The Root of the Matter

When the Mouth Speaks for the Body: Exploring Biologic Dentistry with Dr. Toni Engram

• Dr. Rachaele Carver, D.M.D. Board-Certified, Biologic, Naturopathic Dentist • Season 3 • Episode 17

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Welcome back to The Root of the Matter. In today’s episode, I’m joined by Dr. Toni Engram, a SMART-certified biologic dentist, integrative health coach, and founder of Flourish Dental Boutique in Texas. From the moment we connected, it felt like talking with a soul sister. Our journeys through personal illness, holistic healing, and biologic dentistry mirror each other in many ways, and this conversation is packed with insights for anyone curious about how the mouth and body are deeply intertwined.

Dr. Engram shares her personal story of being diagnosed with Crohn’s disease, and how that turning point inspired her to reimagine the way she practiced dentistry. Instead of following the conventional model, she began to explore oral-systemic health, functional medicine, and the root causes of inflammation. Her journey led her to create a fluoride-free, mercury-safe dental practice where patients are cared for with a focus on prevention, healing, and whole-body wellness.

Together, we explore the connections between oral health, the gut microbiome, and the nervous system. We talk about why airway health, tongue ties, and sleep apnea matter more than most people realize, and how breathing patterns can influence everything from digestion to a child’s development. Dr. Engram also opens up about the challenges of transitioning a conventional dental practice to a biologic model, and why authenticity is so important when guiding patients through this work.

What We Dive Into in This Episode

  • Dr. Engram’s healing journey with Crohn’s disease and how it shaped her career
  • The overlap between gut dysbiosis, oral inflammation, and systemic health
  • Sleep apnea, airway health, and the role of the nervous system in prevention
  • Why fluoride-free and mercury-safe dentistry supports long-term health
  • Salivary testing, microbiome diversity, and why pH balance matters more than fluoride
  • How materials like composites, zirconia, and biocompatible ceramics impact the body
  • The power of ozone, PRF, and functional tools for saving teeth and preventing root canals
  • Creating a dental practice that is truly authentic and patient-centered

This conversation is full of practical pearls and heart-centered wisdom. Whether you’re a patient curious about biologic dentistry, a mom navigating your child’s oral health, or a provider looking for inspiration on the path toward more holistic care, you’ll leave this episode with fresh perspective and hope.

Connect with Dr. Toni Ingram

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

Dr. Rachaele Carver:

Hello everybody, Welcome back to another episode of the Root of the Matter. I am your host, Dr Rachel Carver, and we are very privileged today to have another fellow biologic dentist who I was just telling her off air that I think we're the same person. We've had a lot of very similar experiences, so I'm really excited. But we're gonna dive in a little deeper on some of the biologic techniques. We'll talk a little bit about our sleep apnea. She's a member of the Breath Institute. If you've been listening to my podcast, that's one of the areas I'm really interested in learning more about the causes of apnea and other oral issues. We're going to talk a little bit more about salivary testing and all sorts of interesting things that she's been up to.

Dr. Rachaele Carver:

So let me introduce Dr Toni Engram, who's an integrative health coach. She also did the IIN certification program, just like I did. She is smart, certified biologic dentist and the founder of Flourish Dental Boutique in Texas. So she is fluoride free, mercury safe dental practice. She brings unique, science-rooted perspective to oral health, combining dentistry, functional wellness and personal experience. Healing from an autoimmune disease those of you who know my story right Sounds very familiar and helping people rethink the role the mouth plays in overall health. Like I said, I think she's my soul sister here, so why don't you tell us a little bit of maybe your story right how you got into? Were you doing biologic from the very beginning, or did your autoimmune condition, like me, lead you down this road?

Dr. Toni Engranm:

Yeah, I don't know about you, but I just wanted to be a normal dentist. I don't know about you, but I just wanted to be a normal dentist. And when I gosh, I'm not that old, but when I graduated in dental school being like anything holistic, biological, that was definitely warned against we were told that those people were perhaps unethical. They were seen as the lesser than dentists. So I just wanted to be normal.

Dr. Rachaele Carver:

I had no idea there was this other aspect even.

Dr. Toni Engranm:

It wasn't talked about very much. Thankfully, god had other plans, so I was working full time as an associate. I had a toddler at home, I was opening my first practice from scratch by myself, and where I was working it was in an area where the food choices weren't that great and I wasn't making good food choices. Obviously, my stress level was not well controlled at all, and so I just got super sick. I started having GI issues, turns out I had symptoms before. I just didn't know what they were. But right around that time in 2010, 2011, it really got bad and doctors blew me off for several months until I started losing weight honestly and this is TMI but until I started losing weight and having bloody stools. Then they finally listened and did a colonoscopy and found out I had Crohn's colitis.

Dr. Toni Engranm:

And as I went I'm sure you've shared your story on your illness too but as I dove in and went down those rabbit holes of trying to figure out how to heal, I just really saw the correlation between what I was trying to heal in my own body, which was Crohn's disease it's an inflammatory condition caused at least in part by a dysbiosis like an imbalance in the microbiome and what I was treating in my patients every day tooth decay, gum disease it's all about inflammation and a dysbiosis and the bacteria of the very first part of your gut.

Dr. Toni Engranm:

And so I knew, if I could figure out how to get well myself, then I had to figure out how to do the same thing for my patients. And so that's what got me started in like oral systemic health and learning about those, like the actual connections that I had to learn that your mouth is actually connected to the rest of the body. And then my patients really helped nudge me the rest of the way. So I would start talking about nutrition and prevention and my patients would say at this point I'm starting to attract patients who are more like-minded. And my patients would say that's great, dr Tony, but why are you still using fluoride, or that's amazing, but are you protecting yourself or your assistant from all this mercury that you're stirring around in the office? So it was really my patients that indirectly, very kindly forced me to do the research and figure out that there was another way that was healthier.

