Advancing Pediatric Oral Care with Dr. Boyd Simkins and the Breakthrough Saliva Test

Embark on a journey to the forefront of pediatric dental care with Dr. Boyd Simkins as he unveils the transformative power of early intervention through the lens of his groundbreaking work. The art and science of dentistry converge in our latest episode. Dr. Boyd Simkins introduces the SILHA saliva test, a game-changer in predicting dental disease in children by analyzing their saliva for key health indicators. Unravel the complexities of cavity detection in young ones and grasp why taking action before issues escalate is not merely about warding off cavities but nurturing a foundation for lifelong health.

Experience the intrigue of pediatric oral health's ripple effect on a child's overall development, from the nuances of proper breathing techniques to the subtleties of facial growth. Dr. Boyd Simkins guides us through the maze of mouth versus nasal breathing and how these habits impact everything from sleep patterns to orthodontic health. Our conversation is peppered with insights on the challenges of correcting orthodontic issues later in life, emphasizing the vital, yet often overlooked, connection between oral health and systemic conditions.

Cap off this exploration with a deep dive into the symbiotic relationship between nutrition, gut health, and oral hygiene. Dr. Boyd Simkins shares a personal narrative that brings to life the astonishing effects of diet on gum health and underscores the importance of a holistic approach to well-being. We extend an invitation to reflect on the legacy of parental health, the environmental influences shaping the next generation, and the imperative for collaborative care.

Join us and Dr. Boyd Simkins on this enlightening expedition, and be empowered to join the ranks of those championing a healthier future for our children.

Want to know more about Dr. Boyd Simkins and his practice?

https://castlecreekpediatricdental.com/

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To learn more about holistic dentistry, check out Dr. Carver's website:

http://carverfamilydentistry.com

To contact Dr. Carver directly, email her at drcarver@carverfamilydentistry.com. 

Do you want to talk with someone at Dr. Carver's office? 

Call her practice: 413-663-7372

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

Transcript

Dr. Rachaele Carver: 0:00

Hello everybody, welcome back to another episode of the Root of the Matter. I'm your host, dr Rachel Carver, and today we're very fortunate to have my friend and colleague, dr Boyd Simpkins, who is a pediatric dentist out in Utah and he's wonderful agreed to get up nice and early and have a wonderful conversation with us. Dr Boyd and I we've met maybe last year. We've been working together with Silha, which is a company that does salivary diagnostics, and he has provided kind of the pediatric aspects and I've done more of the adult, and so I really want to have him on here to talk really about how we can intervene in our children to prevent all these adult things. We're talking about all these things on this podcast, all these problems that we can have as an adult. But we know that if we can intervene as children we're going to have a much better adulthood, and we often don't think about that.

Dr. Rachaele Carver: 0:52

We've on the podcast, we've talked before about early intervention, ortho and this kind of thing. But even with the SILHA test we can determine do they have a lot of the cavity causing bacteria? Do they already have a lot of inflammation going on? So again, I'm so about prevention, prevention, prevention, prevention. The younger that we can start this, the better off we all are. So welcome, dr Simpkins. Thank you for taking the time today. Why don't you tell us a little bit about your practice, what you do, what your focus is?

Dr. Boyd Simpkins: 1:26

Okay, all right. Well, thank you, chelle. Glad to be on here. Thanks for bringing this to attention to everybody out there, which is really great. Quick backstories Private practice I've been there 20 years. I've also taught at the Pediatric Dental Residency in Utah, the postdoctoral program for the last 10. And then actually just started teaching at the dental school this fall. So I actually just started teaching at the dental school this fall. So I'm a whole five, six months in. Try not to make too many enemies. That's how that goes, yeah.

Dr. Rachaele Carver: 1:48

Interesting. When your point of view is a little bit different than conventional, you tell the line. But I think what we do is super important and this is how we're going to change the directory of disease management to actual health care. Why don't you tell us a little bit? I don't know if I've talked too much about that the SILHA test very much.

Dr. Boyd Simpkins: 2:10

Why don't you describe that a little bit and maybe how you use that with your population? Yeah, absolutely so. Backstory real quick on that. When I hit this point where we're in pediatrics, it's high value. And so I've been cruising along for 15 years and seeing upwards of like 80 patients a day.

Dr. Boyd Simpkins: 2:25

It's just this mill that you're moving these kids through and I just got so burned out from filling and crowns and sedation. And so I hit this wall where I just was so unhappy with this concept of we wait till the disease manifests and then we're trying to treat symptomatically. And so I took this huge dive and was actually at a conference in San Francisco and I ran into Dr Brian Novy, and so this was my deep dive into looking at what you've termed so well as the ecological plaque hypothesis. Right and long story short, I end up purchasing this machine that we started to use inside the office where we're screening for acidity, we're screening for buffer capacity, inflammatory markers and then ammonia, and learning how to piece all of that together so that I could take these kiddos, we could take these baseline measurements that gives us ideas of shift of the microbiome. Are we looking at more of an acid or cavity producing environment. How balanced is that? Is there inflammation inside the system?

