BrainStorm
Your Mouth, Your Brain - The Oral Health-Alzheimer's Connection with Dr. Rasetto
Your Mouth, Your Brain - The Oral Health-Alzheimer's Connection with Dr. Rasetto
Your mouth may be doing more than you think — it could be a gateway to your brain. In this episode of BrainStorm, host Meryl Comer sits down with Dr. Flavio Rasetto, a Washington DC-based prosthodontist and University of Maryland School of Dentistry faculty member, to explore the emerging science linking oral inflammation to Alzheimer's disease and cognitive decline. Dr. Rasetto breaks down how bacteria like Porphyromonas gingivalis can travel from the gums into the bloodstream and brain, why bleeding gums and bad breath are early warning signs worth taking seriously, and how caregivers can manage oral hygiene for loved ones living with Alzheimer's. The conversation also touches on advances in modern dentistry, barriers to dental care access, and the everyday habits that protect both your smile and your mind.
Support for BrainStorm by UsAgainstAlzheimer’s comes from Genentech. Genentech is committed to pushing the boundaries of scientific discovery in Alzheimer's disease by researching and developing treatments to preserve what makes us who we are.
Dr. Rasetto (00:00):
We are not just dentists. We are dentists treating a patient as a whole. One of the main bacterias that are causing periontal disease is porphyriomonas gingivalis. There are certain molecules that they are able to emit and start creating this neuroinflammatory process that it happens in the brain. Everything is interconnected.
Introduction (00:24):
Welcome to Brainstorm by Us Against Alzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24-year caregiver, an Emmy award-winning journalist, and the author of the New York Times bestseller, Slow Dancing With a Stranger.
Meryl Comer (00:43):
This is Brainstorm, and I'm Meryl Comer. Forget Smile for the Cameras just a photo trick. In the age of prevention, think of your mouth as a control panel or a gateway to the rest of your body. Research now shows that poor oral health increases your risk for heart disease, diabetes, frailty, and even cognitive decline. Today, we're joined by Dr. Flavio Rossetto, a noted Washington DC prosthodontist, former faculty member, and postgraduate lecturer in his specialty at the University of Maryland School of Dentistry. Dr. Rossetto, thank you for joining us.
Dr. Rasetto (01:27):
Thank you. It is a pleasure to be here, Meryl.
Meryl Comer (01:30):
Doctor, today the field of dentistry is highly specialized. How would you explain what you do in practical terms?
Dr. Rasetto (01:39):
Yeah. , The specialty of prosthodontics is, , one of the 12 specialties that we have in dentistry. And we as prosthodontics are able to restore patients' dentition with veneers, crowns, removal partial dentures, complete dentures. The advent of dental implant has provided us a great opportunity to help patients to change life. We do treat patients that they suffer from trauma, facial trauma. We need to have prosthesis done after cancer reconstruction, or patient that has been, , missing, , teeth, , that they didn't have the tooth bath, you know, , since they were born. And, and we can res- restore those patients as well. So basically, in general terms, , we are the specialty that manage patients that hasn't have been seen by any other dentist that they cannot solve problems. They come to us to see if we can help them out.
Meryl Comer (02:36):
How has academic dentistry changed since your years in postgraduate education? , What's different today?
Dr. Rasetto (02:45):
, A lot of things have changed since I did my program, , for good, for the patient's benefit and for us as a profession. So we have incorporate in a routine basis, , a combine CT scan, which is 3D images that can help us to diagnose and treatment plan patients in a much more accurate fashion, especially for patient that need to have reconstruction after they have lost order dentition, , with dental implants. So we can, , interact with oral surgeons planning or periodontist for this type of reconstruction much more efficiently. We have incorporated digital technologies such as intraoral scanners that we can actually capture images of the patient's dentition, kind of taking a video of their, , teeth, , without using that we material that patient used to hate when we will be making impressions to make molds. So that has changed completely the way that we are performing dentistry, helping patients going through a much more favorable experience going through dentistry.
Dr. Rasetto (03:54):
, We have incorporate milling machines that we can use in our offices to fabricate same day crowns or restorations for patients. Years ago, we didn't have that capability. We definitely see the patients much more comprehensively, and we look at patient not only from the point of view of teeth only, but looking at airway. We are looking at patient growth and development. So we are becoming much more comprehensive and interacting with other specialties as well. , So it is a very exciting time, , to be in dentistry.