Dr. Rachaele Carver:

Yeah, I think it's so interesting. I credit so much of my education to my patients as well because, yes, same exact time period, right 2011,. My second daughter was born. That's when all my stuff started coming out, but it was after I started looking at these different alternatives for my healing. It made me think, huh, maybe I could be doing dentistry a little bit differently too. And then it was those patients that you were seeing and you're really like why is that happening? I did the whole Dawson curriculum Cause I'm like why has the bite messed up? Like I don't, we don't really learn too much about that at dental school. And I was like you know, am. And I was like you know, am I screwing something up when I work on one side If it's not balanced? So I've always been that. Why? Why? Type of person? The same kind of thing.

Dr. Rachaele Carver:

My first introduction was via ozone, because I had been doing these colon hydrotherapies. I was like we got to clean out, clean everything out, right, because my minor is eczema, right, which was the same kind of thing. The dysbiosis that's a little bit farther up, higher in the gut, which, in me, my liver not functioning great, so things came up out through my skin, right, I couldn't get it through my colon, so all those toxins were coming out of my skin. Yeah, ozone was my first jumping off point too. What was the first thing that you did? Did you go right into the SMART certification and learning that, or no, I really was resistant for a long time.

Dr. Toni Engranm:

I made changes really slowly, really slowly, like I started by just eliminating fluoride varnish in the practice and figuring out how to make that viable for the hygiene department. And still, how are we treating our patients and how do we make up for that lost revenue? Man, it was really slow and I found that the bulk of my patients couldn't hang, didn't want to hang. It was a very insurance-based practice. I was in network with every insurance under the sun and I couldn't provide the care that I needed to care, the care that I needed to give under that system. So probably the last thing that I wanted to do was try to tell my old school PPO patients that, hey, now I need to do this whole protocol and we're going to wear this spacesuit looking thing to take out your silver fillings, even though six months ago I took out this other one and I didn't do that. So it had a whole lot of moral dilemmas as I was transitioning the practice.

Dr. Toni Engranm:

So I actually happened, alongside of personal changes, in the family too. We had moved from the more rural town closer into the city and so I actually sold that practice and knowing that, hey, I really want to do things differently, but if I'm going to do them differently, I need to do it from the start. Yeah, I just wiped the slate clean, I sold that practice and I started another one from scratch, so that's how I did it. It was really slow until I just set fire to the whole thing and started over, and I wound up doing that in the middle of 2020 which was, in one way, I think it was.

Dr. Rachaele Carver:

that's good, because for me, so in 2011 was when I started learning these things and, like you, so I think this is good for any dentists out there who are interested in this but don't know how to get started. There's not a lot of help. The organizations IOMT, iabdm are great. I'm trying to work with them to create more consulting type of stuff, because how do you do this? But for me, I had a very conventional practice when I bought it in 2009. And same thing it was like little by little, ended up getting that smart certification which stands for safe mercury amalgam removal technique, and the ibdm has something called protect. It's a pretty much identical and I had just but I had been to a dental conference I think it was ibdm, it was maybe a combined conference the beginning of of March of 2020. And I had bought the vacuum the little vacuum that we see and it came in Dallas right, yes, yeah, yeah, I remember all of us at that one.

Dr. Toni Engranm:

That's my hometown, so I remember all of us there wondering how the world was about to change and really having it worked out though, because people assumed excuse me that I was bringing all this in because of COVID.

Dr. Rachaele Carver:

So for me it was just like natural yes, we can help protect you, but it's more of that. And I've found that when you're talking to patients like there's not a lot of dental practices or dentists in our area, so trying to sell a prep like you did you're fortunate that you were able to do that Not so feasible in my areas. I've just had that slow time. I practice 16 years now. It's just been that slow kind of transition and I still have very traditional patients in the list. So it's a really interesting mix. But I found that when I'm talking to patients and you're giving them the common sense like when you're explaining what is acid reflux, for example, and you're explaining people like that makes perfect sense. So it's almost even more exciting to work with somebody who doesn't have any awareness of holistic than somebody who maybe knows too much, right. So that's been really rewarding for me, for people to start thinking differently. And then all of a sudden they're referring their patients to me for all sorts of medical issues too, right? Not just about the teeth, yeah.

Dr. Toni Engranm:

I love them.

Dr. Rachaele Carver:

But those are really two really good options. And it can be very challenging in a practice like my, where you're trying to convert. It is easier in one way to start over challenging and you gotta, where are you gonna get the patients from right? Absolutely, but it is. It's hard like it's. You can't really be in the in between. You either either do the florid or you don't. You can't be wishy-washy about it. So, depending on what, whatever practice you have, you just make that choice. And so my patients will come in, even if they're not necessarily holistic or looking for the biological. Everybody gets treated this way, right. So this is the way we do it in our practice. When I do extractions, you get PRF right. We draw your blood, we spin down your platelets and we put it in. That's just the way it's done in my practice. If you don't really like it, there are other options. But I think if you're going to do it, you got to be all in, because when you're back and forth it's just a challenge.

Dr. Toni Engranm:

And patients sniff that out. I think what the generations younger than us are screaming at the top of their lungs is that, hey, we need our authority figures, which I think include healthcare providers. We need people to be authentic. And so if you're wishy-washy, you're like I'll do fluoride for some, not for others, or we'll do all the mercury protocols for some but not for others, then people sniff that out and don't particularly appreciate that.