Dr. Boyd Simpkins: 3:38

I had all these kids that we could see there was no disease, and then we could all of a sudden say, okay, look, we're having markers that are putting at risk for disease.

Dr. Boyd Simpkins: 3:55

How can we intervene before that disease comes up? And then even better was because we have them fast two hours prior to taking this test. We then can take this test and we can look to see if we're actually seeing improvements in those markers rather than just, oh, look, no cavities. This is good job, but all the while we're in the mode of next time they come in, we're going to have stuff just blow all over, and I've had that before where we see a child, sometimes they're hard to get x-rays on, so I can't really do anything diagnostically with the interproximal stuff. Come back six months and I'm talking to the parent that I have to do a full sedation because I've got to restore age 12 teeth, and so it was liberating, I suppose, to be able to look at the parent and say, hey, look, this is going on and I've got to do this or we're going to end up in this situation. So it was a game changer for me and of course, that just opens up this giant rabbit hole that I'm continuing to fall.

Dr. Rachaele Carver: 4:50

No, it's great and you bring up a really important point. So with the young kids it's very it's hard to take x-rays. So sometimes you can look in the mouth clinically and the teeth look pristine pronged, but this is why x-rays are so important. We can't see between the teeth and this is why x-rays are so important. We can't see between the teeth and this is often where cavities start. Yes, they can be in the biting surfaces, but often they're between the teeth and again, without x-rays we can't see that. So oftentimes maybe the kid's not even, maybe six years old before we get the first x-ray and they're already bombed out.

Dr. Rachaele Carver: 5:18

And so that's why, again, I think this saliva test which this saliva test, unlike some of the other ones, like oral DNA bristle, all these is cheap compared to some of these others and it's instant right. Those other saliva tests, you have to send them away. It takes about two weeks and they're definitely valuable. And those I'm not saying they're not, I love them, but this is a really nice and that's more of a. Those tools are more diagnostic, whereas the Silha is more screened, right. So we always say with Silha, this is a screening tool. We're not diagnosing a specific type of bacteria in the mouth or any specific markers we're looking at. You know the chemistry basically in the mouth, what's happening here. So to me it's a stepping stool, because if every new patient in my office gets the SILHA and it's a screening, okay, do they have high karyogenic bacteria? Do they have a very acid mouth? Is there a lot of inflammation? And so, again, it helps you determine how am I going to treat, because both of us are very the same thing.

Dr. Rachaele Carver: 6:21

I got burnt out, just drilling and filling. I'm like I don't want to be a tooth engineer. How do we prevent this? I'm such a curious person always why, why did this happen and how can I prevent it? I feel like I will have a higher place in heaven if I can prevent disease, because ultimately that's what we all want and, like you, I just didn't feel good just doing that and it just didn't sit right with me. So that's really great, okay. So, as I was saying, if we can't get x-rays until the kid's six years old, this is a wonderful way to be able to intervene early so that kid doesn't have to go through all of that. Dentistry honestly is super important, but every time we have to fill a tooth we're putting in an unnatural material and what is what it is. But hey, if we can prevent that, wouldn't that be so much more worthwhile for the children too? So tell me a little bit more how again how you're implementing it. Just go into a little more detail for us.

Dr. Boyd Simpkins: 7:17

Yeah, absolutely, and I love all the things that you're saying because it just it resonates with me really well. So the way that we're using this right now is, in the beginning, as you're introducing new things into a practice, there's hesitation or there's like way overboard, and so trying to find that balance. But I'm to the point now where I really like to get a screen or a baseline on everybody. The problem we're running into right now is that, because of how dentistry has been set up over the years, is that sometimes getting people to come in not eating or drinking for two hours or not brushing it, can be difficult, and so sometimes it just means it's a quick in and out, coming back in, and most people are pretty good with that. But we're trying to get a baseline so that I can see where we're starting, because what this does for us is if I can get that baseline and then we look at other clinical factors and, like you said, this is a screen. This is just a piece of the puzzle. We've got to look at the whole picture but it gives us that idea of where is risk at that point and so I can then decide versus Claude Hopkins and the Pepsodent advertisement back when saying that we had to go to the dentist every six months. There's no science behind that, and being able to create risk assessments by using something like this that gives us something objective. It's going to put us in a better position to A justify having someone come in more frequently, but then B create that individualized type care that's going to really make a difference for that child.

