Toothbrush Germ Theory

Heart Disease Heart Attacks Stroke Diabetes Chronic Fatigue Chronic Infections Arthritis Cancer Adverse Pregnancy Outcomes Alzheimer’s Parkinson’s Lung Disease Auto-Immune Disorders Chronic Degenerative Diseases

THE TOOTHBRUSH GERM THEORY How chronic, silent infections from toothbrush germs cause damaging, long-term and SILENT INFLAMMATION throughout the body

James Song

The Toothbrush Germ Theory How Chronic, Silent Infections from Toothbrush Germs Cause Damaging, LongLong-Term, and Silent Inflammation Throughout the Body

By James Song

American Health Conferences

Notice This book is intended as a reference volume only, not as a medical manual. The information given here is designed to help you make more informed decisions about your health. It is not intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that you may have a medical problem, seek competent medical help. © 2006 by American Health Conferences All rights reserved. No part of this publication may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying, recording, or any other information storage and retrieval system, without the written permission of the publisher. For such requests, or to quote brief sections in publications or newspapers, contact: American Health Conferences 451 Mirror Court, Suite 103 Henderson, NV 89015

ISBN: 0-9763173-4-6 SAN: 256-2960 Printed in the Unites States of America Cover designed by PIE Design & Marketing Henderson, Nevada U.S.A.

For my Family. And for everyone who brushes their teeth and cares about longevity and quality of life.

Dedicated to: Dr. Ignac Semmelweis, Dr. Paul Ewald, Dr. Barry Marshall, And the germ visionaries and germ mavericks of history who have advanced the boundaries of modern medicine and disease prevention.

Table of Contents

Introduction

7

Chapter 1: The Toothbrush Germ Theory

18

Chapter 2: Germs, Not Genes Cause Most Diseases

34

Chapter 3: The Mouth as a Mirror

53

Chapter 4: Healthy Mouth, Healthy Heart, Healthy Body

68

Chapter 5: Inflammation: “The Secret Killer”

92

Chapter 6: Finally, the Natural Solution Has Arrived!

115

Afterword

141

References

152

Index

174

“Superior doctors prevent disease. Mediocre doctors treat the disease before evident. Inferior doctors treat the full-blown disease.” – Huang Dee: Nai-Ching 2600 BC, Chinese Medical Textbook

Introduction My story is starting to spread like the flu bug in a kindergarten class! Over the past few months, I’ve been in airports, malls, and restaurants where people recognize me from television and say, “Hey, aren’t you the toothbrush–germ guy?” After all the time and the tens of millions of personal dollars that I’ve spent on my mission, my message is finally being absorbed, understood, and certified! I recently received an email from my old college roommate with whom I haven’t spoken in years. He told me that he had seen the Germ Terminator infomercial on TV and that I looked good for being so “old” (42) and for being a father of five. He also reminded me of what a germ freak I had been in college, relative to his reckless disregard for health and hygiene and deplorable lack of tidiness. (Nevertheless, he was still an incredible roommate.) Now he is a father of two, and he says that he tries to be “much cleaner” than when we roomed together in the dorms. He also said that I really grossed him out with “the vast majority of toothbrushes are contamin– ated with E. Coli” factoid from the commercial. What was especially satisfying for me in hearing from him was that his email made me realize that my story is affecting so many people, even people who have never given much thought to their health, and probably never thought about the serious health dangers connected to chronic toothbrush germs. (As of this printing, my mission is moving to Japan, Australia, and Europe!)

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Ever since I was a kid, I had a suspicion that my toothbrush was coated with disgusting germs; living germs that grew and multiplied while I left my toothbrush in that grimy cup that my family shared. I couldn’t see those invisible buggers, but I sensed that they were there. It’s obvious when you think about it — when we remove plaque and bacteria from our teeth, our toothbrush becomes contaminated with germs, blood, and saliva. And though many of us rinse our toothbrush with tap water after brushing, studies show that, without a doubt, toothbrushes remain contaminated with germs. But when I inform people about this problem, the typical response is, “That’s disgusting!” Then they giggle uncomfortably and say, “Well at least they’re my germs, so I guess it’s alright.” Unfortunately, those germs, even though they’re “technically yours,” can be very harmful and potentially pathogenic, and despite the fact that most of them emanated from your mouth, they still are, as USA Today reported, “The Most Serious Threat to Your Everyday Health.” Why do you think your dentist requires (or should require) antibiotic treatment before oral surgery? The answer is because the germs in your mouth can be extremely toxic, and if they leak into your bloodstream, they can cause all kinds of serious health problems. Here’s a fact that you probably didn’t know – our digestive tracts safely harbor the bacteria E.coli because E.coli is necessary for our bodies in order to breakdown the foods we eat. But if you take the same E.coli bacteria found in our gut and put it in our bloodstream, it can be deadly.