Meryl Comer (04:30):
Has fear of going to the dentist changed generationally?
Dr. Rasetto (04:34):
It's interesting. , As we are going through, , many year, years in, in dentistry, there is gonna be always a percentage of patients that are still remembering that particular moment that has been very traumatic to them. Especially older, you know, , patients has had the exposure to dentistry without the use of anesthetic. And early on in life, they have been obviously traumatized. And once you traumatize a, a, a young patient, that experience remain with them for the rest of their life. And
Meryl Comer (05:09):
Dr. Rossetta, what warning signs of oral disease do people too often ignore before they become problems and more severe?
Dr. Rasetto (05:18):
One of the problems that we face is that there are some of these conditions that are chronic conditions, either caries or periodontal disease are both caused by bacterias and they are chronic. And sometimes you could have an extended period of time having these conditions that are brewing in your mouth that they are over- over developing and you don't have yet symptoms. But certain things that are important for patients to know is number one, bleeding gums. If you have brushing techniques or flossing and you are start bleeding, that is a sign that there is early stage of either gingivitis or periodontal disease, which is important for you to see, , the, the, the dentist. Then another important part is, , bad breath. If there is a change, , and it's called halitosis. , A change in, in the taste of your mouth and you start feeling that something is not, , you know, pleasant, that could be linked with bacteria that are called anaerobic bacteria that are into the pockets that are, can obviously affect the, the, the, the bad breath that patient will have.
Dr. Rasetto (06:26):
As, as far as the, the coating that build up in the tongue and some other soft tissues areas. So the patient have to be aware of those factors that, you know, can be leading to these type of problems. You
Meryl Comer (06:38):
Know, healthy aging today is all about preserving function, independence, quality of life as people age. Where does oral health fit in?
Dr. Rasetto (06:49):
Healthy mounts will have the possibility to maintain patients in function, not only for cosmetic purposes, but for functionality. And they're minimizing the risk to have other, , quadrupant or other, , you know, condition that they could be affected by. We are hosting millions of bacterias that are very smart that they colonize around our teeth and gums. And if we are not able to eliminate properly, then this is going to be either causing decay or gum disease. And especially gum disease, which is called periodontal disease, starting from gingivitis first, but then if it start affecting the level of the bone and bone will start obviously reabsorbing, then the bacterias will have an access into the bloodstream that can be actually moved to other part of the patient's body. And that's why this connection of oral health and systemic disease became much more noticeable. There is a genetic component, the type of bacterias that each patient carry, the immune system that we have, the diet and the habit that each patient will have.
Dr. Rasetto (07:59):
There is few factor that plays a role why certain patients become disease with either caries or gum disease, and other patients are not. So if I have a patient that they are not maintaining very good oral hygiene, but those factors are not creating issues for them, they could go through their life without measure issues in their mouth. Doesn't mean that they shouldn't be seeing the dentist because still, even though they don't have perhaps signs or symptoms yet of complaining of any problems, the presence of bacterias can be still leading into the bloodstream because there are certain level of inflammation that happened because of the presence of the bacterias.
Meryl Comer (08:42):
Were you surprised, , Dr. Brisetto, when you, , saw the research about the link to oral inflammation and Alzheimer's?
Dr. Rasetto (08:54):
Good question. I always though that, , we are not just dentists. We are dentists treating a patient as a whole. And we cannot be talking about organs that are separated. Every, everything is interconnected. Obviously the mouth, it is a very dairy area, very, very dirty. You know, we, we are hosting bacterias, unfortunately, all the time. And the soft tissue and the intring can see of how the tooth structure is interacting with the gums and the shape of our teeth. Obviously that will have a port of entrance for these bacteria to get in. And I do see now how different it is the way that we are approaching our patients. The first thing that we are doing is we are spending enough time to understand the patient's overall medical condition before we start talking about teeth. I can see this all the time, that patients sometimes are surprised of how much time I dedicate talking about some other things before I get into the patient's mouth.