Dr. Boyd Simpkins: 8:49

And one of the harder things that we run into in pediatrics and we're really pushing for early visits. Right now, the American Academy of Pediatrics Dentistry, the kind of the guideline is within six months of eruption of the first tooth or by age one. I personally and I'm actually lecturing on that today I think that's too late, but we at least have that in place. And so what we're doing for some of these kids in my office is and we're trying to get this in as much as we can if they're too young for me to have them swish and spit, then we test the parents, spit, then we test the parents, and so we know from all the data out there that we see vertical transmission from the parents at birth. In fact, we're seeing some in utero antigen transfer. That's actually setting up that microbiome and the immune sensitivity for allowing some of that transfer to occur. But we can even look at the parent's microbiome using that screening tool and it gives us an indication of maybe how we need to manage that really small child by looking to see what's going to be transferred.

Dr. Boyd Simpkins: 9:55

And then of course, we have to dive into diet and all of those things that are going to influence how that shifts for us. So so that's the big thing we do right now. I'd love to have that just be standard of care right, and so that's where we're hoping we can get the OBs, we get the primary care positions, we get the primary care dentists, we get everybody on the same boat where we're looking at assessing prenatally and then perinatally. With these type of ideas, then I think we're going to make a huge shift in how oral and general health is perceived and also the outcomes.

Dr. Rachaele Carver: 10:30

I'm really excited. Just to reiterate what Dr Boyd said is he's testing the parents. I just had a new patient, a one-year-old, the other day and he wasn't really opening his mouth and give him a toothbrush and the dad's like, look, he takes the toothbrush, brushes his teeth and then shoves it in the kid's mouth. I'm like, yeah, I'm like, so exactly what you're talking about. We all share this stuff with our kids. We try the food first and some people will say that's ridiculous. You're not going to do anything for a one-year-old. More of a relationship between you and the caregiver because you are telling them how to create healthy mouth. Right, you want to start the good habits as early as possible. So I love what you're saying about the parents, because it is very, very true. What is what's going on in their oral microbiome? So that we can have those conversations? We are always having diet nutrition conversations with our patients, especially those very first ones. We're trying to teach them breast is best, and not necessarily just because of nutrition of breast milk, but also for the development of the jaw, right. We're trying to tell them please, please, please, do not give your kid a squeeze pouch, do not give them a straw when they're that age right. We don't want that sucking action to narrow. It's because I would say in my patient population, 99.9% of us all of us right our jaws are too narrow and they're too far back right. Most of us need to grow that maxilla forward so that we can open the airway. So many people have swollen.

Dr. Rachaele Carver: 12:06

I saw a whole family the other day. Every single one of them kids, parents all had very swollen tonsils and it was interesting because as we were talking, she said they have a wood stove and I said because at first I always think about diet that there's something inflammatory. But then I'm like, oh, all four of them. And I said, oh, geez, I was like maybe you think about, because we do have a humidifier, I was like maybe an air purifier or something.

Dr. Rachaele Carver: 12:26

I think it's causing a lot of problems in the airway which then can lead to other issues. But it was really interesting to see all of them to have that conversation. So it's important to test all the family members and I love that because maybe you're not going to get a kid to swish and spit till they're five or six right, to swish and spit till they're five or six right and, like you said, you're missing all those really crucial years to one develop the right microbiome from the get-go right, so important for overall health. What about other things that we talked before on this podcast about intervening when we see certain conditions in the mouth? I mean a little bit more about your experience with that. What other things are you looking for in those really early years?

Dr. Boyd Simpkins: 13:08

So one of the things I think and where I practice specifically, is that inflammation inside of the pediatric community, inside that mouth itself, is completely ignored.

Dr. Boyd Simpkins: 13:22

In fact there's no periodontal risk assessment for children, it's all just extrapolated from adult information and so I really feel like that inflammation is a portion of that testing that we can do, that we really need to pay attention to, and there are lots of different modalities that runs into it. If we look at 30-year-olds, like 50% of 30-year-olds have periodontal disease, and then you get up to 60, and it's like 75, 79. We're trying to set up some modalities where, if we're seeing some inflammation, we do probe around, like the first primary molars and this is working with one of the faculty at the dental school we're probing on eruption, the six-year molars and the central incisors and that's all just to look for kind of that stage three, a grade C type of molar incisor, type of periodontal disease we're seeing in these kids with these huge pockets that are reversible. But then the other thing that we're seeing with that is that when we talk about inflammatory issues, we're seeing that mast cells are being vertically transmitted from parent to fetus, transmitted from parent to fetus.

Dr. Boyd Simpkins: 14:47

So it's essentially vertical transmission of allergies, which is I've got enough regrets for my children without having something else packed on top. So we're seeing these kids and I can think back. So I have four of my own and I can think back to eczema, which really and we're seeing this from like the National Foundation for eczema, which really and we're seeing this from the National Foundation for Eczema it's just that first sign of inflammation and we see that. And then we start to see markers inside the mouth and it goes back to that idea for that family you had with that wood stove. Suddenly I'm seeing all these kids who have plucked noses. We've got big adenoids, we've got big tonsils and so so suddenly we've moved into this mode of mouth versus nasal breathing and, a if we're not breastfeeding, which gives us that muscular development, then b, we're plugging our noses from early allergen contact and from vertical transmission from our parents so that all of a sudden we have this open mouth posture. We're seeing lower ph, so higher acidity inside the mouth. We're seeing inflammatory components.