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In addition to our own germs left on our toothbrush bristles after brushing, studies also show that tap water in most cities is contaminated with bad bugs like giardia and many other dangerous species of bacteria. No wonder that a British study found 100 million germs on a single, ordinary toothbrush. toothbrush. Importantly, the Office of the United States Surgeon General has concluded that mouth infections can act as the “Silent X–factor” X factor” that may promote the onset of life–threatening diseases such as heart disease, disease, stroke, stroke, pneumonia, pneumonia, diabetes, diabetes, and other chronic diseases. As a college student, I studied biochemistry at the University of Wisconsin and I took used toothbrushes from my classmates and actually grew toothbrush germs on Petri dishes. In just days the dishes were thick with millions of colony-forming germ units that looked awful and smelled worse (no wonder we can have bad breath!) Many of you who have seen our television program probably think that I really did go off on the “germ thing.” Maybe I did, but rest assured, I am not some kind of chronically obsessed germ freak — I studied biochemistry and microbiology and I realize that the majority of germs are beneficial germs that we desperately need and have their place in our ecosystem. But I draw the line when it comes to my toothbrush. My toothbrush has to be sanitized before it goes into my mouth; my toothbrush has got to be clean. It just makes sense. After all, my mother always said that “cleanliness is next to Godliness” and that applies specifically to my toothbrush. Believe it or not, this is something I’ve believed my whole life.

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Get this – the toothbrush is actually classified and regulated by the FDA as a medical device. As a medical device, the toothbrush is designed to remove germs, plaque, and debris from our teeth, gums, and tongue. During the course of each and every day, a multitude of germs, plaque, and food particles accumulate in our mouths and stick to all parts of our oral cavities. It’s up to you and your trusty toothbrush to remove those germs, plaque and particles in order to avoid long term oral health problems like cavities and gum disease. The new research on oral “bio–films” “bio films” is absolutely amazing. These bio–films bio films, films once attached to the oral cavity, develop a culture and a defense mechanism of their own. Imagine what they can do when they get into the bloodstream! Needless to say, the mouth is one of the dirtiest parts of the body; not only are there millions of germs in there, it is the prime portal for infection to enter the body, and it is a major site of chronic and often undetected silent disease. Bottom line is, every time we brush, we coat our toothbrush with millions of diseasedisease-causing germs. Then we rinse our toothbrush under the tap for a few seconds, and throw it in the community cup with all the other germ–infested toothbrushes. We store that cup in the dirtiest room in the house – the bathroom – near the germ–laden germ laden toilet (a toilet with no trap which avails the room to sewer-line gases each time the toilet is flushed) and sink, sink and we return to brush with the same toothbrush 6 to 12 hours later! Gosh! We wouldn’t hang our forks or spoons in the bathroom exposed to bathroom vapors, germ–laced dust and “bathroom bacterial mist,” but we have no problem doing this to

Introduction - 11

our toothbrushes which are, again, FDA-regulated medical devices. Treating our toothbrushes this way is truly a much more dangerous habit because you don’t lacerate your gums and tongue with your silverware as you do with the sharp bristles of your toothbrush. A USA Today article said that after only a few uses, the bristles of your toothbrush become “tiny little needles” that cause tiny cuts in your mouth each time you brush. Everyone has seen blood in the sink from time to time after brushing. Even when you don’t see any blood, your toothbrush is still microscopically cutting and abrading the soft tissues of your mouth. I can’t make this point any more clear: We are literally injecting toothbrush germs directly into our bloodstreams bloodstreams every time we brush with an unsanitized toothbrush. When you really think about it, using an unsanitized toothbrush is a nasty, disgusting practice that makes absolutely no sense at all. We throw any concept of oral hygiene right out the window with this unhealthy practice. What good is it to see your dentist or oral hygienist for preventative care when you use the same infected toothbrush day after day, month after month? Last year I found the following excerpt from a New Haven Department of Health Bulletin article. It speaks volumes about the seriousness of this health problem: “With the evolution of more and more sanitary precautions for the prevention of infection and re–infection the menace of an infected toothbrush now presents itself for considera– tion.