Dr. Rasetto (10:01):
So I'm glad that the community now is much more involved in educating our patient's population regarding the importance of the correlation between oral health and Alzheimer's and other obviously, , , systemic conditions.
Meryl Comer (10:20):
So how does inflammation in the mouth become a brain health issue? Is it crossing the, the brain blood barrier?
Dr. Rasetto (10:28):
One of the main bacterias that are causing perionta disease is porphyria gingi - porphyriomonas gingivalis. We'll call it PG. And once the, , presence of, , pockets and bacterias that are getting into the bloodstream, and they are being mobilized and translocated through the entire body, as it goes through the blood-brain barrier, it goes into the brain. And they like to be attached to areas around the neurons and they start inducing and there are certain molecules that they are able to emit and start creating this neuroinflammatory process that it happens in the brain. So, , the, the key is to go back to where the polyphymoras gingivales are in the mouth primarily. So that's where we need to pay attention and emphasize the importance of having very good oral health is so crucial for the overall condition of the patient's health.
Meryl Comer (11:33):
How do you begin to speak to patients, , about an emerging science so that it motivates them to take better care of their teeth without overstating the certainty that there's a direct linkage because the science is so new?
Dr. Rasetto (11:51):
I provide evidence that research has shown us the importance of having the best type of treatment that we can provide to them, not only for cosmetic purposes, because sometimes they come only for the reason, but from the point of view of oral health. And describing the reason why has been enough evidence that the association between oral health and, in this case, Alzheimer's and cognitive decline, it is a reality. And I trying to explain the importance of minimizing the risk for them to suffer perhaps this type of problem.
Meryl Comer (12:29):
Doctor, many in our audience, , care for loved ones with Alzheimer's. And we've all had the experience that it is very challenging, , to take care of a loved one with regard to their oral health. What do you say to the caregivers out there, , who know what they should be doing and the care is important, but when a loved one refuses the care?
Dr. Rasetto (12:59):
That is a tough one. And I, I face that myself with my father. And I understand that, , nothing is perfect. And what I usually tell patients is patience is very important. To be patient, to be resilient, to be consistent, to learn to play as much as possible and find the things that could be motivating them to be engaged. There are certain obviously, , type of techniques that we can review with the caregivers to see what are the different type of accessories and instrument that we can be working on. Informing them about the diet, which does plays a major role because as one of the components of caries and predontal disease, diet plays a major role.
Meryl Comer (13:56):
The caregiver, I was always concerned what my husband and my mother might be ingesting. So that I used what you use for children because I felt that was probably the safest if they ingested.
Dr. Rasetto (14:10):
The, , type of, , management of the oral hygiene technique, obviously, is very true that when you are start putting certain things like a, a brush into the patient's mouth, some of them could even be hurting you where they will try to be biting in your, , you know, fingers. I already faced that myself as dentist. So we have to be cautious about that part. And then the toothpaste, obviously, when we are using toothpaste, the amount of toothpaste that we are delivering is important. So it has to be pea size. Sometimes we see that people are going to be adding two centimeters of toothpaste into the brush, which is not necessary. And then obviously, , if we are us - you, if you're, if we are utilizing toothpaste that has high concentration of fluoride, the main issue is that if the patient reach a point where they are not aware and they are trying to swallow, that could be creating obviously a side effect.
Dr. Rasetto (15:11):
The baby toothpaste that you are referring to, you know, is gonna be generating some foam into the surface to help to facilitate the process of brushing. And it's true as reducing the risk factors of not inducing any major irritation on the patient's, you know, stomach. You know, you are finding ways to try and to go through each day, helping them as best as you can.
Meryl Comer (15:34):
When you have a nonverbal patient, what are the clearest signs that they may be in oral pain?
Dr. Rasetto (15:42):
Those are the moments that we have to be paying attention to what type of body response does the patient has. If there is any type of, , eyes movement or expression, facial expression that are linked with perhaps something that is creating pain. When they are trying to choose something, it's definitely necessary for us to clinically identify what is the source of problem. So the sooner that we get in areas of the mouth that they have perhaps an infection, the better that we're gonna be to reduce a chance for this infection that we have already identified that could be leading to a complication systemically. Dental pulp could suffer what is called necrosis. And then the process of dying slowly. And sometimes you don't have symptoms, but then you find radiographically those focal infections that are not yet perhaps inducing pain, but they could be very, very detrimental for the overall health of the patient.
