Prescribing Nutrition: A Game Changer for Immediate Denture Outcomes

The connection for me became evident when I started seeing the clinical studies and there's a really prominent study on hip fractures and in women and how this helped promote bone healing. And I'm thinking to myself, okay, now how does that match in the mouth? And if you start to look at this and you have patients who have periodontal disease, you look at babies who have colic, this company can answer to that because they have, you know, strain specific. bacteria that go after these. Some of the pro and prebiotics that are out there are not strain specific. You can just take something, but it might help a little bit. It's not really going at the source. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. As dentists who are performing immediate dentures following multiple extractions, it's one thing to extract the teeth and fabricate the immediate denture. But it's another thing to actually provide therapy to help promote healing and patient comfort during this critical transitional period. Our guest today is a seasoned clinician who has treated countless immediate denture cases. And what sets her apart is her evidence-based approach to supporting healing through nutrition. After noticing patterns of delayed healing and discomfort in certain patients, she started digging deeper into their nutritional status. What she found was eye-opening. Backed by years of clinical experience and literature, she developed a targeted nutritional regimen to address common deficiencies. And the results speak for themselves. Faster healing, reduced discomfort, happier patients. So whether you're new to immediate dentures or have been doing them for years, this episode offers a new layer of care that could change your post-op protocols for the better. Our guest today is Dr. Lori Trost. She's a recognized and sought-after dental educator, author, and clinical consultant who maintains a comprehensive restorative practice in the greater St. Louis, Missouri area. She's been on the show many times, and we're very happy to have her. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Dr. Trost, welcome to the show. Thank you, Phil. How are you? I'm doing very well. Thank you for asking. So in this episode, we're going to be talking about nutrition and how it has a major impact on healing, especially related to denture. cases and why that's so important. And you have a regimen that you've developed that you are going to share with us, which you've had great success with. But before we get into the nutritional aspect of it, tell us about your practice and how you started doing more dentures in the last handful of years. I'm a general dentist, right? A comprehensive started dentist in a small little town. I'm going to say 3,200 people, which is interesting too, because you never know, you build it, well, they will come. And in the last... Five, six years, my practice has completely just morphed into something that has been completely pinpointed on internal scanning and digital dentistry and the advancements that are happening with that. So in 2020, I purchased an internal scanner. It was delivered to my office, my practice, Friday, March 13th. And March 16th, in walks a patient with a maxillary denture. She had a lower full dentition, but was broken in half. And so coincidentally, COVID was starting to just travel rapidly. And so we were on caution how we could see patients. And matter of fact, when I called my lab, I had no idea that they were even going to be open. And they had a skeleton crew. And funny enough, my... lab partner, Chris May says to me, you got the new scanner. And I'm like, yeah. And he goes, okay. And I'm, I'm waiting for him to say, you know, use the super glue, the Loctite, which we all have, you know, see really hidden in our drawer someplace. And we do. And so I did that. And he goes, how's the denture fit? And I said, you know, decent. I said, needs a little relime, whatever. And he goes, just do, you know, light body wash, you know, heavy body, whatever, you know, and I'm like, okay, like traditional stuff. And then I fully expected him say, you know, send it to me. I'll have it back to you, you know, nine, 10 days. which is crazy. And all of a sudden he says, now I want you to use that scanner. I said, I've got it online. I can do that. He's like, yes, scan the denture. I had no idea of the settings. I had no idea what I was doing. And the joke I still make is I think it took 22 minutes. I was like Edward Scissorhands in there holding one thing and moving another and didn't understand what at all. So you were scanning the denture that you had just glued together. Extra orally with the impressed material in it. Okay. And so then obviously then that image was sent to the lab. And then three days later comes back this beautifully printed denture. And at that point, I didn't even really know that you could print dentures. I mean, that's crazy, right? And so I'm thinking, how does that work? And so I put it in the patient's mouth and Pauline's mouth and it's fabulous. It fits. It looks beautiful. It's so aesthetic. And then time goes on. And I love to tell the story how. When