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The toothbrush after once using, is never a sanitary instrument, instrument, and what pathogenic pathogenic germs it must contain when used day after day in an ulcerated mouth! Of what possible value can a prophylactic treatment for pyorrhea of the gums, given by a skilled dentist or his prophylactic nurse, be when the person continues to use the same infected toothbrush? Water cannot cleanse the toothbrush, and so– called antiseptic solutions and pastes cannot destroy the pathogenic germs which the brush has acquired. Keeping the brush in strong antiseptic solutions for twenty–four hours may destroy some germs, but also generally destroys the brush, and with most solutions would cause the brush to be unpleasant or actually danger– ous to the person using it. In mouth and throat infections, including diphtheria, tonsillitis, scarlet fever, measles, etc. the toothbrush used just before the patient became sick must be destroyed. It is a menace, and may cause the convalescent patient to become a carrier of the disease with which he was affected. Children will rarely so care for their toothbrushes as to keep them ordinarily clean, and if one child of a family acquires a contagious disease the contaminated tooth– brush may probably allow infection of other closely adjacent toothbrushes which are reposing in the bathroom. Also a toothbrush exposed exposed to dust and vapors in a bathroom is unsanitary and far from aesthetic. One would

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not hang his spoon and fork in a bathroom and then use them for the next meal. With tender, bleeding gums the toothbrush is an implement of injury, and the bristles may prick prick the gums and cause the very infected areas that it is supposed to prevent. The toothbrush is not the proper implement for massage of the gums. School teaching of mouth hygiene must place more emphasis on the care of the toothbrush, having in mind the likelihood of its dirtiness, its ability to cause injury, and that it may be frequently a carrier of germs that cause serious sickness. Laboratory cultures made from used tooth– tooth brushes have shown many of the dangerous pathogenic germs.” This article was published over 75 years ago and for 75 years the medical establishment has done absolutely nothing to inform the public about this serious “toothbrush” health threat! Hello, Dr. Semmelweis, et al! To make matters worse, according to a survey by Colgate–Palmolive, most Americans replace their toothbrushes every 9 months. 9 months? Can you imagine how many germs and food particles have accumulated on the bristles of an unsanitized toothbrush in 9 months? It scares me to even think about it. Most Europeans replace their toothbrushes on average every 12 months and one country (I will withhold the name to save the embarrassment),

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replaces their toothbrushes on average once every 2 years! Maybe you are one of those people who think that somehow, your toothbrush is different. If you’re one of these people – please, give me a call, I have some amazing oceanfront property in Nevada that I’d love to talk to you about. Tap water will not sanitize your toothbrush, and mouthwash (generally 16–25% alcohol) and toothpaste cannot and will not destroy the pathogenic germs that can infest your toothbrush. Keeping your brush in strong antiseptic solutions like rubbing alcohol, hydrogen peroxide, or other chemicals for 12 to 24 hours may destroy some germs, but it can also destroy the brush, and with most so–called antiseptics the brush would be unpleasant and, most importantly, become potentially toxic to the person using it for the very same “bloodstream” reasons that we’ve been discussing; you don’t want to inject concentrated alcohol, hydrogen peroxide, or other potentially cancercancer-causing chemicals into your bloodstream. A Chicago dentist said this: “The typical toothbrush is reused for months, never cleaned thoroughly, and usually is stored under warm, moist conditions conducive for bacterial growth.” Hey, the toothbrush is the very foundation of home dental care. For many people, especially people in low–income brackets and people without dental insurance, toothbrushing is the only from of dental care they receive. I think we should show the toothbrush some respect. Think about all of the massive and habitual procedures that doctors, dentists, and dental