Meryl Comer (16:51):
Thank you, , for addressing some of these issues that people live with every day. And, , , they're not often talked about. Speaking of aging, we have a generation now that are outliving their dentures. No one ever thought about that. <Laugh> What do you do for the 70 plus set these days?
Dr. Rasetto (17:16):
So if the patient has a good, , overall health procedures that we know that are, , predictable, and they can provide with the appropriate stability for them to have adequate function, adequate aesthetics, that will make them feel very comfortable to continue on with their life.
Meryl Comer (17:43):
How do you reach into communities who face barriers to treatment, , either because they can't afford treatment, , or it's just culturally just not part of their, , regular hygiene?
Dr. Rasetto (17:59):
Before coming to America, I practiced five years back home. And I dedicate an entire day treating patient that they, , were in need. And I moved to the first world. I went through all my training, and I still now see that there are places that patients unfortunately cannot receive the right care because of financial burden and, and the amount of investment they have to do. I think that there is a, an effort that has to come from the government, from the community, from the veteran organization that are related with, in this case, our profession. Adversity of Maryland, , has done this, , where I used to go with the residents as a group and care for Indian reservations in Navajo re- reservation. It was part of Mission of Mercy that we will go and spend two days or three days providing, , service to our patients.
Dr. Rasetto (19:04):
And we will see so many patients that they couldn't have access to a private sector, you know, a dental school, , , a, a, a, a dental service. So I, I definitely see that there's so many things that we could do to improve. I belong to this organization that we are, you know, seeing Holocaust survivors patients. So I offer time in my office with my colleague to see some of those patients, you know, for free. And I, I think that it is a constant, you know, effort that we as clinicians could be doing to help patients to receive care. Dr.
Meryl Comer (19:40):
Rossetto, what has that experience taught you about dignity and sense of self? And more importantly, access, , early access to care?
Dr. Rasetto (19:53):
We have to understand that there are people that they need certain services that we take for granted. And we as a community can really makes a difference when all of us are putting that attitude toward helping people in the way that we could, obviously, based on what we are doing. And so it's, it was, it was and it still remains a wonderful feeling an experience.
Meryl Comer (20:19):
Well, thank you for your service. , Dr. Rossetto, if people want to avoid the dentist, what should those must-do habits be each day when it comes to oral health?
Dr. Rasetto (20:32):
We spend time learning how to have a very good oral hygiene technique. And your dentist and your hygienist can review and provide all the necessary support. And then that motivation that you get out of that particular session has to stay and stick with you because that's the main issue is when you provide this training on patients and you leave the office and you feel motivated. And then after a week, and you start lacking, we have to pay attention to what we eat. When do we eat? It's important for us to have the, , disciplines to understand that if we like to have sugary drinks, and if you're sipping through the course of the day, and in between meals, having snacks, those are the nutrients, the ideal fuel for the bacteria that you are hosting to really have a fist. Either if you suffer from decay or even if you suffer from periodontal disease.
Dr. Rasetto (21:41):
And the third part, if possible, trying to maintain a, a regular dental visit. And if you cannot do a comprehensive treatment because of the finances, it's still trying to maintain either every three, four or six months, a recall program with your dentist so we can, number one, help you to diagnose problems. And number two, preserve what you have.
Meryl Comer (22:10):
Thank you, Doctor. We know your patients are waiting. Our guest today has been Dr. Flavio Rossetto, a notable Washington DC board certified prosthodontist affiliated with the University of Maryland School of Dentistry, who spent his career helping patients restore function, comfort, confidence, all contributing to their oral health. And don't forget, join us for the 11th annual National Alzheimer's Summit on September 16th and 17th. This year's theme, The Time Is Now: Advocating Alzheimer's Policy for Every Generation that highlights the importance of caring for the brain at every stage of life from childhood through the older adult years. Go to usagainstalzheimers.org/allsummit to learn more and register for this virtual event. That's it for this edition. I'm Eriel Comer. Thank you for brainstorming with us.