we marry denture patients, and we do in the past, and I hate doing dentures for this very reason, because you are constantly adjusting, and then you readjust. It's a copier process that we've all learned, and it's completely different now. Long story short, I'm using that mindset of the old ways of thinking copy denture. There's going to be adjustments. How am I going to get her in? The office is running on a skeleton crew, limited hours, the whole deal. A few weeks go by. And I asked my front desk, I said, Hey, have they called? Has Pauline called? She's like, no. And I'm thinking to myself, wow, well, I hope she's okay. And I'm thinking medically, maybe she's sick, you know, who knows, right? Or a family member, who knows? And now we're in a month in and I finally, I get the courage of, I've never, ever called a denture patient my entire life. And I called her and I said, how are you? And she's like, oh, I'm well, you know, everything's fine. I haven't gotten cold. Okay, good. You know, and I just want to follow up with you to make sure. Oh. Oh, you want to know about my denture? And she just goes on and on. And she's like, I love it. It fits so. I don't have any. This is the best denture. And she's been a denture wearer. She was 57 at the time. She's been a denture wearer since she was 25 years old. So here's this new denture in her. It fits beautifully. And so then we obviously set up a time for her to come back in and re-care, clean her teeth. But I have never done a denture adjustment on her. And it kind of. Now that's a printed denture that was made from a scan. And how long did it take? the lab to print it and send it back to you. So they're able to print. It's crazy. I mean, these only take a fraction, but within an hour, once they've got the record, they can print these. So it's a matter of how many are on the platform. This is with a carbon printer, and this is using the Dent Supply Serrano Lucitone, which has been a gold standard material for how long, right? So absolutely beautiful. This was a carded tooth case that we did, wanted to have nice aesthetics on it. Again, I had no idea what I was getting into when Chris did this all for me. So fast forward six years. years, 2026, are you printing your own dentures in-house? I do not. I have the lab do that. Okay. They design and they print. We'll be getting right back to our guest in a second. But first, when it comes to the final step in indirect restorations, cementation is crucial. That's why thousands of top clinicians rely on TheraSem by Bisco. This dual-cured calcium and fluoride-releasing self-adhesive resin cement is ideal for looting crowns, bridges, inlays, and onlays, with no need for a primer. TheraseM forms a strong bond directly to zirconia in most dental substrates. Its easy cleanup, convenient delivery system, high radio opacity, and continuous calcium and fluoride release make TheraseM a top choice among dental cements. For cases where you choose to apply an adhesive separately, Duolink Universal Adhesive Resin Cement is the perfect solution. Compatible with all dental materials, it works seamlessly. Seamlessly with Bisco adhesives, such as Z Prime Plus and porcelain primer, ensuring optimal strength and adhesion. It's time to get the most out of your indirect restorations with Bisco's Advanced Dental Cements. To learn more, visit bisco.com. Sometimes I mill, depending on what the case calls for. And you're finding you're getting good strength on these printed dentures and longevity. Absolutely incredible, yes. And the cost has got to be much less for the patient, right? um i i don't know necessarily if the cost it's the turnaround of the time it's it for us it's a very profitable procedure because you really cut down on uh obviously the copier like we talked about fewer adjustments the accuracy is really what's off the charts now because the internal scanning uh whether you're scanning tissue whether you're scanning the impression the fit is incredible and uh what happened was i started building upon that and i started really in the next year understanding more about dentures because ironically i had a few more patients come in i started understanding fundamentally how i needed to be better at the information that i gathered and then with the onset of covid starting at the end of 2020 and then 2021 Somehow crazy, I had tons of patients who were coming in, neglected dentition, very sick, very ill. The periodontal disease was off the charts. Immediate dentures became a very huge presence in our practice. And I never liked to take teeth out. I never liked to condemn teeth. But what I started paying attention to was what brought these patients in, what led them to this point. And then from that, I started creating... a whole protocol for how you get patients through a very barbaric practice that we've always known as an immediate denture and completely changed how that protocol looks like to make it, number one, healthy. Number two, comfortable that they wear this and they transition into a healthy, functional, regaining capacity of chewing and occlusion and reestablish their health. It's really massive. So tell us how you made that connection between good nutrition and