Dr. Rachaele Carver:

Yeah, absolutely so. Let's talk about some of the materials, because that's one big thing. One thing I think about is okay, so we're taking out these mercury amalgams, that's got all these heavy metals, and we're putting in basically plastics, right. And then you think, ugh, you see all the news about all these microplastics, all these things. Now there's a lot of research about BPA. We know that's one of the worst plastics, right, and they think they see all the news about all these microplastics, all these things. Now there's a lot of research about bpa. We know that's one of the worst plastics. So obviously I think, maybe better, maybe they don't last as long.

Dr. Rachaele Carver:

Amalgams weren't good because they did last a long time. Inevitably, they tend to crack the teeth and we need crowns. For the most part, it was a decent material. However, we live in a very toxic world. Now I have I'm sure you did too. In your other part you have patients who are in their 70s and 80s with a mouthful of mildomas didn't really have any health issues. That's because they grew up before plastics were a thing. Before we had 80,000 environmental toxins right Before glyphosate. Before all this, their immune systems developed strongly. They didn't have 70 vaccines before age 18. So they're much healthier overall compared to kids born today. We're seeing all the obesity, seeing our children with these autoimmune conditions, diabetes it's just unheard of even just a generation ago. So talk to me about the materials that you use that are a better alternative to some of these other things. Yeah.

Dr. Toni Engranm:

And, like you said, we do our best, we're really intentional and I think that's the difference between biological dentists and maybe our more traditional colleagues is that we're trying, we do our best.

Dr. Toni Engranm:

We're very intentional with the materials that we choose.

Dr. Toni Engranm:

So I am careful to choose materials that don't have fluoride, that don't have BPA in them, use more of the what they say are the ceramic based composites and porcelains where we can, zirconia where we can, things that are more biocompatible, that are at least not not containing heavy metals anywhere possible and hopefully aren't creating that galvanic battery effect in the mouth. But I still like sometimes my super crunchy patients, my really holistically minded ones, we've got to tell them, remind them that hey, it's still dentistry, we're still putting manmade materials in the mouth. So nothing is going to be as natural as what God put there in the first place. But we do the best we can to create the safest environment possible with the safest materials we can possibly find. And then if we can go upstream and prevent new dentistry from needing to be done, then we're really working some magic when we can get your body to heal and do what it needs to do on its own so that you don't even have to have the restorative material, the filling the crown, the, whatever the case may be.

Dr. Rachaele Carver:

Yeah, and that's where we're on exactly the same page. I'm so big I am sure with your background in health coaching too, we're just so big on that nutrition and prevention. Once you cut into a tooth, we haven't figured out how to grow enamel back yet. I'm sure it's coming, but I don't know how soon. So until we do that, we want to try to prevent that. Once the tooth has got a restoration in it that's lifelong, you're going to have to have that replaced, probably several times. What do you talk to your patients about? Let's say I find it interesting I have a lot of moms who are holistically minded. They come in and they're like I don't understand, I'm doing everything right and the kid still has a mouthful of decay. And they say they're not using the fluoride. And then, of course, the conventional people think that's why, because they feel like they're feeding them the right nutrition. And I'm just curious your take on that. And how do you talk to parents about prevention?

Dr. Toni Engranm:

I really try to approach it similar to a functional medicine physician, so we're trying to go upstream and look at those root causes. So I ideally I really want to be collaborating with the pediatrician, with whoever the medical team is. Hopefully they're more integrative and are looking at these things more strategically also. But when it comes to a mouthful of decay and we think the diet's pretty on target, then we're looking at gut health. So is the kiddo having normal poops? How often are we having poops?

Dr. Toni Engranm:

We're looking at the acid level in the mouth. Is the pH too low and why might that be? And we're looking at airway. Are they breathing through their mouth at night or are they able to close and breathe through their nose really well? So that's when we really have to rope in the healthcare team, because if there are allergies that are or swollen tonsils that are contributing that, we all need to be on the same page to get kiddos breathing better so that they can close their mouths, have an adequate level of saliva that's at the right pH and go from there. And then we're looking at at kids. It's a little more transient than microbiome. It changes really quickly, but we still want to know what exactly does their microbiome look like? Are there imbalances that we need to strategically correct in the mouth so that they can have a healthy environment that's more resistant to decay in the first place?

Dr. Rachaele Carver:

Absolutely so I'm exactly on that page. Look at the gut Again. Like you said, the gut starts in the first place. Absolutely so I'm exactly on that page, right, like. Look at the gut, right Again. Like you said, right, the gut starts in the mouth. So we can't forget this. We think it's yes, it does have a different microbiome and they're completely, they talk to each other all the time too.

Dr. Rachaele Carver:

So I've also found, the more I'm sitting and the more I know myself as that kind of mom too, looking at the kids' nervous systems. Right, so if you're mouth breathing, right, you're going to be more in that sympathetic state. Absolutely. When you are in sympathetic, naturally, like physiologically, you shut down digestion. Right, so you could be eating the healthiest diet. But if you don't, I'm not producing the stomach acid, you're not producing the peristalsis to move things through the GI tract, right, you're gonna get fermentation, you're going to get a toxic overload, you're gonna get that dysbiosis.

