid, sodium citrate, EDTA, and other things like that. So, uh, we've gotta think that these companies market things very, very well. [00:41:00] Yep. So you were saying toothpastes to be, uh, abrasive? Yes. Some will be more abrasive than others.

If you go into a, a supermarket, I mean, you get the whitening toothpaste, the, there's so much going on there with so many chemicals in all this. Some of these will abbra your teeth more than others. And so you have to be very, very careful. Yeah. So I think the best thing is to speak to your dentist about what you want to use, what you've been using, and get their take on it.

Yeah. Because the toothpaste along with the toothbrush, if we're really heavy handed yes, we'll cause damage to our teeth. Now another thing just seeing is we're on it about whitening teeth. Teeth. Were never meant to be white. Uh, but that's a whole, that's a whole other subject. That's a whole other subject there 

Dr. Linda Bluestein: that, that's so funny because my son was going to the store one time and I told him, because I've sensitive teeth, so I, I wanted [00:42:00] sensitive teeth, toothpaste, but not whitening.

And he said, mom, you want yellow teeth? And I said, I just don't want the whitening in there because I have sensitive teeth already. And it was so hard for him to find a sensitive, I know that there are, there are ones, and of course he ultimately found it, but it. It is so hard nowadays to find a toothpaste that doesn't say whitening on the label.

'cause I feel like most of them do say that now. Yeah. Right. Yes, 

Dr. Audrey Kershaw: yes. Is that something that, 

Dr. Linda Bluestein: that, that is a good idea to avoid? I think your tip is excellent to talk to your own personal dentist, but just for the general person listening, what do you think about the whitening versus not whitening? 

Dr. Audrey Kershaw: My personal take on it is to try and have everything in your life and diet as natural as possible without colorings, preservatives, additives, and a lot of toothpastes have so much of this.

Now, do we really need the red and blue stripes in our toothpastes? What are they doing? Another thing we have in toothpaste is something [00:43:00] called sodium laurel sulfate, and that is a foaming agent. Now, that is a naturally occurring foaming agent, but uh, that can cause a lot of issues with, uh, mouth issues, rashes, mucosal issues, a condition called lichen planus.

So a lot of the time we say to patients, find a toothpaste without sodium laurel sulfate in it. So it's a bit of a minefield out there, but I personally prefer to keep everything as natural as possible. Yeah. 

Dr. Linda Bluestein: Mm-hmm. Okay. And I use a 

Dr. Audrey Kershaw: toothpaste called Kingfisher toothpaste. Oh, interesting. They don't pay me, they don't pay me for my advert.

But that has got, that has got only natural stuff in it. I go for the fluoride one as well. 

Dr. Linda Bluestein: Okay. That's great. That's very, very helpful information. 'cause of course most of us are brushing two, I brush usually three times a day, so we're ex exposing ourselves a lot to that toothpaste. So making a good choice there is probably very important.

Dr. Audrey Kershaw: Ah, could I also say about toothbrushing? We could do a full, we could [00:44:00] do a full talk on toothbrushing. Yeah. Very, very, very important. The last thing you do before you go to bed is brush your teeth. You should then not have a drink of water afterwards and you should not rinse your mouth. In Britain, we have a thing called spit.

Don't rinse. Okay. Oh, I dunno if you knew that, Linda. Yeah. Mm-hmm. Do you, do you rinse your mouth out after brushing your teeth? I usually do. Yeah. Okay, Linda, I'm so pleased we're talking. I'm so pleased we're talking. When you brush your teeth, you've got the fluoride that's going on them. You want the fluoride to stay there.

So spit and don't rin. Okay? You also want to go to bed. When you go to bed, your saliva rate drastically drops. Okay? So your saliva will wash away the fluoride toothpaste or whatever collating agent you've got in your toothpaste, and it won't do as much good. So you want to brush your teeth, do nothing else, go to bed, reduce your [00:45:00] saliva flow, and the toothpaste will be on there, you know, for as long as we can have it on there.

Dr. Linda Bluestein: Mm-hmm. Mm-hmm. 

Dr. Audrey Kershaw: So it's gonna be doing so much, so 

Dr. Linda Bluestein: much more. 

Dr. Audrey Kershaw: Good. 

Dr. Linda Bluestein: Okay. Okay. I love that. And so then if we're spitting but not rinsing, then do we also have to be careful not to use too much toothpaste? Well 

Dr. Audrey Kershaw: just use a pea-sized amount, whatever it says on the packet. Yes. Uhhuh. Yeah. Okay. Um, when I started spitting and not rinsing, when my children were small, and when they would tell me, mom, what are you doing?