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hygienists go through to steam autoclave their instruments, decontaminate their counters and chairs, and the extents they go through to use gloves, goggles and masks. But I bet most dentists and dental hygienists never sanitize their own toothbrushes. They, like everyone else, simply rinse their toothbrushes with tap water for a couple of seconds and throw it in that typical grimy community cup. What kind of infection control procedure is that? What What sense does that make? And do you know that millions of people never see a dentist or dental hygienist on a regular basis? And do you know that millions of people share toothbrushes, especially in the low income sector? Again, for many people, using a toothbrush is the only dental care that they receive. Or, should I say using a dirty toothbrush is the only dental care they ever receive! Recently, CNN Headline News reported, “Hiding in those bristles is a multitude of oral microorganisms that can lead to several health problems, including oral inflammatory diseases that that you can get from your own self– self contaminated toothbrush.” toothbrush. Ironically, we are hurting our health every time we brush our teeth, unless we are brushing with a sanitized toothbrush. Believe it, cavities are caused by a certain oral bacteria that are contagious. contagious The bacterium that causes gum disease is also contagious. contagious The virus that causes cold sores, Herpes Simplex Type–1, is also

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contagious. contagious So are the viruses that cause the flu, the cold, Hepatitis, and HIV. Strep, Staph, and Candida, which causes thrush, are all contagious. contagious Get the point? Toothbrushes not only harbor these germs, but they can transmit them as well. This fact, known as cross–contamination, is well documented but, the good news is, it’s preventable. Like cigarette boxes, it’s my belief that toothbrush packaging should have a mandatory Surgeon General’s warning. It should read: Surgeon General’s Warning: An unsanitized toothbrush is hazardous to your health. For me, it’s a dream come true that the Germ Terminator story is moving from household to household. It’s a story that must be told about a problem that many people have never considered, a problem that quite possibly may be the reason for many unexplained health ailments, and a problem that now has a solution. And the keep–it–simple– stupid solution is my baby – the Germ Terminator. Thanks for reading my book and listening to my theory about toothbrush germs. I believe that the chronic attack by germ–infested toothbrush bristles on our immune systems is killing us, slowly. After reading this book, it’s up to you to form your own opinion and decide what’s better, a dirty toothbrush or a sanitized one. We know that toothbrushes harbor and transmit disease. To what degree is this needless overexposure to germs responsible for rising rates of inflammation, including C–reactive protein (CRP)

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levels, and Interleukin–6 levels? Right now, we don’t know for sure. But why take the chance when we don’t have to? Extensive studies should be conducted on this serious health issue, but in the meantime, when common sense tells us that something is dirty, it should be common sense for us to have it cleaned before we stick it in our mouths. Here’s wishing you the best of health—because after it’s all said and done, there are few things as important as your health and the health of those you love. – James Song

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1 The Toothbrush Germ Theory “Studies have shown that contaminated toothbrushes not only harbor, but also transmit both viruses and bacteria that cause systemic, localized and oral inflammatory diseases.” – The Journal of the American Dental Association (Vol. 132, September 2001) 2001) I came across an interesting article in Time Magazine entitled “Wash those hands!” The article was about how doctors and nurses working in hospitals can actually make us sick by forgetting to wash their hands or failing to wash frequently or effectively. In doing so, they spread infectious germs to the patients they treat. After reading the article, I started to contemplate this daily personal hygiene task and how much we may or may not take it for granted. According to Time Magazine, nearly 90,000 Americans die in hospitals each year from infections, infections and apparently the situation is much worse in other

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countries. Shockingly, many of these deaths could be prevented by doctors and nurses simply washing their hands more often. often What’s even more frightening are the results from a study that show hospital staffs generally adhere to hand–washing guidelines less than 40% of the time – and sometimes a lot less. Since reading the Time article, I came across another article in Newsweek Magazine that cites “needless” hospital deaths from infection at an average of 195,000 per year in 2000, 2001, and 2002. “That’s the equivalent of 390 jumbo jets full of people dying each year,” says Dr. Samantha Collier, Vice President of Medial Affairs at HealthGrades, a health–care–rating organization that conducted the study. I wonder how many of these deaths could have been prevented by hospital staff practicing better infection control procedures, like washing their hands. Did you know? 80% of all infectious disease is transmitted by both direct and indirect contact, according to Dr. Phillip Tierno, the director of clinical microbiology and diagnostic immunology at New York University Medical Center. Center. This means that nearly all infectious disease could be prevented by paying more attention to infection control procedures.