Dr. Rachaele Carver:

So I see a lot of moms who, like I, was so worrying and so fearful I'm doing everything right. Why is my kids? But kids, especially the first six years of life, their nervous system really is developing based on their primary caregivers, right, and if we are. I was this mom, so worried, but now I have teenagers and they just they buck everything. I say because I came at it with this fear-based mindset that if you don't do this, such and such it's going to happen, instead of being like, hey, it's all good, let's you know, let's try this or something.

Dr. Rachaele Carver:

So that nervous system piece, I think, is really important too. So, again, that mouth breathing is so crucial to make sure they're getting in that parasympathetic Cause. Like you said, why is the pH high right? Why you know what's happening, why isn't digestion working perfectly? So, to go really far upstream, think what's happening at that nervous system level. So I think that's what I've seen, experienced and visualized in the last couple of years. I've started putting the pieces together. I was like why, if they're doing things right and you're thinking nutrition, there has to be something else. So, thinking about the saliva, though, let's talk a little bit about the salivary testing that we can do, because, speaking of this, I just recently did two kids. The mom asked me to do these kids and I was like, oh, okay, yeah, and you could see there was some gut issues and the mom is super educated. It was like let's, I want to dive into the gut testing more, and I'm like yeah it's fascinating.

Dr. Rachaele Carver:

So what kind of tests are you using to look for these things?

Dr. Toni Engranm:

Right now my hygienists are getting a microscope for use chair side. We don't have one yet, but, man, they are chomping at the bit to get it. So right now we use a whole lot of like an outside lab. I use Bristle because I like the diversity of the species that they test for, and Bristle is really cool because you can actually patients can order that themselves and they've got a ton of educational materials on their website. Obviously, if we're running the test, then it's more targeted and we're going to set up specific protocols based on their test results. But that's really been my favorite so far and I like to do those tests at the beginning of a treatment protocol and then again a few months later so that we can objectively see okay, did this do what we needed it to do or do we need to do some more tweaking?

Dr. Rachaele Carver:

I'm telling you we're the same person. I also love bristle and I'm like, okay, my microscope is being ordered for the fall.

Dr. Toni Engranm:

Stop it, I'm serious.

Dr. Rachaele Carver:

But I also really love the bristle. We've had the owner on the podcast because the big one used to be the oral DNA, but it only looked for the bad or pathogenic. Yeah, it's giving the whole shot because we all have those, even in health, right? Yeah, bristle test for 700 different species so you can see not only do you have that, but how much good do you have, because that's the thing that we're really looking for. If you're so important different treatments, I feel I used. If you don't have, if you have too much bad, not enough good, we need to treat that. But there's also treatment like how do you get more good, how do we diminish the bad, but also how do we grow the good? So, yeah, I'm a big fan of that testing too and love all the bristle protocol because they are. It is built for more conventional dentists, which is amazing. If you don't really know anything, it's. They do have awesome education. But again, but and now they have you can customize your trip, which is very nice.

Dr. Rachaele Carver:

I was talking to them a lot about them, like I don't love all these things, can we? So that's really nice. But I had a patient who had a pretty good saliva test and then and I was like okay, don't follow this, do this. But she decided to take it on her own and started using I don't know if you've ever seen this, but the biocide and toothpaste. And she is my third patient I've seen now using the biocide, not only like the drops for gut health, but the toothpaste too. It's all natural, but it is too killing and her first test was pretty good.

Dr. Rachaele Carver:

Keep doing it Again. I had two people refer to me from a functional medicine doc and now her as my patient. She used it completely decimated everything, like all of her beneficial bacteria that she'd had three months prior gone. And I saw this in my functional medicine patients. They were sent to me because the doctor was like I don't understand, we're doing a gut healing protocol, why is the oral pathogen, why are they higher? And so we combined it with a stool test. You could see that the secretory IgA, which is an antibody that kind of, creates a barrier in the mucous membranes. It prevents toxins and things from getting into circulation and that had been decimated, so gone. So now there's no more barrier to prevent those things from getting in and out.

Dr. Rachaele Carver:

Yes, biocidin is a very natural product, but even natural things can be too killing. You know we use that for killing, but ooh, it might be peppermint even. That's why some of the Robitin is one of my favorite toothpaste. They don't use a lot of pepper. They only had citrus for a long time until finally people were like we don't like the flavor. So now they have a mint one, but it's very specially formulated. So not to have too much, because too much peppermint is killing and right. That's not the goal. The goal is to create a healthy balance. But anyway, I think saliva testing is really good. I love that We'll give our patients pH tape also too, because here's something you can track daily. It's not very expensive. You can buy pH tape, comes in like a roll in a little plastic container. You can test that throughout the day and that is a really good.

Dr. Rachaele Carver:

I was talking to a friend of mine who is a functional medicine doc and his son was having all this decay and I said you got to look at the gut. He's like I don't know, that doesn't resonate with me and I'm like if you tell me that all the time, I'm like, yes, I see this daily. This is why I'm telling you have him monitor your pH. If you have neutral pH for the average of the day, obviously it becomes acidic right after you eat and hopefully you have enough good buffering capacity in your saliva that within 30 to 60 minutes you'll get back to that neutral pH. But if you consistently have acidic saliva you're going to be more prone to those things. So then you got it. We got to think deeper, like you said, what's the cause? What's the upstream cause of that pH and again I think it's mostly due to that digestion. Things are not happy very well going on there.

Dr. Toni Engranm:

So let's know what's. Funny though that reminds me of that, it reminds me that sometimes I have to remind myself that even functional medicine practitioner families are not always perfect. And what? Who's a very well-known functional medicine doctor in my area and her teenager kept struggling with tooth decay. It turns out she's drinking soda every day every time she's out of the house away from mom.