What I find I have to do, Linda, I don't know if this isn't help help you in any way, but I find it so hard to leave the sink. So what I do is I close my mouth, I put water over my face, and that sort of fills myself that I think I'm rinsing and I'm not. 

Dr. Linda Bluestein: Ah, okay. Okay. I love it. I I love that the devils are in the details.

You know, these are Yes. Little things that we can do to make a big difference. So, yeah. 

Dr. Audrey Kershaw: Yeah. So they're just very, very basic dental things, but they're so important, [00:46:00] utterly important for adults 

Dr. Linda Bluestein: and for children. Most of us don't have this kind of time with our dentist to discuss these things, so, uh, this is so helpful.

If it's okay with you, I wanna move on to the next topic. Yes. Okay. I wanna talk about quote unquote dancing teeth. So a past guest mentioned that people with EDS have dancing teeth, and I wanted to talk to you about what your thoughts are on this matter. Um, do people with EDS and, and let's maybe stick it to hypermobile EDS because we know periodontal d EDS is a different animal.

Right. And we'll talk about that a little bit later. Yeah. So, so do they have teeth that, that move more? 

Dr. Audrey Kershaw: So, um, we all know that with orthodontic treatment, teeth will move faster and it'll be sore if you have your teeth straightened. Um, so that is one thing, and I know our Austrian colleagues are looking at, are doing a, a study in this at the moment, or was it you that you'd, or was it, I think it [00:47:00] was maybe yourself that said your dentist was looking into this.

Was that right? Did I see that on a podcast? So yeah. It was 

Dr. Linda Bluestein: yourself. My oral facial, uh, TMD doctor is, uh, studying this right now. Yeah. Yes. 

Dr. Audrey Kershaw: You know, so that's great. So, um, I think we've got to remember that the connective tissue in hypermobile LS Danlos will be different than in another people. Mm-hmm. I wonder if maybe the teeth might just be a little bit more, nobody would even notice, but the same as people's joints, connective tissue is different.

Maybe the teeth would be different. I don't think this has any bearing on anything whatsoever. Yep. I don't think there's any bearing to that whatsoever. Um, I think if you did have gum disease, periodontal disease, that. If you had heads yes, the teeth might be more prone to move. Mm-hmm. Mm-hmm. But, uh, not in any massive way, but maybe just in a small way.

But, you know, if we can get the gums healthy, we're not going to have a problem. Yeah. [00:48:00] So, um, yeah, that's my sort of take on that. Mm-hmm. 

Dr. Linda Bluestein: Yeah. Mm-hmm. And as far as, you know, this isn't something that has been studied or published, um, about it. I've 

Dr. Audrey Kershaw: not heard anything until you had mentioned this to me, Linda.

Yes, sure, sure. Yes. And we know that lots 

Dr. Linda Bluestein: of things are not published and I love bringing guests on here to share their clinical experiences as well as things that have been published because we know we don't all have time to publish things and there's valuable anecdotes. Um, you know, as well as double blind randomized controlled trials.

We just have to factor into consideration what level of evidence various different things are. So, 

Dr. Audrey Kershaw: because I see only oral surgery patients and dental patients. I'm very aware of what I'm seeing in the mouths and you know, it's not like the teeth are easier to come out in patients with hypermobile, ls, Dan loss or anything like that from the, from the rest of the population there.

Yeah. Yeah. Sometimes I find teeth in patients with LS, Dan loss are [00:49:00] much more difficult to come out. So that goes very much against the idea of dancing teeth. I, I wish some of these teeth would dance out at me. Um, last week on clinic, um, I'll change the guy's name, but we had a, a young man in 25 years old.

Lovely, lovely man. Um, 25 years old. Undiagnosed tells Danlos, I reckon he's now going down the pathways to get diagnosed. But I see this in quite a few of our EDS cases. Their teeth can be horrendously difficult to come out and Zy, which we'll call them. Absolutely amazing. So, so anxious, neurodivergency, managed life so well, a lovely, lovely young man.

Sat there. Sat there and let me do, do, let me get on with what I had to get on with. And I have the utmost admiration for these guys. And we quite often see this in EDS patients, Linda, they are very, very anxious, but they make the best [00:50:00] patients ever. And I don't know how they do it. So anyway, that was Ozzy from last week.

Dr. Linda Bluestein: Yeah, I, I've observed that too, that I feel like people who have EDS and HSD oftentimes they've had to deal with so much over their lifespan, even if they are young, like Ozzy. Um, and so it seems like they are so much more resilient in some ways to these kinds of things, whereas people who have been healthy for their whole life and know something happens, oftentimes they just fall apart.

So it's, uh, it is very interesting. Obviously I don't want anyone to have medical problems or oral problems at all, but, um, that is an interesting observation. 