Closing (23:15):
Support for Brainstorm by Us Against Alzheimer's comes from Genentech. Genentech is committed to pushing the boundaries of scientific discovery in Alzheimer's disease by researching and developing treatments to preserve what makes us who we are. Subscribe to Brainstorm through your favorite podcast platform and join us for new episodes on the first and third Tuesday of every month.
About This Episode
Your mouth may be doing more than you think — it could be a gateway to your brain. In this episode of BrainStorm, host Meryl Comer sits down with Dr. Flavio Rasetto, a Washington DC-based prosthodontist and University of Maryland School of Dentistry faculty member, to explore the emerging science linking oral inflammation to Alzheimer's disease and cognitive decline. Dr. Rasetto breaks down how bacteria like Porphyromonas gingivalis can travel from the gums into the bloodstream and brain, why bleeding gums and bad breath are early warning signs worth taking seriously, and how caregivers can manage oral hygiene for loved ones living with Alzheimer's. The conversation also touches on advances in modern dentistry, barriers to dental care access, and the everyday habits that protect both your smile and your mind.
Support for BrainStorm by UsAgainstAlzheimer’s comes from Genentech. Genentech is committed to pushing the boundaries of scientific discovery in Alzheimer's disease by researching and developing treatments to preserve what makes us who we are.
Transcript
Dr. Rasetto (00:00):
We are not just dentists. We are dentists treating a patient as a whole. One of the main bacterias that are causing periontal disease is porphyriomonas gingivalis. There are certain molecules that they are able to emit and start creating this neuroinflammatory process that it happens in the brain. Everything is interconnected.
Introduction (00:24):
Welcome to Brainstorm by Us Against Alzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24-year caregiver, an Emmy award-winning journalist, and the author of the New York Times bestseller, Slow Dancing With a Stranger.
Meryl Comer (00:43):
This is Brainstorm, and I'm Meryl Comer. Forget Smile for the Cameras just a photo trick. In the age of prevention, think of your mouth as a control panel or a gateway to the rest of your body. Research now shows that poor oral health increases your risk for heart disease, diabetes, frailty, and even cognitive decline. Today, we're joined by Dr. Flavio Rossetto, a noted Washington DC prosthodontist, former faculty member, and postgraduate lecturer in his specialty at the University of Maryland School of Dentistry. Dr. Rossetto, thank you for joining us.
Dr. Rasetto (01:27):
Thank you. It is a pleasure to be here, Meryl.
Meryl Comer (01:30):
Doctor, today the field of dentistry is highly specialized. How would you explain what you do in practical terms?
Dr. Rasetto (01:39):
Yeah. , The specialty of prosthodontics is, , one of the 12 specialties that we have in dentistry. And we as prosthodontics are able to restore patients' dentition with veneers, crowns, removal partial dentures, complete dentures. The advent of dental implant has provided us a great opportunity to help patients to change life. We do treat patients that they suffer from trauma, facial trauma. We need to have prosthesis done after cancer reconstruction, or patient that has been, , missing, , teeth, , that they didn't have the tooth bath, you know, , since they were born. And, and we can res- restore those patients as well. So basically, in general terms, , we are the specialty that manage patients that hasn't have been seen by any other dentist that they cannot solve problems. They come to us to see if we can help them out.
Meryl Comer (02:36):
How has academic dentistry changed since your years in postgraduate education? , What's different today?
Dr. Rasetto (02:45):
, A lot of things have changed since I did my program, , for good, for the patient's benefit and for us as a profession. So we have incorporate in a routine basis, , a combine CT scan, which is 3D images that can help us to diagnose and treatment plan patients in a much more accurate fashion, especially for patient that need to have reconstruction after they have lost order dentition, , with dental implants. So we can, , interact with oral surgeons planning or periodontist for this type of reconstruction much more efficiently. We have incorporated digital technologies such as intraoral scanners that we can actually capture images of the patient's dentition, kind of taking a video of their, , teeth, , without using that we material that patient used to hate when we will be making impressions to make molds. So that has changed completely the way that we are performing dentistry, helping patients going through a much more favorable experience going through dentistry.