Dr. Rachaele Carver:

Oh yeah, there's lots of teenagers.

Dr. Toni Engranm:

So even in our holistic families, sometimes it's just hey, we got to cut the Dr Pepper.

Dr. Rachaele Carver:

Yes, I know it's unbelievable With my kids. They come out and even I go into the rooms and I'm like where did you get all this perfume? I'm like this is killing your hormones and I had to let go a little bit because, talking about nervousness, I have to stop because that stresses them out. So I had to be like you know what.

Dr. Rachaele Carver:

I've tried to give them the basis, but I can't control them as much anymore, so I just hope that someday they will come back and they will say hey, mom, can you help me get better? You know, and again, I prevent these things. This is the things I keep trying to teach them. We got to prevent, we got. Prevent these things, this is the things I keep trying to teach them. We got to prevent, we got. Again, I had to chill out a little bit, just be like, just let it be, because, again, like, the more I stress about it, the more I'm going to manifest those things that I don't want to happen. So, yeah, like I just I got to do the best I can. I have to just keep doing, trying to model right the right behaviors and stuff and just hope they'll come around once.

Dr. Rachaele Carver:

I'm not this crazy weird person anymore, so let's talk a little bit more about like the breath. Tell me a little bit about what the breath institute is and why that matters and how we talk about that with sleep apnea and stuff and different treatments for that.

Dr. Toni Engranm:

Yeah, so it's Zaroosh Zoghi who came up with that. He's an ENT physician out in California I think he's in the Los Angeles area and he really developed these protocols around how to properly revise lip and tongue ties, specifically tongue ties in older kids and adults, because we know that impacts breathing so much when you can have a tongue that's functioning the way that it should and when it can naturally rest against the roof of the mouth for the majority of the day. And so that was. It was a fun training to do, and I actually do.

Dr. Toni Engranm:

I wind up doing tongue tie revisions on infants more than I do the big kids and the adults, but I still do the older kids. The procedure's a little bit different and the protocols, the prep work before and after, is a little bit different depending on the age. But, man, we can impact so much by just helping patients be able to have functioning tongue that helps develop the jaws and the airway the way that it should, which then in turn helps them breathe and sleep the way that they should. It's just all so much more important than we were able to appreciate when we were in dental school a couple of decades ago I didn't know any of this.

Dr. Rachaele Carver:

It's obvious when you have a tongue tie on the tip of your tongue right, and often at birth that physician will see that and they might clip it or something. But it's these what we call posterior tongue ties that often aren't caught and then create a problem. Because I'm always telling my patients, your tongue is connected by a fascia all the way to your toes. So if you have tight pulling on that tongue, that affects all of your posture, your movements. The body is amazing and very adaptable.

Dr. Rachaele Carver:

The thing about if you have hip pain, knee pain, is that related to your bite being off, and people were like, what does that have to do with anything as an athlete you have? If you get certain injuries or certain feet pattern, like bunions, right, that's a weird foot pattern and that's related to how everything you know. Yes, it can have a genetic component too, but again, that's all structure related and again, since we've cut the head off from the rest of the body right In medicine you never think about those things. But what do you notice? Like when you do a tongue tie on, say, a teenager or an adult, what are the responses? It's there. That's what they feel right.

Dr. Toni Engranm:

Yeah, that's right.

Dr. Toni Engranm:

A lot of times it's, and we'll take pictures before and after and it's really cool because when you take a picture from the side, most of the time when they're starting, they have this super common forward head posture like we all tend to get over time tech neck, staring at a computer too long, hunching over for too long and you can see that if they've got the right body work, if they've done their myofunctional therapy, if they've done their body work, then on procedure day, literally that day, they are able to straighten their head and neck posture and reverse that forward head posture as soon as the procedure is complete, which is insane to me.

Dr. Toni Engranm:

It's like a weird magic party trick and they do. They get this parasympathetic like automatically stimulates the vagus nerve and they really can open their chest bigger, they can breathe better. A lot of times they'll feel like a rush of energy. So, depending on how sensitive the patient is sometimes they're aware of it, sometimes they're not but all number of things We'll have reducing of head and neck tension, an easing of some of their shoulder tension Anybody who gets tense kind of in their traps a lot of times that will finally relax when they get the tongue tie released and then obviously a lot of times they're breathing better and they're sleeping better, which means overall their health tends to get better over time.

Dr. Rachaele Carver:

Yeah, it's amazing, and if we think about temporal mandibular joint disorders, so much of that can be muscle related, and so we always ask that TMD, do they have a tongue guy? Is there all this tension in these areas, and could part of the picture be that that tongue? We tend to make splints and this is what we learn right in dental school maybe a little make all these splints and through all these things, but to me it's a band-aid because you're addressing the symptom you're not really addressing. Well, why is that joint like that in the first place? I think as biologic dentists, we're always asking that question why, what? What is the cause? Let's think upstream because we want to be able to solve stuff and, like you said, we're so interested in prevention and so we think a little bit deeper versus just you know, because in conventional dentistry your toolbox is about this big.

Dr. Rachaele Carver:

Maybe you have a few things in your toolbox. As biologic dentists, our toolbox is enormous because we're just thinking outside of the box, literally. What are these other modalities that we need to look at or think about? And also really thinking about how the entire body is connected right, and so we need to think beyond the head and the neck and how these things are impacting all of us. So tell us about sleep apnea. You use the Fotona laser, like I do, for a procedure called night laze. So again, how do you go about deciding whether they might be a good candidate for the laser treatment, or is there breath work involved? Exp expansion Tell me a little bit about your process and how you might diagnose a sleep issue.