Dr. Audrey Kershaw: What I find about them is, is we need to work to get them on our side. And as I said in a previous podcast, this all starts with the dentist referring them in saying, Audrey's an okay oral surgeon.

You go and see her. The reception staff are nice when they're getting the appointment booked. Just like we know you're anxious, we're going to look after you. You come along and talk to us. And when [00:51:00] we have so much work done before the patient even sees me, and then we continue with it, but we very much need to get them on side so they know we are all on the same side and we understand them.

And I think that's one thing I've learned with learning about Ehlers-Danlos Syndrome. There's a knack to managing this. 

Dr. Linda Bluestein: Yeah, definitely putting people at ease and letting them know that, you know. About the different needs of people with EDS at the same time of the general needs of their oral health and, and things like that.

'cause of course, you know, as you mentioned earlier, which I just think is such an important point to, to mention that you could have two different things going on, but that doesn't mean that they're correlated with each other. So it's just always important to, to remember that. So, so could we talk about periodontal EDS?

Can we move on to that? Is that okay? Absolutely. 

Dr. Audrey Kershaw: I think that's one the listeners will like to hear about. So periodontal EDS is very, very different than any other type of EDS. Um, it's caused by a genetic, a [00:52:00] genetic change in C one R or C one s gene. And it presents very, very diff very differently. I think when heads patients think they've got some gum problems, it's very easy to then label that as periodontal lead s.

Completely different. Our Austrian colleagues, I've sent you a link. Our Austrian colleagues have given us a, a really good YouTube video and they've got papers out on it as well. And that's well worth a watch. Now we've got to remember the periodontal EDS is said to be one in 1 million. Okay? I have my eyes open to EDS.

I know what EDS is about. I find rarer forms of EDS, vascular, classical, classical. Like I see different things. In the past seven years, I have only seen one case that may be periodontal EDS. Wow. So it's very, very [00:53:00] rare. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Audrey Kershaw: Mm-hmm. Uh, this young man has gone for genetic testing and we're waiting for that to come back.

But, um, when you, when you know what periodontal EDS is, when I saw this man, it was like. Why has this not been picked up before? Because when you know what you're looking for, it's obvious when you dunno about it and you dunno that it's a, a thing very hard to pick up. So this was a, a 39-year-old man who actually looked about 25.

A lot of issues. I won't say too much about him. Um, and very bad gum disease had lived in Germany, had periodontal surgery, gum surgery in Germany, was back over here and was having similar stuff and teeth were falling. A couple of teeth were falling out. Yeah. Uh, he came to see me about a wisdom tooth.

Wasn't, wasn't coming to see me about ER's, Dan loss. And I thought, my goodness, there's something going on here. So let's just have a chat about the key signs and [00:54:00] symptoms of periodontal s Yeah. So that would be severe early onset gum issues. Okay. Very different from other gum issues. Generalized lack of attached gingery.

So that's quite a technical term. So if you look in the mirror later on tonight, you will see that coming down from your teeth, your gums seem to be attached until maybe about a centimeter up. And then the gums. Are more movable. Yep. In periodontal EDS, they don't have any gums that are atta firmly attached at the top, at the top of the tooth to the bone.

Yep. If anybody wants, they can google this a bit more, but it's a very obvious look about them and it's very different. Yep. They have, um, bruising on their shins. I think you know about all this, Linda, won't you? Yeah. They have bruising on their shins. They would've easy bruising. Hypermobile joints sometimes limited to their hands or their [00:55:00] feet.

I believe their skin can be more stretchy and their skin can be fragile. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Audrey Kershaw: So the EDS society, I think the guidelines of how to pick up a case they have, you have to have one major CRI criteria and that is bad. That is bad. Gum disease, loss of attached gwe, pretibial plaques, and a family history. So you just have to have one of those four things to be considered to have periodontal EDS.

And then you have to have two of the minor criteria. Yeah. So, you know, things like easy bruising, hypermobile joints, increased rate of infections, hernias, you know, uh, things like that. Um, it's all in the links I'm sending. Um, and then they would have to go off to be, uh, genetically tested, I would reckon.

Yeah. So it's just very, very different. Um, Enni and Ika, as I said, they've got a very good [00:56:00] video or there's also some very good patient testimonials on the EDS support UK site of people with it telling about their journey. Yeah. The literature says normally people's teeth would fall out. In their early teens or their early twenties.

But I think from what I read, because of better dental care, some of these patients are keeping their teeth longer. Yeah. So this man I saw was in his late thirties and he still had a, a really good number of teeth. He still had pretty bad gum disease, but you know, it's not the sort of textbook case of, um, their teeth have all been lost.