denture success in your practice? I started really diving into nutrition. They're eating fast foods, they're eating and they're drinking sugary beverages. There's no, there's a caloric intake there, but there's no nutritional value. And so then I start breaking down and in my mind, I'm thinking, how can I be better? And subsequently, I started then reading some wonderful nutrition books that are out and they've been released. And I think we've got a great. push now in our country to get our health back and better. So you were looking for soft tissue healing, nutritional boosts, right? Absolutely. So you wanted your patients to, and we talked about this when we decided to do this episode, you were looking for something you could do to change the diet of the patient. Of course, you'd love to do it for their whole life, but at least you could do it during the term of their healing from the extraction stage until. the final denture was placed in, right? And to get that tissue to heal. So what did you actually find? So I started breaking down. There's three components that are really involved in an immediate denture. One, you have to have bacterial balance. You have to have gut support. um many of these patients if you think about they're coming in with a periodontally um and you know stage class who knows it's off the charts right uh they have mobile teeth they have calculus tart they have no bone you you have you have a substructure that's really tough to get to heal the vascularity is compromised uh secondarily i have to look and and think and consider cellular health how do i start to promote healing what can i feed that body? What can I get at a cellular level to improve it so that it can really boost once I start to get the gut health better? And then the third component is pain management, because you want to minimize the pain. How's the comfort going to be better once you put this in? So it's kind of a threefold process. So I start again, I'm doing tons of reading. I'm listening to different, I love to listen to medical doctors as well as dentists on this. I think there's just so much information out there right now, but I end up landing. on a company that has the most tried and true clinically studied, dentally driven probiotic on the market today. It's from BioGaia, and it's a combination of Osfortis and ProDentist. And it's a strain specific, it goes after L. Ruteri. And it really is the only true probiotic on the market today that literally goes in and it can restore the balance. So let me ask you this, Dr. Trost. How did you make that connection between L. rutiri, the bacteria strain that this particular probiotic is targeting, and better healing in the oral cavity? the connection for me became evident when i started seeing the clinical studies and how this has been studied over in europe massively and they've done uh there's a really prominent study on hip fractures and in women and how this helped promote bone healing and i'm thinking to myself okay now how does that match in the mouth and if you start to look at this and you have patients who have periodontal disease you look at babies who have colic this company can answer to that because they have you know strain specific bacteria that go after these some of the pro and prebiotics that are out there are not strain specific you can just take something but it might help a little bit it's not really going at the source so it really helps to balance the gut then therefore it goes up to the mouth because the floor becomes one and it works in the function together some of these override other elements or other bacteria and got to be careful of that too so i wanted to start down a path i wanted to see as soon as immediate you know immediate potential patient is diagnosed in my practice i'm going to give them tools to make them healthier and better. So the research is supporting the fact that ProDentis, this probiotic that targets this specific bacterial strain, actually helps with periodontal healing. Tell us about that. Because it is strain specific. And I'm going to go back to that again. It's been proven in clinical studies that it is a regimen of choice for periodontitis. It helps the bone to have a platform that it can rescaffold to when it has to add in or fill in or minus sometimes too, depending on if there's extractions or if there's bony defects. I'm not saying I can grow bone back with this, but I'm saying it can promote a healing platform. It gives it the opportunity to do that and it gives it a leg up in that aspect. And all of the studies show that this strain-specific protein dentist does this and so that's why I kind of really focused in on that I thought to myself what's happening when you're taking and extracting teeth you've got a scaffold bone in there as much as you can you don't want to take it away you want to they've already had enough taken away so that's where I kind of decided so what's the what's the treatment therapy like as far as this particular probe yeah what do you do as far as the dose how long do I have to be on it and what are you seeing as results We'll be getting right back to our guest in a second. But first, when it comes to digital workflow