Dr. Toni Engranm:

So on all of my new patients I'm doing a CBCT to look at the airway, see anatomically, does it look like they're breathing through a nice big pipe or does it look like they're breathing through a coffee straw? And when we're looking if they are having sleep issues we're always questioning. That's on our intake forms. So we're screening everyone for symptoms and if they are having symptoms of poor sleep, waking up in the middle of the night, snoring, anything like that, and we can tell that they have excess soft tissue that's impeding the airway. If it looks like their airway is restricted, then a lot of times they're great candidates for nightlays. I always want to do a sleep study just to see where they are, if they've got actual apnea or don't have actual apnea, because we want to see the full story. And nightlays can be used for as a treatment for mild to moderate sleep apnea or it can be used as a treatment just for snoring and so it can have a great impact. It can be done as a standalone, we do a few sessions and that gives them enough excess expansion in their airway that they're able to breathe better and feel better and have better sleep. Or it might need to be done in conjunction with some other things. If they've got diagnosed true sleep apnea and maybe they're in a bad state, then they may need to do some other more traditional sleep apnea treatments first and then I'll have some patients.

Dr. Toni Engranm:

I don't know about you, but I'm. I personally don't do any of the adult expansion like the Vivos appliances or anything like that for expansion, but I have some friends in the area who do those and don't do night lays. So sometimes we'll share patients because I think the night lays is really good because it's semi-permanent, it's not permanent, permanent and so sometimes we'll do night lays to help open things up as they're starting their vivos expansion protocols with the other provider, so it gives them some immediate relief while my colleague is literally trying to open up their airway and widen their airway. Some, so lots and lots of uses. I think it's really versatile and it's an expensive machine, but I'm sure I'm glad I have it. I wish more people had it, yeah.

Dr. Rachaele Carver:

No, it is amazing. And, as we were talking about before we started recording, I started to notice with my CBCTs the 3D x-rays that some patients had large airways, but yet they still had sleep apnea. So I started to think okay, so there's more than just the anatomy right.

Dr. Rachaele Carver:

And so a lot of it also had to be breathing. The nightly is great. It's laser, it does not hurt. It's a little bit of a tedious procedure, it can be challenging those daggers, but it's every single one of my patients we've done, I said. They immediately feel like they're sleeping better, and I think it's important to know that this is not going to cure necessarily sleep apnea. Right, and, like you, we do the sleep first, because if you have that severe, like you, we do the sleep study first, because if you have that severe like, you have to see the sleep physician.

Dr. Rachaele Carver:

I'm not going to tell you I'm going to do this laser procedure and then your sleep apnea is gone, because there again, there's more to it than just the structure, and some people have apnea, but they're the. If you look at the back of their throat, everything looks good, but there are some people where it's really stretched out. The uvula, the taking down, is really stretching. You're like, okay, we can help that, because what the laser does is it stimulates the collagen, and it stimulates the collagen to plump back up and go back to where it is, but that and that again helps open the airway. But we still got to think. Why, though is that happening Sometimes? It's structural right. So I like to do the opening devices. I think they're absolutely amazing. So it's again it's like in conjunction, because when you're opening it with an appliance, you're getting at the root cause of it, right. So you're opening that A lot of people.

Dr. Rachaele Carver:

I started noticing even better success with nightlays when I started giving a homeopathic sanguinaria, because that's known for snoring and sleep apnea and having them do myofunctional exercise. So there's my favorite website it's on YouTube Six exercises for snoring and sleep apnea. So when they and then the person has to be compliant, obviously. But again, it's not just about the laser, just about the appliance, right, we got to think holistically and three-dimensionally about all these issues when they start doing the tongue exercises, because we said, just like with the tongue tie, we can't just go in and cut your tongue tie. You've got to prepare the tongue. You got it. Especially if you're older, right, with a baby doesn't matter, they don't haven't learned too many bad habits yet, but as an adult you've been using the tone in a certain way for decades. Perhaps you have to retrain that.

Dr. Rachaele Carver:

So, again, a lot of it is snoring, because I started snoring a decade ago and I was like what's happening there, my collagen starting to droop a little bit, my airway didn't necessarily change, but stress and breathing patterns and all these things. So I had to really teach my tongue where it's supposed to be. Like you said, it's supposed to be on the roof of the mouth and my mouth would fall open. So when I first started doing like mouth taping, I was like ripping it off in the middle of the night because I was like, oh my gosh, I'm not used to breathing through my nose.

Dr. Rachaele Carver:

And so again, like you, retrain your nervous system. I think a lot of we know central sleep apnea is due to brain activity, but even some of the other, all breathing pattern is related to the nervous system. So we've got to retrain that nervous system if we want to get total resolution. So the patient kind of has to buy in. There's some homework that has to be done. That's why I talk to my team all the time about being partners, like I can help you, but you got to meet me halfway.

Dr. Toni Engranm:

And what's interesting too, especially the age range where we usually start seeing symptoms of this is for women it's right around the time of perimenopause, leading into menopause. So we can't discount the fact that a lot of times there's a huge hormone component to this. And so we've got to be looking, and I think as dentists we, like any profession when you're a hammer, all you see is a nail Like it I have to remind myself that, hey, we've got to. Even as cool as our tools are, we have to look again, go upstream.