Dr. Rasetto (03:54):
, We have incorporate milling machines that we can use in our offices to fabricate same day crowns or restorations for patients. Years ago, we didn't have that capability. We definitely see the patients much more comprehensively, and we look at patient not only from the point of view of teeth only, but looking at airway. We are looking at patient growth and development. So we are becoming much more comprehensive and interacting with other specialties as well. , So it is a very exciting time, , to be in dentistry.
Meryl Comer (04:30):
Has fear of going to the dentist changed generationally?
Dr. Rasetto (04:34):
It's interesting. , As we are going through, , many year, years in, in dentistry, there is gonna be always a percentage of patients that are still remembering that particular moment that has been very traumatic to them. Especially older, you know, , patients has had the exposure to dentistry without the use of anesthetic. And early on in life, they have been obviously traumatized. And once you traumatize a, a, a young patient, that experience remain with them for the rest of their life. And
Meryl Comer (05:09):
Dr. Rossetta, what warning signs of oral disease do people too often ignore before they become problems and more severe?
Dr. Rasetto (05:18):
One of the problems that we face is that there are some of these conditions that are chronic conditions, either caries or periodontal disease are both caused by bacterias and they are chronic. And sometimes you could have an extended period of time having these conditions that are brewing in your mouth that they are over- over developing and you don't have yet symptoms. But certain things that are important for patients to know is number one, bleeding gums. If you have brushing techniques or flossing and you are start bleeding, that is a sign that there is early stage of either gingivitis or periodontal disease, which is important for you to see, , the, the, the dentist. Then another important part is, , bad breath. If there is a change, , and it's called halitosis. , A change in, in the taste of your mouth and you start feeling that something is not, , you know, pleasant, that could be linked with bacteria that are called anaerobic bacteria that are into the pockets that are, can obviously affect the, the, the, the bad breath that patient will have.
Dr. Rasetto (06:26):
As, as far as the, the coating that build up in the tongue and some other soft tissues areas. So the patient have to be aware of those factors that, you know, can be leading to these type of problems. You
Meryl Comer (06:38):
Know, healthy aging today is all about preserving function, independence, quality of life as people age. Where does oral health fit in?
Dr. Rasetto (06:49):
Healthy mounts will have the possibility to maintain patients in function, not only for cosmetic purposes, but for functionality. And they're minimizing the risk to have other, , quadrupant or other, , you know, condition that they could be affected by. We are hosting millions of bacterias that are very smart that they colonize around our teeth and gums. And if we are not able to eliminate properly, then this is going to be either causing decay or gum disease. And especially gum disease, which is called periodontal disease, starting from gingivitis first, but then if it start affecting the level of the bone and bone will start obviously reabsorbing, then the bacterias will have an access into the bloodstream that can be actually moved to other part of the patient's body. And that's why this connection of oral health and systemic disease became much more noticeable. There is a genetic component, the type of bacterias that each patient carry, the immune system that we have, the diet and the habit that each patient will have.
Dr. Rasetto (07:59):
There is few factor that plays a role why certain patients become disease with either caries or gum disease, and other patients are not. So if I have a patient that they are not maintaining very good oral hygiene, but those factors are not creating issues for them, they could go through their life without measure issues in their mouth. Doesn't mean that they shouldn't be seeing the dentist because still, even though they don't have perhaps signs or symptoms yet of complaining of any problems, the presence of bacterias can be still leading into the bloodstream because there are certain level of inflammation that happened because of the presence of the bacterias.
Meryl Comer (08:42):
Were you surprised, , Dr. Brisetto, when you, , saw the research about the link to oral inflammation and Alzheimer's?
Dr. Rasetto (08:54):
Good question. I always though that, , we are not just dentists. We are dentists treating a patient as a whole. And we cannot be talking about organs that are separated. Every, everything is interconnected. Obviously the mouth, it is a very dairy area, very, very dirty. You know, we, we are hosting bacterias, unfortunately, all the time. And the soft tissue and the intring can see of how the tooth structure is interacting with the gums and the shape of our teeth. Obviously that will have a port of entrance for these bacteria to get in. And I do see now how different it is the way that we are approaching our patients. The first thing that we are doing is we are spending enough time to understand the patient's overall medical condition before we start talking about teeth. I can see this all the time, that patients sometimes are surprised of how much time I dedicate talking about some other things before I get into the patient's mouth.