equipment, it's important to partner with companies that provide premium products with unparalleled service. all at an affordable price. That's why you should check out Shining 3D Dental, a company that offers a complete and integrated suite of high-quality and easy-to-use digital dental equipment. Their local offices are based in California and Florida, so you get in-time comprehensive support. In fact, Shining 3D Dental can furnish your office with an entire suite of digital equipment for under $27,000. This includes their AoralScan 3 wireless intraoral scanner, MetaSmile, 3D facial scanner and the AccuFab 3D printer with its post-processing equipment. Plus, the Shining 3D Dental Digital Workflow solution includes cloud storage, synchronization, and software for consultation, analysis, and design. So whether you're taking your first step into digital dentistry or you're looking to add additional equipment, check out Shining 3D Dental's complete digital dental portfolio. To learn more, visit shining3ddental.com. So they take one lozenge twice a day, morning and evening. Okay, simple and easy. They started at three months out. So initially when that patient's diagnosed is an immediate denture. Okay, so I'm going to get ready to start taking those posts of your teeth out or getting to that process. Three months, I want them on this protocol. It's very simple. That's number one. The second thing I want to do is I want to start boosting the cellular response. So I started looking at vitamin C, simple and easy, right? It's an antioxidant, antiviral. We all know that we need, you know, we need a small amount, you know, not a whole lot, 90 milligrams per man, 75 for a woman per day. But many of these patients come in so compromised, they do not have, and humans don't make vitamin C. All right. We have to acquire it. So you have got to get it into your diet. You've got to actively make sure that you have enough. Ironically enough. Many of my patients were smokers, and I'm going to say the word smokers because we talk about that, but one cigarette will reduce. If you have an amount of 90 milligrams of vitamin C in your system, one cigarette will reduce that by 75 milligrams. So you're already deficient if they smoke more than one cigarette. Think how many times that we've seen, and I have seen this in the mouth. We've all seen it, but we look at the tongue, we look at the saliva, we look at the tissue, we look at what that gingival looks like. If they've got gingivitis or periodontitis, but vitamin C is really critical because it is such an immune system. It's a wound healing. It promotes wound healing. It also blocks the histamine release sometimes that can get in the way of healing too. So we've got to really build up the stores of vitamin C. And so I have patients immediately go on 1,000 milligrams of vitamin C a day. They will start to feel better. Vitamin C is just amazing what it can start to help them feel like because, again, they're in such a deficit when they come. regimen of vitamin C plus the probiotic you do that together yes and then the other third or well another component of that too I have them increase their protein why is that Protein drives metabolism. You know, it rears up the arginine and the glutamine. You've got to have that. And in order, if their metabolism is dropped off, they're not going to have the reared up ability to have that energy to cellularly heal. So you need those essential amino acids. But the thing is, if they're eating three burgers a day, you don't need to give them more protein. So you obviously get a good diet history. Absolutely. You've got to take a good diet history. And the other thing is I have many patients who have very compromised dentition, obviously. It's not good. And so their ability is to chew any of those kind of foods. Many of them are on nutritional supplements now. And they think that taking one of these, I hate to say insure, but some of these drinks, that is going to be what, no, that's not adequate. They're very high in sugar. Those are loaded with sugar. sugar. Exactly. They make the system worse. So I want them to get a very good dedicated protein powder. And again, I can refer them to a local health food store and say, hey, look, they know what I'm talking about here. I want you to go in there. They have these two items that you can go after and get those and see how you deal with that. And you'd be surprised. It's a very simple protocol, but they start to feel better. That's pea protein? Yes. So you have them on the probiotic. You have them on vitamin C supplements, 1,000 milligrams a day. Yes. And then you have them on a quality powdered protein in a recommend dose where they mix it into a shake or something like that. Absolutely. Yes. And a lot of times, you know, I tell them, hey, if you want to get your vitamin C, we can do that with the protein sometimes too. They can combine that. They're not going to compete and they're not going to negate. And then what I do is once the teeth are removed, the third component is the pain management. And I use a product that's been around for a few years now, but it was developed by an oral surgeon out of Texas, but it's called Ora Soothe Socket