Dr. Boyd Simpkins: 15:50

We've all seen that child, especially teenagers are the worst. But anyway we've seen that child that they open their mouth and you look at the gum tissue and it bleeds and we're seeing that, but then we're seeing that alteration in growth patterns because we can't breathe properly through our nose. So now we've got this, looking at it from a side profile view, like typical orthodontics, we've got this clockwise rotation where we're pushing the mandible down and back, we're occluding the airway, we're creating kids who have sleep-related breathing disorders, and so now, if we're not addressing those issues early on, it gets so much more difficult to try and change that pattern of growth as they get older. And this is a huge combination of things that just come together and it's also interrelated that you ignore one thing and you're going to miss something on the back end, and so it's complex but at the same time, isn't that kind of why we went into this profession?

Dr. Rachaele Carver: 16:48

Yeah, that's interesting. Pediatric dentists who I've interviewed on the podcast before. She wants to see everybody before six. She's after that not to say that it's too late, but the success will go down because they've already had seven years or whatever of. I think I read somewhere age four to seven is when you undergo the most.

Dr. Rachaele Carver: 17:14

Get in there at 84 or younger and correct those habits, because it doesn't take long to develop habits and it's a lot harder to unwind some, some of those habits. I I my whole thinking with adults when I'm working with expanding their palate stuff and I just had working. But oh geez, I think I'm missing the boat, because what about all the habits? What about their tongue habits and their breathing habits? We can't ignore that piece too.

Dr. Rachaele Carver: 17:32

Again, it has to be holistic. We need to teach the child how to breathe properly, swallow properly. It's so much easier. And again, we always say, hey, if we can get the structure right at the get-go, then hopefully we never need orthodontics. We don't need to go that because we've developed the child the right way.

Dr. Rachaele Carver: 17:52

And it seems more and more common to have these allergies. I just think in today's world so many toxins our feeds are so highly processed, it's hard, even when you're aware it's hard to eat, right, it's a challenge. We're just always on the treadmill in the US or just go, go, go, go go. And even for me, who is so aware, it can be challenging to not sit down, relax, have a meal, try to be doing eight million things at the same time. Again, we have a real advantage to be able to intervene at such an early age and make, I just want to think, people understand the major impact this has on one's life.

Dr. Rachaele Carver: 18:33

To be able to breathe properly, to sleep properly, to grow in your whole structure right With the way your brain is structured, that helps your muscles, your spine, like all of that is so key to proper development of the nervous system, right, if we don't breathe through our nose, then we might be in that sympathetic tone all the time, which so many of us already are, and as a child who's growing so rapidly, we need them to be able to get into that calming nervous system to develop well. So it's fascinating. You were saying before we started recording that you're working with some orthodontists and Tell me a little bit about those cases 60% of facial growth is done, and so by the time that we're hitting age 12, we're at 90%.

Dr. Boyd Simpkins: 19:35

So the last 10%, how much influence can you have on where the growth is going to go? And so we've got these kids who are super severely constricted in that maxilla, and then we've also got the kids who are super retreated in the mandibular area and it's difficult in that. Really, the only options that we have inside the orthodontic world that are really being thrown out there right now as far as like standard of care are these functional appliances which we have, the and all these things. But we're not seeing that they're really doing what we want it to do. We're not seeing mandibular advancement. All we're seeing is dental alveolar compensation, which includes restriction or retraction of that maxilla. So not only are we putting these things in to try to push the mandible forward, it's not pushing the mandible forward, it's actually pushing the maxilla back. And so we're compounding these issues.

Dr. Boyd Simpkins: 20:33

And I won't even get into the possibility are we creating TMJ issues by pushing that condyle back inside the faucet? I've seen so many teenagers already that I've taken a combi mom and I've got this condyle that looks like a J up inside that faucet. It's just, it's insane. And the point is that once I get to that point, there really aren't any good solutions outside of waiting till later, and then are we into a surgical situation. So avoiding that it's huge. Nobody wants to do that, nobody wants to put their child through that, and so starting early can we just completely avoid all of those conversations, which would be fantastic, absolutely.

Dr. Rachaele Carver: 21:14

So let's say, with the younger child you've got the SOHA test that you've done. Inflammatory markers are maybe high keratin bacteria. The pH is too low so they're very acidic. What kind of strategies are you telling the parents? How are you trying to fix that?