Now maybe I’m wrong, but I thought that hospitals are places we go to get better, not to become even more sick or even to die from an infection! After learning about this problem, I started to speculate as to what the hand washing habits of the general public might be. If our health care professionals are so lax about washing their hands, then what could I expect of the general public?

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Although I was somewhat hesitant as to what I might find out, I decided to do a little research on the subject. Not surprisingly, I learned in my investigation that the American public is far worse at remembering to wash their hands than hospital personnel. (Furthermore, they wash their hands in a way that makes germ killing very ineffective.) A study released in 2003 at the Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC) found that 74% of men wash their hands after using the restroom, and 83% of women wash their hands after going to the bathroom. But just because you don’t wash your hands doesn’t necessarily mean that you are a disgusting person in the restroom arena. Some of us don’t wash our hands in public restrooms for fear that there is a higher risk of exposure to germs from touching public faucets, soap dispensers, towel dispensers, or hand–drying buttons. Another study reported by CNN found that less than 35% of people wash their hands after coughing or sneezing, 20% after handling money, and 45% after petting a dog or cat. All in all, a lot of Americans simply don’t wash their hands. This is what got me thinking that the purpose for hand–washing has somehow been forgotten. Do we not remember the reason why this simple activity is so necessary? Washing our hands is almost like a trend — something we feel we have to do out of societal obligation, not because we know why. Some of us feel we have to wash our hands or our mothers will yell at us or the other people in the restroom will look at us like we’re gross. When questioned in a

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written survey, 95% of the people surveyed said that they wash their hands after using the restroom, although several different studies have shown that this is not the case at all. We’ve all seen the signs in restaurants and food places that read: “Employee’s MUST wash hands!” We know that we should do it, and some of us do, but why? Aside from habit, there has to be a real fundamental reason why we wash our hands in the first place. So what is the reason, what is the use? The answer is, simply enough, so we don’t get sick. Deep down we already know this, and the number of people who die each year from infection proves this. But I believe that the reasoning behind hand–washing has somehow been lost with habit. We do it or don’t do it without even thinking about it. I would argue that the same thing goes for brushing our teeth. It is something we just do. Most of us don’t think about the reason or the purpose for brushing. It’s just like when we wash our hands, do we really think about the nasty germs that are being lathered away when we wash or how many nasty germs still remain? I don’t think so! Most people simply use soap, rinse, dry, and think nothing else of it. Similarly, many of us don’t consider the millions of microscopic germs and bacteria that are being removed from our teeth, gums, and tongue by our toothbrush when we brush — and few of us think about the fact that those disgusting germs and food particles continue to live, breed, and rot on the the bristles of our toothbrush in between brushings.

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Well, I do think about those germs. In fact, over the past few years some would say that I have spent too much time thinking about those germs. I’ve taken the last ten years researching killer germs, germ theories, health problems related to germs and infections, and the definitive link between the health of the mouth and the entire body. After years of research and all my work towards developing a solution to the toothbrush–germ problem, the most significant conclusion that I have realized is that brushing with a sanitized, germ– germ–free toothbrush is critically important for your overall health. Obviously, it’s got to be better than using a dirty, bacteria– bacteria–ridden toothbrush. It’s as simple as that. Clean Clean wins. I think that every dental, medical, and health practitioner will agree with the fact that brushing your teeth is pretty much essential to maintaining oral health. Whether they agree that it is essential to maintaining overall health is another question. Most dentists that I have come into contact with are concerned with the state of the mouth only and less aware or cognizant about the health of their patients beyond the oral cavity. Utilizing a toothbrush — whether it is germ–free or germ–infested — is something that we have to do every single day, twice a day at the minimum (or better yet, after every meal, soft drink, or snack). If you’ll allow me to make a quick analogy, I would say that our hands and fingers are also things that we have to use everyday — at least in order to function normally. But we have a choice as to whether we decide to go around touching people, food, and other things with washed and disinfected hands or leave our hands contaminated