Do you see many cases of periodontal BDS, Linda? No, I don't think I've ever seen 

Dr. Linda Bluestein: one actually. 

Dr. Audrey Kershaw: That's 

Dr. Linda Bluestein: good for the listeners to know. Yeah. I've never sent someone for, sent someone for genetic testing because I suspected periodontal EDS. I have, I, I really, yeah, I have patients who do have gum disease, [00:57:00] although I would say that most of my patients do not.

Um, but I definitely, you know, that's not my area of expertise, that's not the focus of my exam. And I wouldn't know what I was looking for, uh, necessarily. But, um. Since we just were talking about, you know, quote unquote regular gum disease, distinguishing periodontal EDS from regular gum disease. Um, is there anything else that you want to add about that?

Dr. Audrey Kershaw: No. It is just much, much more severe at a younger age, and you don't have the gingiva, uh, joined onto the bone at the top of the tooth there. You know, um, I mean, I think Claire Franko manos paper on the red flags, reasons for Genetic Testing. That's a, that's a great paper, isn't it? Yes. That you've got on your website, Linda.

And you know, it, it's things like the pre, like the pretibial plaques, the bruising on the shins, that doesn't go away. That is quite a big giveaway sign. Although the case I [00:58:00] found did not have the pre. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Audrey Kershaw: Um. Yeah. I, I think it helps when you've seen several of these things. You've not seen any, and I've seen a possible one, Linda.

So, and I, I don't think I, I don't think many people have seen many at all, so it's really quite difficult. Um, yeah. But it, it's a very different disease. 

Dr. Linda Bluestein: Okay. Very good. Um, so, you know that we finish every episode with a hypermobility hack, or if you have even more than one hack, that would be great. Yes. Um, what, yeah, what hacks do you have for us or hack?

Dr. Audrey Kershaw: Oh, I think I'll just sort of, maybe it's, it's sort of a bit of a summary, but I think, I think, Linda, I'm gonna change my hack since for the, from the conversations we had. So one of them is spit, spit, don't rinse. Mm-hmm. No more than four sugar episodes a day. Mm-hmm. And that includes hidden sugars. Yep. Um, dental issues are very common in the [00:59:00] population and.

Dan loss patients have them as well. Yep. They might be, there might be slight complications with EDS, but we do not have to manage them differently most of the time. Yeah. I would also say, as we said in the last one, work with your team, work with your dentist, be on the same side as them. Yep. Mm-hmm. Also, as I said last time, can we ask everybody to help us to try to spread the word?

Can you send your dentists to the podcasts we've done? Uh, you know, can people just help spread the word because the dentists are wanting to know therapists, hygienists, whatever they want to know. So just help us to spread the knowledge and if your listeners have any questions, I'm opening myself up for a flood of emails here.

They are very welcome to 

Dr. Linda Bluestein: reach out. Okay, wonderful. Well, I really appreciate that and, and, uh, you might get flooded with emails. We'll see. Which, speaking of, uh, where can people find you and learn more about your incredible work? 

Dr. Audrey Kershaw: [01:00:00] Um, so thank you. Um, if they just do a Google search, Audrey Kershaw, um, it's amazing what comes up.

They can see pictures of my dogs and everything there. Um, uh, if they just Google me, they can find it. Uh, they can also get, get me at Oral Surgery Scotland. Okay. That's very easy to remember. Oral Surgery, Scotland, my email address is there. They can go through our website. Uh, I think sometimes people think oral surgery Scotland is really quite something.

Uh, big it, it, it's great. It's good. But if you email Hello at Oral Surgery dot Scotland, I'm gonna get the email. Oh, okay. Yeah, so they can, they can reach me there. 

Dr. Linda Bluestein: Okay. Okay. Very good. Well, I'm so grateful to you for coming back on the podcast to share this really, really fabulous information. And it is so interesting because I find this so often when I'm talking to experts like yourself that there are often some really nuanced [01:01:00] things that we can possibly do that can really make a big difference.

And sometimes it's not the big surgeries or, or big, big things, but it's sometimes a lot of the small daily habits that we can change that can influence our health. So I'm so grateful to you for, uh, coming back on bendy bodies. 

Dr. Audrey Kershaw: Thank you very much, Linda. And, and thank you for asking all the questions you did to get the important bit out that I was forgetting to see.

Thank you.

Dr. Linda Bluestein: What a great conversation with Dr. Kershaw, and I'm fascinated, as you probably are as well, that there are some small things that we can do that can greatly improve our oral and dental health. So I wanna thank you for listening to this week's episode of the Bendy Bodies. With the Hypermobility MD podcast, you can help us spread the word about joint hypermobility and related disorders by leaving a review and sharing the podcast.

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