Dr. Ryan Nolan talks about preventive products and the three pillars of disease: biology, chemistry, physiology. A healthy biofilm in one person may be an unhealthy biofilm in another. Dr. Nolan breaks that down for us in this week’s TIPisode.
Thank you to Elementa for sponsoring this week’s TIPisode!
Ryan Nolan, DMD is a practitioner, commentator, and creator of the amazing podcast The Biofilm Factor — where he discusses biofilm management and diet with other dental professionals. He is also a co-founder of Elementa Silver, which specializes in nano silver-driven oral cleaning solutions. His work in dentistry and oral health care is guided by his previous education in chemical engineering, and he approaches the field with an eye for results-based research.
The Biofilm Factor – http://thebiofilmfactor.com/
Elementa Silver – https://elementasilver.com/
Elementa Silver on Amazon – https://www.amazon.com/s/ref=bl_dp_s_web_0?ie=UTF8&search-alias=aps&field-keywords=Elementa+Silver
Elementa Silver on Instagram (@elementaoralcare) – https://www.instagram.com/elementaoralcare/?hl=en
Ryan on Instagram (@ryannolandnd) – https://www.instagram.com/ryannolandmd/?hl=en
This TIPisode has been transcribed for your viewing pleasure:
Dr. Ryan Nolan: Hey, guys. This is Dr. Ryan Nolan. I am the owner and cofounder of Elementa Oral Care. Today, I’m going to talk to you a little bit about disease states and how we think about disease states in the modern age as well as products and kind of what we think about in the process of making those products, right?
To give you a bit of background on me, I focus a lot of my research on nanotechnology. So I look at how nanocompounds, specifically plant-based precious metal compounds, can be utilized in dentistry and dental hygiene.
So one of the things that frustrates me a lot is whenever I look at data, one of the things that I see is despite the fact that we’ve implemented all this prevention, whether it be fluoride, sealants, that kind of thing, and even educational programs, we still have a 92 percent prevalence in the United States today for decay. And, to give you an idea as far as periodontal disease, it’s 47 percent in the United States alone, okay?
So the reason why I’m so focused on this preventative aspect stuff is because I feel like there’s a lot of unaddressed issues, and I think there’s a lot of room for improvement. And so that’s why I kind of study this.
So one of the things that I really think about a lot — right? — is I think about the three pillars of disease and, again, the treatment of disease, and that is biology, chemistry, and physiology, okay?
So biology is pretty well understood, I feel, by a lot of clinicians and RDHs and things like that. And that’s the study of biofilms and their outputs and then also inflammation and the host response — right? — to those outputs.
But I feel like what gets less understood is physiology, which is the study of mechanism, mechanism of action, how things work, how things are employed. So logical modes of action, okay? And that can range from anything from an antimicrobial agent in an antibiotic as well as a remineralization agent.
And then we have chemistry. Chemistry is the study of pH. So acids and bases, equilibriums, ions, targeting systems and delivery systems, and things of that nature.
So we really are looking at a combination of those three things when we’re looking at disease and we’re looking at trying to change how things are, right?
So I’ve been a practicing dentist for some time now. I graduated in 2014, so this will be my sixth year of being a dentist. One of the things that I found the most frustrating was I would talk to patients until my — until the moon came out — right? — about diet and trying to change the way they act and the products that they use. And obviously there’s some people who’ll listen to you and there’s some people who won’t. But it just ended up being a situation where I really found, as a dentist, I was treating the same problems over and over, but I really wasn’t seeing a solution as far as the preventative side of things.
And, as an RDH — I’m sure a fair amount of people listening to this are RHDs — you will have a lot more time to sit with the patient and kind of explain how things are and how to manage the disease when they [sic] patient goes home and not just at the dental office, right? Because there’s nothing more frustrating than a patient coming every three to six months and you basically got to tell them they have the same problem over and over again. I mean, I think that’s frustrating, right?
But, anyways — so kind of let’s — let’s kind of break this down, all right? So, when we’re looking at biology, I think that’s the most well-understood component amongst clinicians. So we’re looking at biofilms and tissues, right? And so we’re kind of looking at how tissues — so in this case, that would be bone and gum tissue — are effected by biological outputs and vice versa and what kind of biofilms are causing issues, what their output’s to, is there toxins, things like that.
So we know for periodontal disease this is basically a very, very heavily important factor because if the immune response from an individual for one or two different kinds of bacteria is very, very sensitive, they’re more likely to develop the disease process than someone like myself who might have those bacteria but is just not as sensitive to their outputs, right?
And so this kind of begs the questions of everybody’s biofilm is different, but a healthy biofilm in one person may look like a disease state for another person. So everybody is different, okay?
And so the reason why all these three factors — physiology, chemistry, and biology — come into play is because every individual responds differently to different outputs, all right? So there’s really no “standardized method” for every individual. So we need to be willing to try different things and see what works for different patients.
As far as the physiology aspect goes, which is basically the mechanism of action, one of the things I really focus on is specifically how do I deliver active agents or agents that I think are beneficial to their target sites? So that could be a difficult site that’s subgingival. That could be hydroxyapatite, which is buried under biofilm, plaque, or whatever. So I’m trying to deliver a beneficial agent that could be a remineralization agent, that could be an antimicrobial agent to the target site, could even be an antibiotic.
We know that — based on what we know right now is that certain agents are less likely to be delivered to a target site depending on their size, depending on the amount of biofilm present and things like that, the pH, that kind of stuff. So we really need to be able to understand and incorporate these concepts in with each other.
And, as far as chemistry, that also has a huge, huge effect on how things work, right? So, when we look at chemistry, we’re looking at remineralization. We’re looking at antimicrobial action. We’re looking at disease states and what the buffering capacity of plaque is and what our saliva looks like. What’s the quality of saliva? What’s the quantity of saliva? So we really need to focus on a lot of these things and try and understand them. And it’s really important that we try and balance the situation as much as we can so that we’re not losing any critical minerals or trying to make a product that maybe attempts to remineralization but doesn’t have the critical components that are found in hydroxyapatite or the mouth in order to have the effect that we’re looking for, right?
So I feel like a lot of misunderstandings occur from the clinician’s side of view by not incorporating all these things together. And so the reason why I really, really like nanotechnology is because I feel like we can use anti-inflammatory compounds, we can utilize plant-based medicine, we can utilize things that target biofilms as well as the physiological mechanisms for delivery agents, and then changing pH as well.
So a lot of these different disease states actually suffer from some of the same contingencies surrounding how the disease state starts, and so we can utilize similar agents and kind of standardize methods more efficiently by understanding that, right?
So that’s why I really like nanotechnology and kind of focus on that in general. But, also, I really like the idea of understanding the biologic components and what can I do to make things better, right?
So I hope that you guys got something out of this. I feel like the dental prevention scope of interest is expanding, and we’re getting better and better all the time.
Again, if you have any questions, feel free to reach out to me. My handle is @ryannolandmd. Thanks for listening. All right. We’ll see you next time.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.