Dr. Boyd Simpkins: 21:35

So we run to nutrition first. Right, we're all looking at what's going in. Are we pounding the trigger, which I laugh? I had an acquaintance of mine send me an article just recently that I hadn't seen, where it shows that sugar-sweetened beverages cause gingivitis and periodontitis. And we're talking about the sugar, we're talking about the inflammation, we're talking about the processed foods. We're trying to get all that inflammation down and then we have to go into are we breathing through our nose? Are we breathing through our mouth? What type of kiddo is this? Is this the allergy, consistently congested?

Dr. Boyd Simpkins: 22:10

And so we're trying to use auxiliary people as much as we can. I've got an allergist that we're sending the kids to, who's an ENT at the same time so we can evaluate terminitis and all that kind of things. We're using the probiotics, we're using the remineralization type of modalities with some of the toothpaste and stuff that we use, and those are corrective, right, those are where we're trying to shift. But the true prevention comes into that diet modification and preventing that congestion and that habit forming of moving air through the nose versus through the mouth. And it's hard to. And this is where it really gets difficult. And this is one of the things, and we did an informal survey inside of our office is that when we talk about some of these subjects because it can be so foreign or abstract to parents, it does a dick. And so we've all seen that glazed look, once you go past about 30 seconds, where they're thinking about what are we going to make for dinner? They're staring right past you. What are we going to make for dinner? They're staring right past you.

Dr. Boyd Simpkins: 23:13

So showing them something on paper has been really influential for me, because it's almost like you're taking something out of the stratosphere and setting it in front of them and all of a sudden, oh my goodness, it's real.

Dr. Boyd Simpkins: 23:23

Because we know that if we look inside that Fisher-Owens model of healthcare, there's certainly individualized care, and in my world, because individualized care from a child is not possible, it's got to extend that sphere of influence minimum to the family. And then how do we even move that out further to community type level sphere of influence so that we can start impacting? Especially and this is one of the things that's been really hard for me too is that the population that I'm seeing so many of these issues in is in that underserved population, where resources are scarce anyway. And so what's our modality and what do these families need in order to be able to move in these directions? Where we're reducing inflammatory impact, we're seeing better school performance, reducing that sympathetic tone that you talked about, it's going to improve and it's going to decrease these healthcare expenditures that are just going out of sight, and that's a whole other conversation that we could run down that road Absolutely.

Dr. Rachaele Carver: 24:31

And that's a whole other conversation that we could run down that road. Absolutely, it is challenging. I think we all know that we should probably eat grilled chicken versus the chicken nuggets at McDonald's. That's not something that even a five-year-old probably knows to divide healthier for them. But that's always the challenge is how do you, especially again with our modern lives, how do you help families when I think you create the awareness and like what I talk about all the time.

Dr. Rachaele Carver: 24:56

Like you said, we need more minerals, right, minerals is what's really important for balancing pH, and the problem is in our food supply today. Our food is really lacking. So, you know, a lot of foods have vitamins that are added in, but the mineral content is really poor. Or the minerals that are added are not. You know, they're not minerals that our body can absorb, they're incentives to things. And even some of the vitamins we'll see a lot of times they put for B12, cyano, cobalan Cyano that's cyanide. Right, we should not be having that, but I think that's a really cheap form of B12. So you'll see that in a lot of vitamins and foods. I think that's what's in vitamin water. It's the cyanocobalamin. So we think, hey, okay, I'm not going to have the soda. I'll have a vitamin water, but again, be careful, read, read the ingredients.

Dr. Rachaele Carver: 25:46

But it always gives my kids the eye roll. They get exasperated. I was like I can drink. I'm like water's good. You can drink milk Like I get it. It's frustrating to find that. That's what I think that's.

Dr. Rachaele Carver: 26:00

My biggest hurdle is how do we? We can inform the patient, but how do we? How do we help them? One of the most nutrient dense foods on the planet is liver. We don't eat liver anymore. Maybe our grandparents used to all the time. So I tell them hey, they do sell desiccated liver in a capsule. Maybe that's your. That's what I have to do. I can't. I tried so hard but I just can't. Maybe if somebody makes it for me, it's okay. I like pate, but trying to cook it myself, I have heart, but I think that's always a strategy. Always.

Dr. Rachaele Carver: 26:25

What I'm looking for is how do we? Because the more we create awareness about deep nutrition things, the more, because the only way we really change food supply is with our dollars, right? So if we stop buying these things that are loaded with, things that are processed terrible things, that's the only way we can change Part of the podcast again, creating awareness so that we try to make better choices. Even when my kids were younger and I wanted vernalin bars to send in their lunchbox, even the so-called healthy and organic ones still have bad oils in them. And well, it's again. So it's super challenging and we all have the time to make homemade meals three days a week. Seven days. Three days, three times a day, seven days a week? No, not necessarily Right, that's what I'm always trying to trying to think.