Gel. septodont is the promoter of that and i can tell you i've had fantastic experience with this it helps to soothe the tissue i i can i can tell you honestly i i don't know the last time i wrote a script for any narcotic because and especially i mean i'm talking about taking out anywhere between six to eight teeth per arch and they do not need a narcotic so what how is that applied to the socket how is that placed So once we have the initial clotting, I'll go ahead and take the socket gel. We chill it. We just squirt that into the immediate denture and then we put that in there. It just helps to soothe and provide a comfort level over that extraction site. It doesn't interfere with it. It's a natural product. It's got a multitude of just, it's got aloe and cloves. Right, I figured there was aloe in there. What's that called? Aura Soothe Socket Gel. Okay, and that just gets, that gets squirted into the inner side of the denture yeah that goes against the tissue yes and the secondary quality for me that's a beautiful thing it actually helps to aid a little bit of retention too because it keeps the surface and and many of these patients they have dry mouth because there are myriad of you know hypertensives or you know who knows i mean i mean all those anti-anxiety meds and what happens is that that dry mouth is really uh that's overcome by this because and there's also orsooth rinse now that we're able to get. So we keep moisture in the mouth. I don't allow it to get dry. I don't want it to get dry. So they have to apply the Orsooth, I assume, over a period of time once they get home. It's wonderful. It comes in a nice syringe. And honestly, we code that into insurance. That is usually you able to get reimbursement for that, which is ironic. But we send the syringe home with them. It's a nice, easy to handle syringe. We show them how to do it. And it gets them through the first three to four days of that healing process. And they're feeling good. Their pain is greatly reduced. I mean, it's just unbelievable. So you're having really good success, obviously, with these patients after the extractions, but you pre-treat them with this nutritional boost before you plan the extraction. So you have to see them and say, listen, we're going to be taking these teeth out. And typically, how much in advance of the extractions do you have them on this regimen? We'll be right back with our guest in a second, but first, if you're looking for a digital dental camera, I highly recommend the iSpecial digital camera by Shofu. Hands down, it's the easiest camera to use, takes beautiful high-res photos, and it pays for itself quickly with the boost in case acceptance. Don't wait. Visit Shofu.com and use the code VIVA for a special offer. Depending on how many teeth need to be extracted or what's presenting, they're usually on this protocol for two to three months before we do the final yes placement. And it just makes enormous amounts of difference. And do you think these patients continue on this nutritional supplement regimen after they get their denture when everything's healed? Yes. They will tell the difference and many continue. They absolutely do. So I do want to ask you, what do you say to the patient when they say, you know, I appreciate your recommendation. But I take a multivitamin and I'm not one for supplements and I don't want to spend the extra money for these things because I'm not sure this is proven. I'll take my chances or whatever. How do you sell this to the patient? And I ask when I use the word sell, how do you get them to feel like this is really critical towards the success of the healing process? We need to make sure that denture is supported by a healthy ridge. When I have a patient come, I want to be able to create a relationship with them and gain their confidence quickly. And I can show a myriad of... the work of the galleries. But usually these are people who've come to me because someone has told them, go to see Dr. Trost, go see Lori. And that word of mouth is strong. And I tell them on the onset, I'm here to handhold you. I'm going to be your cheerleader. I'm going to be your number one fan, but we've got to work together as a team. And here's what I've come to learn. I can help you in a way that's very dramatic and it's going to make this a very successful process. It's going to minimize discomfort. It's going to be the pathway for you to gain your health back. But here's what you need to do. And I rarely ever get pushed back on that. I'm just very genuine when I talk to them because you need to handhold them. This is like, again, very barbaric practice that we've done in the past. We're changing our mindset. It can really be welcomed, I think, in with a better protocol and really paying attention to these details like I'm talking about. At the end of the day, you're seeing, and I hate that phrase end of the day when I'm using it, you're seeing some real definitive changes in the success that you're getting in patient comfort, patient... healing. Eventually, I guess your patients in the past, before you had these nutritional therapies, eventually they healed, right, after these extractions, but it may have been a more