Dr. Rasetto (10:01):
So I'm glad that the community now is much more involved in educating our patient's population regarding the importance of the correlation between oral health and Alzheimer's and other obviously, , , systemic conditions.
Meryl Comer (10:20):
So how does inflammation in the mouth become a brain health issue? Is it crossing the, the brain blood barrier?
Dr. Rasetto (10:28):
One of the main bacterias that are causing perionta disease is porphyria gingi - porphyriomonas gingivalis. We'll call it PG. And once the, , presence of, , pockets and bacterias that are getting into the bloodstream, and they are being mobilized and translocated through the entire body, as it goes through the blood-brain barrier, it goes into the brain. And they like to be attached to areas around the neurons and they start inducing and there are certain molecules that they are able to emit and start creating this neuroinflammatory process that it happens in the brain. So, , the, the key is to go back to where the polyphymoras gingivales are in the mouth primarily. So that's where we need to pay attention and emphasize the importance of having very good oral health is so crucial for the overall condition of the patient's health.
Meryl Comer (11:33):
How do you begin to speak to patients, , about an emerging science so that it motivates them to take better care of their teeth without overstating the certainty that there's a direct linkage because the science is so new?
Dr. Rasetto (11:51):
I provide evidence that research has shown us the importance of having the best type of treatment that we can provide to them, not only for cosmetic purposes, because sometimes they come only for the reason, but from the point of view of oral health. And describing the reason why has been enough evidence that the association between oral health and, in this case, Alzheimer's and cognitive decline, it is a reality. And I trying to explain the importance of minimizing the risk for them to suffer perhaps this type of problem.
Meryl Comer (12:29):
Doctor, many in our audience, , care for loved ones with Alzheimer's. And we've all had the experience that it is very challenging, , to take care of a loved one with regard to their oral health. What do you say to the caregivers out there, , who know what they should be doing and the care is important, but when a loved one refuses the care?
Dr. Rasetto (12:59):
That is a tough one. And I, I face that myself with my father. And I understand that, , nothing is perfect. And what I usually tell patients is patience is very important. To be patient, to be resilient, to be consistent, to learn to play as much as possible and find the things that could be motivating them to be engaged. There are certain obviously, , type of techniques that we can review with the caregivers to see what are the different type of accessories and instrument that we can be working on. Informing them about the diet, which does plays a major role because as one of the components of caries and predontal disease, diet plays a major role.
Meryl Comer (13:56):
The caregiver, I was always concerned what my husband and my mother might be ingesting. So that I used what you use for children because I felt that was probably the safest if they ingested.
Dr. Rasetto (14:10):
The, , type of, , management of the oral hygiene technique, obviously, is very true that when you are start putting certain things like a, a brush into the patient's mouth, some of them could even be hurting you where they will try to be biting in your, , you know, fingers. I already faced that myself as dentist. So we have to be cautious about that part. And then the toothpaste, obviously, when we are using toothpaste, the amount of toothpaste that we are delivering is important. So it has to be pea size. Sometimes we see that people are going to be adding two centimeters of toothpaste into the brush, which is not necessary. And then obviously, , if we are us - you, if you're, if we are utilizing toothpaste that has high concentration of fluoride, the main issue is that if the patient reach a point where they are not aware and they are trying to swallow, that could be creating obviously a side effect.
Dr. Rasetto (15:11):
The baby toothpaste that you are referring to, you know, is gonna be generating some foam into the surface to help to facilitate the process of brushing. And it's true as reducing the risk factors of not inducing any major irritation on the patient's, you know, stomach. You know, you are finding ways to try and to go through each day, helping them as best as you can.
Meryl Comer (15:34):
When you have a nonverbal patient, what are the clearest signs that they may be in oral pain?
Dr. Rasetto (15:42):
Those are the moments that we have to be paying attention to what type of body response does the patient has. If there is any type of, , eyes movement or expression, facial expression that are linked with perhaps something that is creating pain. When they are trying to choose something, it's definitely necessary for us to clinically identify what is the source of problem. So the sooner that we get in areas of the mouth that they have perhaps an infection, the better that we're gonna be to reduce a chance for this infection that we have already identified that could be leading to a complication systemically. Dental pulp could suffer what is called necrosis. And then the process of dying slowly. And sometimes you don't have symptoms, but then you find radiographically those focal infections that are not yet perhaps inducing pain, but they could be very, very detrimental for the overall health of the patient.