Dr. Rachaele Carver: 27:12

How can we, how can we employ these, these diet things? Because, honestly, if you eat good, healthy food, it can be cheaper. Jeez. You go to McDonald's or Panera now that plate is freezing you can spend like almost $80 for a family of four. Fast food is not really affordable anymore. So let's take that affordability out of it and let's say you buy 12 pack of fresh chicken tenders or something at the grocery store and you have three to four meals out of that. Right, where it's whole foods, you can add whatever herbs and spices you want. Yes, maybe it takes a little more time, but you're gonna really benefit from that. That's what I'm working on. I'm trying to figure out strategies, how we can help people even though, like you said, we don't have a lot of resources. How can we help them? All of us eat better so that we don't have these health problems. Really, a lot of that crux of it is what we're eating.

Dr. Boyd Simpkins: 28:08

Yeah, I totally agree, and one thing that we're trying to implement and we've been doing this for a little while is one of the things that I'm finding and I find it in my own life and you've alluded to it is that we act so much in there's this word called no that I really don't know what it means and I'm trying to figure that out. But what we're trying to do and this is something that we've moved into our office and it's my assistants and my hygienist, so my team will do this for us is that when I sit down, they've already come up with one goal that we're trying to work on, and we we have like a, like a hygiene goal and we limit it to one, and then we have one height or one nutrition goal, whether it's like a substitution, and we're finding that elimination versus substitution we're moving in the substitution area just because elimination is so difficult. So I tell the parents all the time I said this is a marathon like this isn't a sprint, and so what we do is we determine the periodicity so how often we're going to see these kids based on the risk and then what we do is we set up these one goals and then we follow up with that goal at that next visit and for the more severe kids, we're certainly seeing those more often. So it means that we can track those goals closer. And then, once we have a goal that's turned into a habit with when we can talk about dopamine response and all those kinds of things, then you move on to the next thing.

Dr. Boyd Simpkins: 29:37

And is it a slow process? Yeah, absolutely. But is there anything that is quick, that is going to be as beneficial? And the unfortunate fact is no, not really. And so I'm trying that and we're trying to see that, and I'm hoping that that is moving into the families as well, because, like I said, we have to focus on the family, because that child's not going to be the one that's going to the grocery store and picking up the goldfish crackers, it's the parent. So those are things we're trying right now. Do I have data that's showing that it works? Yeah, of course not. We're all trying to do that. Do that. There's data in the literature that shows the dopamine response and it shows habit formation, and there are 200 different health books that talk about that. But putting that into practice, like you said, is so difficult.

Dr. Rachaele Carver: 30:20

I love it. You've made it so simple, right? All right, this time we're going to focus on one goal. Everybody can do one thing, so I think that's a fantastic way to approach something. Okay, we're seeing that the karyogenic bacteria on the silvite chest very, very high. Okay, how about one thing we're going to substitute now, not even talk about diarrhea now, maybe we're just going to add some probiotics, but we're going to do this for two months and then we're going to see you back. I think that's fabulous because, again, it can be so overwhelming. One if they've never even heard any of this information, they're already getting glazed over, as you said. So it's very challenging. We have a lot of diet stuff written up so that it goes home with them because, again, I may say something, but, like you said, that maybe they only get one out of 20 words that I said. So they have that to fall back on if they're interested, want to learn more about. I really love this chapter.

Dr. Rachaele Carver: 31:16

Come to me on one goal and, like you said, the value of that silica is determining the risk. I need to see them before six months If we really want to be and, like you said, because Silite prints out a pretty little graphic. You don't have to know any science whatsoever but you'll see on the graph whoa, that looks really high. I see it all the time. Picture's worth a thousand words. That can really make an impact for the parent or caregiver and may help to implement that one goal. So all of those tools. I use a lot of graphics too in my to try, when I'm explaining to adults why it's when I'm a my for adults, I'm always looking at the it's. When I'm a cell hot my what for adults I'm always looking at the markers white blood cells, blood and protein, because to me that's signifying that and what's fascinating, I think, and why I really value the cell hot is in adults. Like myself even I've never had a cavity. I don't, my gums don't bleed, I don't have bad breath, but my cell hot test was showing a little bit high in phlegm because gut I am always working on my gut and trying to heal it and so the gut begins in the mouth. So very interesting to me. So when I see those markers in patients' cell hot tests I'm thinking, okay, let's talk about what's going on in the gut. Are there other inflammatory conditions and can we impact? So when mine came back a little bit high in those things. I changed my oral regimen a little bit. I started putting a little bit more oxygen using oxygen drops changed I was doing a little more tongue scraping. I changed a few things because I said if I can impact here, then I'm not going to swallow bad bugs and toxins that's then going to negatively impact my gut.

Dr. Rachaele Carver: 32:54

I just think it's a really fascinating tool. It's instantaneous, so within five minutes you get the results. So you can do it at the beginning of your appointment, do the normal appointment things and then you have five minutes later you can pull. So I love that idea where you pick one thing, the biggest thing that comes, that blaring out of those seven markers right Start there. Then you have some people, some of my patients, because I know I was a little more holistic, they were already on board and they want to know, they want to do everything. So great. But again you have to meet your patient where you're at. And that's been one of my biggest lessons, I think, over the last 10 to 15 years is you know you can't shove your knowledge down people's throat. They will come to it when they are ready.