Dr. Toni Engranm:

Is the cause the small airway, the excess tissue? Or is the cause a drop in progesterone and an increase in cortisol? Because we're all in that age range where our stress levels are higher, and not only our stress levels are higher. We've got less of the progesterone and estrogen to combat the cortisol and help keep things in balance, and that can play a huge role. So, yeah, sometimes doing night lays and expanding the airway if there's tongue tie, if the airway is super small, then yeah, I think doing the dentistry first makes a ton of sense. But then there are some cases like you were mentioning. If the airway looks okay, then probably doing some airway work from the dental office is not the first best option that we should look into. It's getting that patient to the functional medicine doctor, to their gynecologist if they have one, who understands hormones which is not always a given and making sure that part is balanced and in check so that they have the ability to be able to breathe, even if they do need some help mentally down the road.

Dr. Rachaele Carver:

I think that's such a major point. That is really important to me as a biologist is, as you mentioned earlier, right, it's that team. Right, I've learned so much because I didn't have a lot of people in my area that were like-minded, so I was just, I was learning and that's why I went and did the health coaching certificate and learned all those kinds of things, but you're so much better off as a patient, not one person. So it's I know a lot, a little bit about a lot of things, right, but in some cases, like you need that specialist, right, like it's sometimes it's hard, it's very disconnected when we have all these subspecialties. But that's why creating that team, I think, is so valuable, because there are things that you know, as knowledgeable as we may be. Like you said, the hammer and the nail. We're thinking more of dentally. Yes, we have a more holistic view, but sometimes we just get in that route and then a colleague will be like well, did you ever think about this? And it's like that makes so much sense, and so I think it's nice to have those different perspectives. That's how we become better doctors when we're being taught. That's like what you said about your patients. I love it when my patients come to me and teach me something that I never thought about it. Or just because we have all these expertise and all these letters after a name, we're not the patient and I'll leave letters after a name, we're not the patient. So I also love it when sometimes I'm like I have no idea what's going on and the patient and I'm gonna say what do you think's wrong? To the patient right, they know their body the best and that is where I think so much valuable information. I'm like that's when I started using biofeedback, because I'm like there's some of these cases and I'm like I have no idea and so I love using these energy tools.

Dr. Rachaele Carver:

I had a really fascinating case a couple of weeks ago where somebody drove all the way from California. She had a crown that she'd had been redone four times and then they were talking root canal and she said she'd listened to the podcast. She's like I just don't want to have a root canal. And I said she didn't really have any inflammation, tooth nerve symptoms. So I was like it's just weird, but I don't know, because the crown looked good. I took a 3D x-ray. Everything looked fine. Pulled out the biofeedback machine and what we were talking about earlier about materials, ceramics and dental cement came up as allergens for her and I was like what, like I never ever would have saw it, and so, having that laser, I was like what, like I never ever would have thought, and so having that laser.

Dr. Rachaele Carver:

I was so fortunate that I was able to take the crown off whole, so it was a zirconia because I was like, oh, I hate that. Like the crown looks good, I hate having to charge this patient all this money. Yeah, took it off, got rid of the smadges, the ozone, cleaned up the tooth and then I muscle tested her. I had her hold the crack because it's a zirconia crown. I've never heard of somebody having sensitivity to zirconia. So she held that. She was very strong. So I was like, okay, it's not the crown.

Dr. Rachaele Carver:

But and then I had a few different cements and she did not test for the resin cement. I still do have a glass ionomer cement and the mineral-based ceramere. She tested terribly for the resin and the glass ionomer and very strong for the mineral cement. So like, and when I took it off it looked like she maybe had a glass ionomer cement in there. So I was like, interesting, so we were able to put that back on without having heard to have a rook and hopefully I haven't heard back if it was bad or not but I was like how fast.

Dr. Rachaele Carver:

And I never would have known that without that tool, cement would never have, never, ever have crossed my mind. So it was just fascinating when you think about. And then, and she had said, and I had asked her, I was like, when you had the temporary on, did it bother you, because we use different materials for temporary crowns and temporary cement and she said, oh, actually it wasn't that bad. And so then I was like, okay, maybe it is the cement or the material. So again, it's just fascinating when you and again, is the patient's experience right? She's like I just want to take it off out of my mouth and I was like that sounds like an allergen, right, like an itchy weird.

Dr. Rachaele Carver:

So, yeah, just this fascinating, all these different things that we can do. Tell me about, like, speaking about a root canal. This is my biggest cross, like I'm always thinking how can I prevent that? What, what in my powers, and I've used so many different like modalities between ozone and certain herbs and nutrition and red light. Do you have a protocol? Maybe when somebody comes in, they're on that fence of reversible versus irreversible.

Dr. Toni Engranm:

Yeah, same, I'm usually hitting it hard and heavy with the ozone If we're on the border and it's still technically reversible, because, man, we're trying to avoid that root canal. We're trying to avoid that discussion about a root canal versus pulling the tooth, if at all possible.

Dr. Rachaele Carver:

Yeah.

Dr. Toni Engranm:

It's usually and sometimes we'll do if they live close enough that they can get to me. Then we'll do ozone injections once a week for a month or two to see if we can get it to feel better.

Dr. Rachaele Carver:

And I'm always thinking I think that's the best way. But again it's like, how often is the patient? If they're not super close, are they going to be able to come in every week? So I'm always like, okay, what are the at-home modalities? Not everybody has an ozone machine. They're relatively affordable nowadays, so it's not a question. But not everybody feels comfortable injecting themselves, right?

Dr. Toni Engranm:

Yeah, have you had much luck with people doing red light? At home I've had people that have red light, but not enough to really be able to test it.