Meryl Comer (16:51):
Thank you, , for addressing some of these issues that people live with every day. And, , , they're not often talked about. Speaking of aging, we have a generation now that are outliving their dentures. No one ever thought about that. <Laugh> What do you do for the 70 plus set these days?
Dr. Rasetto (17:16):
So if the patient has a good, , overall health procedures that we know that are, , predictable, and they can provide with the appropriate stability for them to have adequate function, adequate aesthetics, that will make them feel very comfortable to continue on with their life.
Meryl Comer (17:43):
How do you reach into communities who face barriers to treatment, , either because they can't afford treatment, , or it's just culturally just not part of their, , regular hygiene?
Dr. Rasetto (17:59):
Before coming to America, I practiced five years back home. And I dedicate an entire day treating patient that they, , were in need. And I moved to the first world. I went through all my training, and I still now see that there are places that patients unfortunately cannot receive the right care because of financial burden and, and the amount of investment they have to do. I think that there is a, an effort that has to come from the government, from the community, from the veteran organization that are related with, in this case, our profession. Adversity of Maryland, , has done this, , where I used to go with the residents as a group and care for Indian reservations in Navajo re- reservation. It was part of Mission of Mercy that we will go and spend two days or three days providing, , service to our patients.
Dr. Rasetto (19:04):
And we will see so many patients that they couldn't have access to a private sector, you know, a dental school, , , a, a, a, a dental service. So I, I definitely see that there's so many things that we could do to improve. I belong to this organization that we are, you know, seeing Holocaust survivors patients. So I offer time in my office with my colleague to see some of those patients, you know, for free. And I, I think that it is a constant, you know, effort that we as clinicians could be doing to help patients to receive care. Dr.
Meryl Comer (19:40):
Rossetto, what has that experience taught you about dignity and sense of self? And more importantly, access, , early access to care?
Dr. Rasetto (19:53):
We have to understand that there are people that they need certain services that we take for granted. And we as a community can really makes a difference when all of us are putting that attitude toward helping people in the way that we could, obviously, based on what we are doing. And so it's, it was, it was and it still remains a wonderful feeling an experience.
Meryl Comer (20:19):
Well, thank you for your service. , Dr. Rossetto, if people want to avoid the dentist, what should those must-do habits be each day when it comes to oral health?
Dr. Rasetto (20:32):
We spend time learning how to have a very good oral hygiene technique. And your dentist and your hygienist can review and provide all the necessary support. And then that motivation that you get out of that particular session has to stay and stick with you because that's the main issue is when you provide this training on patients and you leave the office and you feel motivated. And then after a week, and you start lacking, we have to pay attention to what we eat. When do we eat? It's important for us to have the, , disciplines to understand that if we like to have sugary drinks, and if you're sipping through the course of the day, and in between meals, having snacks, those are the nutrients, the ideal fuel for the bacteria that you are hosting to really have a fist. Either if you suffer from decay or even if you suffer from periodontal disease.
Dr. Rasetto (21:41):
And the third part, if possible, trying to maintain a, a regular dental visit. And if you cannot do a comprehensive treatment because of the finances, it's still trying to maintain either every three, four or six months, a recall program with your dentist so we can, number one, help you to diagnose problems. And number two, preserve what you have.
Meryl Comer (22:10):
Thank you, Doctor. We know your patients are waiting. Our guest today has been Dr. Flavio Rossetto, a notable Washington DC board certified prosthodontist affiliated with the University of Maryland School of Dentistry, who spent his career helping patients restore function, comfort, confidence, all contributing to their oral health. And don't forget, join us for the 11th annual National Alzheimer's Summit on September 16th and 17th. This year's theme, The Time Is Now: Advocating Alzheimer's Policy for Every Generation that highlights the importance of caring for the brain at every stage of life from childhood through the older adult years. Go to usagainstalzheimers.org/allsummit to learn more and register for this virtual event. That's it for this edition. I'm Eriel Comer. Thank you for brainstorming with us.
Closing (23:15):
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