Dr. Rachaele Carver: 33:39

For example, my brother-in-law, he was great he was saying at the beginning of this year.

Dr. Rachaele Carver: 33:44

He said we're going carnivore.

Dr. Rachaele Carver: 33:45

He and my sister-in-law went carnivore, but at least he's really gotten into grounding and like all this stuff that I've been talking about for years.

Dr. Rachaele Carver: 33:52

And and he said the other day I never really understood what you guys were talking about. I thought it was woo, woo and blah, blah, blah and it's just, it's. I'm like smiling as he's telling me all this stuff and how great it is, like I know and and he's I just I just didn't get it and I said no, because you were raising kids, like your focus was on your kid work and all this stuff. And now you have a little more time, now you're ready and I have to, as a practitioner, I have to understand that everybody is going to come to their own things at a certain time. So I think that's a challenge is knowing when to push, when to. Just sometimes you're telling a patient of that glazed lug, or you know, or you just can't gauge how they're feeling. So, again, that's why I like doing a podcast, so we try to get that information out there. Sometimes I think studies say you got to hear something seven times before it sinks in.

Dr. Boyd Simpkins: 34:44

Yeah, my wife would agree with that.

Dr. Rachaele Carver: 34:48

The other thing that was fascinating about my brother-in-law he said no matter what I did, I always had bleeding gums. The other thing that was fascinating about my brother-in-law he said no matter what I did, I always had bleeding gums. Now, three months into this carnivore diet, he's exercised, he's lost all his weight, looks great, all this energy, work, everything he's doing. He said my gums never bleed anymore. He said I didn't change anything with my role. And I said exactly this is exactly what I talk about all the time.

Dr. Rachaele Carver: 35:09

When you clean up the gut, when you remove all of those, a lot of that is not necessarily the carnivore diet, but because he changed his diet and he took out all the processed stuff, he healed his gut right.

Dr. Rachaele Carver: 35:19

So a lot of people can do well on carnivore or paleo or keto, whatever you call it, but most of it's because you're changing your diet and you're removing all of a lot of the processed stuff, and so, again, I'm not saying everybody should go high on the board, but it's the fact that you take away the processed stuff that you get good healing. So I love having stories like that because I think when I'm talking to patients, when you tell them a story, it seems more relatable somehow, versus just barking them like you're lecturing to them. So those kinds of things, I think, are invaluable you have other people sharing those stories and especially for families maybe they've got a bunch of kids and they're both working. But it's hard and we just want to make people's lives easier. We really do. That's our goal as healthcare clinicians, especially the two of us who are really focused on that yeah, yeah, I totally agree and I love the idea of meeting people while they're at.

Dr. Boyd Simpkins: 36:15

I know for me, when we started this whole journey between the silha and then looking at airway and how all these things interplay, I day one like I'm pounding it in and I'm given all the scary things and I and then I actually had a mom tell me one time she she said you're scaring me, and it was a little bit of a wake-up call and what I've had to learn in that same tone is that I have to sometimes approach this from where they're expecting me to come really specific towards airway. We know the effects of airway, we see the growth and development, we see all the microbial shifts and the inflammatory issues that come with that and we can pick that up on these screening tools. But what was happening for me is that I had to reframe the conversation for a lot of my parents where, and like you said, there are people that are coming to me specifically for airway. And then I know, okay, yeah, I'm good to go, but someone coming in just for that oral health assessment at the Claude Hopkins six month coming in and if I start diving into, oh geez, does your child possibly have sleep apnea. It's just whoa, hold on.

Dr. Boyd Simpkins: 37:21

So I had to frame it with okay, I'm seeing crowded teeth, I'm seeing a retarded jaw, I'm seeing this malocclusion, and we know we have to create space for the teeth to come in. How this malocclusion and we know we have to create space for the teeth to come in how are they breathing? Do they breathe through their nose? Do they sleep well? And so I've had to reframe for some of my patients and honestly, for a lot, where I come from a perspective of where they think I should be, and then I can move into these other modalities that are very important, that are the root cause behind the manifestation of what's going on, and I found that that's had a lot more traction as well, and so I like the idea of coming from where your patient's at.

Dr. Rachaele Carver: 38:01

And sometimes it is timing, I totally agree For my kids, every new conviction. So we've created a little worksheet where we have a picture of crowded jaws, circles under their eyes, all these things, and so it's a page with maybe nine photos and we check the photo. Here's your child, we're seeing these, right. I just the more graph, the more things that Perry can visualize or you know patient.