torturous, uncomfortable, long-term, drawn-out situation. But you've shortened that curve, right? Yes. And you're starting to see, tell us how long actually you've been seeing the results of this nutritional boost. So I've been promoting this for the last two and a half years in my practice and have had enormous success. And I, again, it's the protocol that I've come up with from what I've learned and read and have developed. I think that every clinician has to start diving into this. We were never taught really nutrition in school. We were taught about sugar, caries. And I agree, Dr. Trost. I mean, other than talking about sugar for obvious reasons, we did not talk about nutrition very much, if at all. The mouth-body connection was... was barely discussed when I got out of dental school and probably not for you either. So it's great that you're pursuing this now. And I think dentists are starting to see that we are physicians, physicians of the mouth specifically, but we also understand that organs perform better with better nutrition, specifically for patients that are needing an immediate denture, which is somewhat traumatic. You're getting teeth extracted, a denture placed right away. There's a lot going on there. So good nutrition, certainly, as you have talked about and as the literature proves, does help a tremendous amount. I assume you would have liked to take this approach soon after dental school, not just a few years ago. I wish I would have known about it. I do. And I think, but again, you know, information is knowledge and power. And I think you have to constantly be a student of this, pay attention to your patients, see what's out there, see what's coming on the market, seeing what's clinically proven. I want to be a science-based dentist and bring that chair side. So again, that's a very strong foundation for me to come from. Yeah, and you give a course where you pack a room, and we've talked about this. You get 1,000 people to listen to you, 600 in the room and 400 online. We're going to do a special program on that. But what you probably teach is that dentists might say, I don't have the time to get into nutrition. That's for a nutritionist. I don't have the time. I need to make the denture and get to my next patient. And they're running on this. this wheel, this hamster wheel where they're never stopping and they're producing and producing and producing. They think that's what they're supposed to do. They end up burning out. But there's tremendous career satisfaction in slowing down a little bit and looking at a patient as a human being, not just a mouth. And that's what you're showing in this episode, that the patient has a complete, you know, connection in every system of their body and nutrition plays a... absolute role in every bit of their health. Every organ functions better under better nutritional intake. And you're showing that that applies to dentistry. There should be way more education on this in dentistry. You should do a special course. Do you do a special course just on this? So I do teach digital dentures. I've created a curriculum for that. And within that, underneath the immediate dentures, my protocol is in that. And I share that now. And it's really gained a lot of traction. And I think, again, colleagues really appreciate that because we've not been taught this. And when you sit there, you have to think about something for a second. Macroscopically, every time we put food in our mouth, we're supposed to chew it 30 times and then swallow it. Think about someone who's compromised, right? Let's talk about someone who's got endpoint dentition. They can't. So they're already deficient. And we have to be able to answer that in dentistry. We've got to be able to stand up as a profession and offer better options. And I think everything digitally is so much better now to be able to do digital dentures, printed, milled, better fit accuracy. I mean, we need to replace these dentures every five years too. That's another thing I want to outline because there's a great... really great position paper out for American College of Prosthodontists and a chronic irritation and inflammation, it is responsible for leading to precancerous situations. So we has, you know, as a professional, we've got to answer to this, be better, do oral cancer screenings consistently and constantly, learn how to do that as well. So it all bundles together, seeing the whole thing. Oh yeah, absolutely. And I've read a lot about that too. Irritations, it's like an apthys ulcer that keeps coming. Those things lead to, just like smoking, they inflame the cells and the cells start to have uncontrolled mitotic activity down the road because of it. They get dysplastic because of all this inflammation. Yeah, the program gets screwed up and in very basic terms, it turns into cancer. Anyway, it's really nice to hear your point of view on this and it's very important. I think more dentists should... take the time to realize that we're all connected, every part of our body is connected, and we need to take nutrition as an important part of our treatment in dentistry. Thank you so much, Dr. Trost. Great discussion, as usual. Good. Thanks, Dr. Klein. Appreciate it.