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with nasty germs and bacteria. For most of us, the choice seems obvious when it comes to our hands, but why is it different with our toothbrushes — something we put in our mouths and scrape against the delicate mucous–membrane tissues of our gums? Why is it that practically no one (or at least less than 0.5% of the world’s population) sanitizes their toothbrush before every brushing? The fundamental reason for washing our hands is absolutely the same fundamental reason why we should sanitize our toothbrushes: so we don’t don’t get sick, either in the short term or in the long term. Furthermore, it’s so much more important to sanitize your toothbrush than it is to wash your hands because with your toothbrush bristles, you are directly micro– micro–cutting and abrading your gums and tongue tongue and thereby bypassing your immediate immune defenses by injecting germs directly into your bloodstream — you don’t do this with your fingers. To understand this idea more, it will help to take a detailed look at why we take the time to clean certain things – like our hands – in the first place. A Little Germ History The very first hand–washing advocate was a Hungarian physician named Ignac Semmelweis. He was the “maverick” who in the 1840s suggested that doctors wash their hands in between seeing patients in order to prevent the spread of disease, and he is the reason that we wash our hands today, some of us religiously, whether we know why or not. Whether we do an effective job of removing the germs from our hands is another story.

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Semmelweis’ hand–washing concept seems obvious now, but in the late nineteenth century when he suggested the idea, it was common practice for physicians to operate on cadavers in the basements of hospitals and then go upstairs to deliver babies without ever washing their hands! The babies and the mothers who were treated by the doctors with dirty hands would often die from infection. So, Dr. Semmelweis proposed that doctors wash their hands in between seeing patients in order to reduce this high rate of death. Nearly 40 years later, Semmelweis’ theory was finally proven and accepted by the medical establishment, thanks to the work of other revolu– tionary scientists like Louis Pasteur and Joseph Lister (and the advent of the microscope) who showed us that invisible germs are in fact responsible for the proliferation of many dangerous acute and chronic illnesses. Consequently, we now know that one of the best defenses we have against germs (and illness) is simply keeping our hands clean, which is easier said than done. These are things that we know today, things that both science and our mothers have taught us over the years. Nevertheless, a little over one hundred fifty years ago, medical establishment leaders ridiculed Dr. Semmelweis’ theory and nearly had him exiled from the medical community. Can you believe that he was actually ridiculed and laughed at? That he was nearly thrown out of the medical community? Just for imploring that physicians wash their hands? Nowadays, Ignac Semmelweis’ “hand–washing” theory is universally accepted and practiced so much that it is common knowledge to almost every person in the world — even little kids know that we need to wash our hands.

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We’ve known for a long time that germs cause disease and that we can protect ourselves by doing simple things like washing our hands and necessary things like sterilizing medical instruments. But why hasn’t this wisdom been extended to our toothbrushes? For that matter, is there another another medical device that comes into contact with human soft mucous– mucous–membrane tissue that isn’t supposed to be sanitized before each and every use? The toothbrush is an enigma, but I am on a mission to change that. Poop Germs? We can’t see the microscopic germs that are on our hands but somehow we know they are there, which is why we wash them. Dr. Semmelweis — and our mothers for that matter — taught us that the germs on our hands can make us sick and we should take care to clean them every chance we get — before eating, after coming home from public places, or after using the restroom. Again, we can’t see the germs, but we make sure to wash them off. So, what makes us think that our toothbrushes are so clean? What makes us think that we shouldn’t have to wash our toothbrushes? Like the germs on our hands, we can’t see the germs that are on our toothbrushes. But let me assure you, your toothbrush is home to literally hundreds of thousands of germs and other bugs. A recent British study found 100,000,000 (one hundred million) germs on a single, ordinary toothbrush. I am sure that your mother never told you to “wash your toothbrush.” It’s not her fault. Somehow, long ago society mistakenly formed a mindset that suggests that the toothbrush is

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an instrument used to clean the mouth and therefore it doesn’t need to be cleaned itself. No governing entity, regulatory body, infectious–disease organiza– tion, or health association that I am aware of has taken the time to issue a public health warning on the dangers from germs that are on our toothbrush bristles. Germs that were removed from our mouths the last time we brushed in addition to other germs gathered from external sources like airborne contaminates in the bathroom, including sewer–line and ventilation–duct gases and droplets (especially in apartment settings), direct contamination from hand– touching, and surrounding toothbrushes. And beyond all of the other germs, you’re not going to want to believe this, the vast majority of toothbrushes are contaminated with fecal (yes, poop) poop) germs. Disgusting, right? Can these germs make you sick? Absolutely. Are these germs a danger to your long– term health? Well, what do you think? What does common sense tell you? Maybe you don’t believe me because it’s too gross to contemplate, but to help convince you that I’m not making this up, here are some pretty disgusting facts from some very credible sources:

“It may surprise you – or sicken you to know – that if your toothbrush is stored near the toilet, the chances are great that it is covered with E.coli bacteria. Each time you flush the toilet, bacteria disperse in the air in the form of tiny particles…” - A Professor of Risk Analysis, Harvard University School of Public Health

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“Did you sanitize your toothbrush today? Fecal matter and bacteria, bacteria it turns out, can spray as much as twenty feet upward when a toilet is flushed. Toothbrushes Toothbrushes can be contaminated with fecal matter…” - Wall Street Journal article entitled “You May Not be as Clean as You Think.” November 5, 2003 “49% of used toothbrushes tested positive for fecal coliforms [i.e. poop germs]…” - Independent Australian Biotech Laboratory Study In spite of all the evidence, some people try and fool themselves into thinking that these things aren’t true or that they don’t apply to their toothbrush. But make no mistake, your toothbrush toothbrush is like a toilet brush, a bacterial hot–zone filled with all kinds of disgusting germs. You can be sure that allowing these germs to enter your mouth and bloodstream each day is harmful to your long–term health. Aside from poop germs, several studies have proven that a multitude of potentially pathogenic bacteria and viruses can survive and multiply on the bristles of your toothbrush. The Chicago Dental Society cites research that establishes that thousands of microbes can grow on toothbrush bristles and handles. Among these microbes are Influenza viruses, Herpes simplex, Streptococcus, Staphylococcus, Candida, Porphyrom– onas gingivalis, and other bacteria that cause gum disease, chronic infection, and inflammation. The United States Centers for Disease Control has stated,

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“Even after being rinsed visibly clean, toothbrushes can remain contaminated with potentially pathogenic germs.” Furthermore, your trusty toothbrush can also function as an ideal breeding ground for these bugs, meaning they can grow and multiply in the dark, moist areas in between bristles and where the bristles attach to the toothbrush head. The Journal of the American Dental Association has confirmed that the toothbrush is a moist, fertile breeding ground for bacteria. To make things worse, the toothbrush serves as the perfect vehicle for germs to enter the the body (via the tiny lacerations made in your gums by the bristles). USA Today reported that the “sharp tips of toothbrush bristles can cause tiny lacerations in the gums that allow infections to enter the body.” A professor of oral pathology at the University of Oklahoma Health Sciences center says that, “Your toothbrush is a perfect breeding ground for bugs…” Still think you are safe from toothbrush germs? Studies show that toothbrushes become contaminated after just one use. The Journal of the American Dental Association states, “contaminated tooth– tooth– brushes not only harbor, but also transmit both viruses and bacteria that transmit systemic, localized, and oral inflammatory diseases.” There Are Always Skeptics Even with all the evidence and the common sense (more of which I will share with you), there are loads of skeptics out there and, as Dr. Semmelweis experienced, I’ve just got to deal with them, endure the ridicule, and go on with my mission. I’m doing my

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best to bring this important issue to light since I started airing my thirty minute Germ Terminator “Silent–Epidemic” TV infomercial; however, there are some people who just don’t get it, including many health practitioners. Some television media experts have told me that people don’t want to hear about germs and fecal bacteria on their toothbrushes. In fact, they find it so distasteful that they’ll turn off my program. But, you know, the truth is the truth. I believe that these disbelievers are not unlike the critics Dr. Semmelweis’ encountered during his crusade for proper hand–washing. Like Dr. Semmel– weis, I have encountered much opposition to my theory, but I believe that the truth must be told about toothbrush germs no matter what. Besides, I have common sense on my side, which says that clean has got to be better than dirty, especially when it comes to something you put in your mouth. I’ve made it my mission to educate people about the health risks from toothbrush germs. It’s a fact that many people either still don’t believe the aforementioned quotations about poop germs even though the citations are from reliable sources, or they are perplexingly unconcerned with the potentially hazardous consequences. That’s probably because they don’t want to believe that their toothbrushes can be that nasty. Even some doctors and dentists don’t believe that germs on toothbrushes are dangerous, and it’s also because there hasn’t been a safe, simple, and effective solution.. (You’d think that doctor’s would say, “Sure, a clean toothbrush has got to be better than a dirty one. Show me a simple, effective, safe, and inexpensive solution, and I will recommend it to my patients.”)