Dr. Rachaele Carver:

No, we do sell those and they're nice, the little, the intracoral so I think that's my next best step. This is something you can take home and use all the time. So I think that's great, because when I think of the nerve dye, I'm thinking, oh, there's less energy. How do we pump more? And that's why ozone is amazing, because you're like pumping electrons and energy directly into the system. So I use a lot of the ozonated olive oil, right, but again, it's the same as the gas, so we give that to patients.

Dr. Rachaele Carver:

There's a little herbal combination which I think I first found out about that in that conference in 2020 in Dallas called Oral Health. It's a bunch of Chinese herbs and you're supposed to put it against the tooth. But again, that's what I'm thinking. How do we increase the energy in that area? And again, the red light is really good for circulation. So we talk about, like b vitamins again, good circulation. How do we get more energy, trying to avoid the energy disruptors? But still, I've never, I haven't found the magic bullet right again, unless you did weekly for a long time. That can be good, but and it can be good for a while but but again, what made it? Do that first, like, how do you have to always do that? I'm still searching for the bad people out there.

Dr. Toni Engranm:

I know, and what I hope that more of my patients understand anyway, is that sometimes they expect us because we're biological deaths, because we're more holistic, they expect us to never say that you need a root canal to save a tooth and it's not a fun conversation, but sometimes that is the conversation of it's one or the other. You don't have to do the root canal, but if you don't do the root canal then that tooth needs to go. And I hope that people understand that biological dentistry is not the same thing as supervised neglect. You're not the same, because I think sometimes that's what our patients prefer At least some of mine do anyway, it's fine I can just leave it.

Dr. Rachaele Carver:

I'm like, no, that's the hard conversation, right, because a lot of people have these abscesses and we might not find them without a 3d x-ray and they don't, and so it doesn't hurt, I don't want to take it out and so having to try to explain, okay, but that is. I was like if you have an infection on your arm, right, you wouldn't really necessarily ignore it. If there's pus in it, you wouldn't ignore it, you would treat it, but if it's in your mouth and your jawbone, you can't see it, you can't feel it. It's hard and I get it. It's a very hard conversation. People are coming to Biologenics because they want us to save everything, and I really liked that you made that comment, because that's true. They do think we're going to fix everything and everything's going to be magic, and while we want that to be true and while we're always educating ourselves and learning, it's not always possible, and that's why you and I are both so big on prevention, right, let's not get to the point where it gets. And again, don't make me have these hard conversations. Yeah, stop it. The body is so complex and that's the value of going to the dentist more frequently, and so a lot of my holistic peers.

Dr. Rachaele Carver:

I don't want x-rays and I'm like I understand, but digital x-rays now have very little radiation. You get more from the sunlight but I can't treat you. I'm not going to take them every every six months or whenever we every person. We look at them as an individual, but I don't necessarily like to go longer than three years because a lot of things can happen. Right. But I need to have a baseline and I need to know like it's on me. If I don't take the x-ray and something happens to you, I'm at fault. Even if you signed something that refused, I am still at fault in the legal system. It is still my fault because I am the expert and I have to know better. So that's a frustrating conversation with me. With patients, I get it.

Dr. Rachaele Carver:

We use homeopathics and before an x-ray you want to minimize the radiation or you want to help your body clear, take a lot of antioxidants ahead of time, right. Take some high dose like C, drink some pomegranate juice, take some glutathione if you have it, like those kind of things, and then, like I said, in our office we offer a homeopathic low remedy right after and that again can help the body remove. The acid doesn't get stuck in the body and cause problems. So again, nothing. If you go on an airplane ride, you get more radiation there. So there's risk everywhere in life and we want to help you mitigate it. But we also want to catch those infections and those problems super early, and x-rays are the only way we can do that.

Dr. Toni Engranm:

Yeah, absolutely.

Dr. Rachaele Carver:

For just about an hour. This has been an awesome conversation. Anything else you want to mention or you think that's really relevant, that our patients would be eager to hear?

Dr. Toni Engranm:

I will leave them with an encouragement. My encouragement is that and I know that you share this view as well is that our bodies are designed to heal. So, if nothing else, like we said, we don't want to overtreat, we don't want to undertreat, but know that we're just here to help. Your bodies are designed to heal on their own, and so I think you and I both just want people to. We want to support people along their own journey to health and walk alongside them and partner with them.

Dr. Rachaele Carver:

I love it. That's a perfect ending and exactly how I feel too. And, yes, we want to give you encouragement and optimism there that, yes, like you said, we will walk alongside you, we will help you get there and, as we continue to learn and evolve, we will bring to you, hopefully, the newest and greatest treatments and prevention. So thank you so much, dr Tony. And if there are people who'd love to reach out to you, can you, and we'll also put everything in the show notes. But if you wanted people to contact you, how would they find out more about you and your practice?

Dr. Toni Engranm:

Yeah, absolutely so. Our practice website is flourishdental, and probably our most busy platform is on Instagram, and so you can find me personally on Instagram. It's at Dr Tony. Ingram Tony with an. I Ingram with an E Great.

Dr. Rachaele Carver:

And that'll all be in the show notes for you guys. So I hope you really enjoyed this conversation as we dove deep into the ins and outs of biologic dentistry how to be your own best dentist here and find the right provider for you. So until next time, everyone, I hope you have a wonderful day and we'll see you then. Huge thanks to you, our amazing listeners, for helping us climb into the top 5% of podcasts in the oral health space, With all the love and support. We've been getting many requests for one-on-one consultations, so we made it happen. Are you ready to take your oral health to the next level? Click the link in the show notes to book your personalized consultation and let's kickstart your journey to a healthier, brighter smile, starting today. We'll see you then.