Dr. Rachaele Carver: 38:24

I think I think super helpful too, because maybe they're not saying but maybe they pull that out a week later and be like should I look at it Because there's so much information? I'm like just go on YouTube, watch this. There's a lot of information. As we're wrapping up, what else do you want our audience to know about pediatrics?

Dr. Boyd Simpkins: 38:42

Honestly, if there's anything that I would really love to just really pound down, is that we really need to be taking care of us as parents and potential parents first, and if we really can focus in on that and I know that you do a ton of this already with the parents, but you set yourself up and I have this slide that I've put into my presentations and it's a picture of a flight attendant putting a mask on and so it's that whole idea that you have to take care of yourself before you can take care of anybody else around you, and so I really want to move pediatric oral health and pediatric general health to free natal adult health. That is just going to give me this leg up for when I see these kids, so that I don't have a one-year-old in my office and we're already playing catch up. And that's the big thing for me. If we can start looking at that and getting away from the waiting until disease manifests model, it's going to help us all. That's the big message that I really want to send home.

Dr. Rachaele Carver: 39:45

I love that and it reminds me of a conversation I had with my 15-year-old the other day. She was in the car and she was telling a story about her friends and how one of the baby had gone sick with cancer and she was like, oh, it's just so sad. And she said but the dad, is he going to be able to have more kids? And I said his men can have babies till they're very old. And she's like, but I heard that fertility was really going down. It was harder for men. I I said, yeah, we talk about that a lot. They could carry their cell phones right in their back pocket, radiating. And I said to her you're born with all the eggs you're ever going to have. You're going to be careful. She had her cell phone right on her lap and immediately she, you know, pulled it off to the side. She said I'm so afraid. You're ready to have a baby. We're going to detox you, we're going to clean you and your partner up and at that point you'll be ready. You know, right now she doesn't want to have anything to do with anything that I talk about and it was a really satisfying conversation for me because she thought about it and she really understood that to prevent that in the child, she needs to be very healthy first, and so I think this is a very valuable point that you make. We need to go back even farther. Yes, we like the one-year visit, but it really does.

Dr. Rachaele Carver: 41:01

Years and years ago I used to think that with autism, I was like to get them from the mom. I had this one patient. She had an autistic child, nonverbal, and she was doing all the things, all the organic foods and this and that, and I started listening more of her story. She had had five rounds of antibiotics when she was five, so totally destroyed her gut microbiome, so she has no bacteria to pass on to the baby. Right.

Dr. Rachaele Carver: 41:28

And again, this is not a blame game. This is not about shaming and blaming anything like that. This is the world living, but that's what we want to do. If we can focus a little bit more versus just taking your prenatal vitamins and not eating fish and cured meats or whatever it is, there's going to be a little bit more to to that prenatal care is that trying to minimize all of the processing toxins and all that trying to get us as healthy as possible, then we're going to, like you said, the kids already born predisposed to these allergies and stuff.

Dr. Rachaele Carver: 41:59

So that's fascinating and a really, really great point. And what we talk about all the time, also on the podcast, is how do we create more collaboration between dentists and physicians and have these groups that we're're all working together? Because if you're in healthcare, one of the main reasons you went into that was to help people, so we need to help each other to be able to help everyone. But I hope that that message really gets out there and we can salute you and your support and trying to get everybody involved, because that's really, like I said before, that's how we're going to really create health.

Dr. Boyd Simpkins: 42:35

Yeah, yeah, totally agree, totally agree, and there's so many stats you can go into that just show how we don't collaborate. And one of the reports it was from the NIH, from their cranial facial research department, and that was one of the big points was that dentists isolate and we also, because we have more autonomy, I would say, versus maybe like our medical colleagues, it really gives us an opportunity to not isolate. And it's hard. You talk about how electronic health records don't collaborate and we can't send, and it really just comes down to creating those relationships with people around us. And it's so simple. In our community I've got some pediatricians. I just drop in people around us. And it's so simple. In our community I've got some pediatricians. I just drop in and say hi, and it's that simple. But yeah, I totally agree, it's going to take this multidisciplinary approach, just like anything, to make sure that we're doing the right things.

Dr. Rachaele Carver: 43:26

Dr Simkin, thank you so much for taking the time this early morning and I hope you have a wonderful lecture. If anybody's curious or has questions for you, how could they reach you?

Dr. Boyd Simpkins: 43:36

Honestly, feel free Email castlecreekpd so p as in peter, d as in dog at gmailcom. It's awesome, I'm more than happy to get back to you that second, but I'll get back to you eventually. Yeah, absolutely. But yeah, please feel free to reach out. I'm more than happy to chat.

Dr. Rachaele Carver: 43:52

Thank you so much, everyone. I hope you enjoyed this episode. If so, leave us a comment, let us know other topics that you are interested in learning about, and we'll see you on the next episode. Have a great day, everyone.

Dr. Boyd Simpkins: 44:04

Thanks, Rochelle.