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Here’s an email I received from the wife of a physician who purchased a Germ Terminator and “had” to return it:

“To Whom It May Concern: I recently received the Germ Terminator in the mail. The box is unopened and I would like to return it. My husband, who is a doctor, feels that since the human mouth is home to thousands of germs that having a clean toothbrush makes little difference. He has consulted his dentist friends and they agree with him. There is no use trying to talk to him when his mind is made up. Could you please email me back with your procedure for returning it?” So there you have it. This doctor and his dentist friends have pushed themselves back 150 years by stating that a dirty, germ–infested toothbrush is okay — that it is no different from a health standpoint than a clean, sanitary, germ–free toothbrush. That’s okay though — I’ll continue with my Semmelweis–like stand and theory, take the abuse and criticism, and stick to my beliefs and my mission. You might even be thinking along the same lines as the doctor’s wife. If so, you are among the 99+% of the world’s population who use a contaminated toothbrush each day, and you are among those who believe exactly what our present– day oral–hygiene culture believes. Here’s the mainstream philosophy:

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I’ve been brushing my teeth ever since I can remember and I am not sick, and therefore, brushing my teeth with a germ–free toothbrush can’t be that important. The millions of germs that accumulate, grow, and multiply on my toothbrush between the times that I brush are harmless. Besides, my mouth is home to a multitude of germs. Why should I care about a clean toothbrush? On the surface, this philosophy seems plausible. It’s the same philosophy of the doctor whose wife returned the Germ Terminator. But my research and the research of others demonstrate that this kind of thinking is absolutely wrong. Sure, there are a lot of germs already present in the mouth, but having fecal bacteria and other germs in your mouth and injected into your bloodstream simply cannot be good for your health. Even the television media are starting to believe the facts I’ve presented. Not long ago, the Discovery Channel Network aired an episode of its continuing show called “Myth Busters.” The show features two guys who investigate the truths and untruths behind urban legends. On one edition of the show, they tried to debunk my claim that toothbrushes are rife with germs, germs, especially fecal germs. Conducting their own investigation, they tested my claim that nasty germs jump from toilets to toothbrushes by either airborne or direct contam– ination. They tested 24 toothbrushes and 2 controls that they themselves used for 30 days. The result? Of the 24 toothbrushes, all 24 tested positive for poop germs — that’s 100%! Even

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the 2 control toothbrushes they stored in the kitchen cabinet tested positive for fecal germs! But here is the most disturbing element: When they asked the University of California San Francisco microbiologist who tested the toothbrushes and grew the poop germs on Petri dishes whether having fecal germs on our toothbrushes was hazardous to our health, she replied, “No, it’s not dangerous. After all, we all brush our teeth and we’re all healthy.” At the end of the sentence, she seemed like she knew that what she said wasn’t particularly convincing because her voice trailed off and clearly did not exude 100% confidence. And, regardless of her scientific statement, the hosts of “Myth Busters” weren’t too impressed with having poop germs on their toothbrushes. This microbiologist claims “we’re all healthy.” Actually, I would argue that as a nation we have never been unhealthier. Perhaps life spans have increased in the past fifty years and Americans are living longer than they used to, but living longer does not necessarily equate with living better, and it’s obvious that health care and health insurance issues have never been more pressed. Why? Because chronic illness in America is at an all– all–time high. Heart disease is widespread. So is is cancer. cancer. Who doesn’t know someone suffering from diabetes, diabetes, rheumatoid arthritis, Alzheimer’s, Parkinson’s, Parkinson’s, chronic fatigue, fatigue, an autoimmune disorder — or some other chronic degenerative disease? At the moment, the leading causes of death in America are: 1) Heart Disease, 2) Cancer, Cancer, and 3) Infectious disease.

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Infectious diseases are obviously caused by germs, but how much of an effect do germs have on heart disease and cancer? The shocking answer is that germs have a more instrumental role in the onset of chronic illness than we ever imagined. On March 7, 2002, ABC News reported the following:

“Can you catch a heart attack? Is cancer contagious? The conventional answer is “no;” these diseases are caused by bad genes and bad diet. But a revolutionary band of scientists thinks these sicknesses are actually caused by infectious bugs. If they’re right, it will be a medical revolution… So why is the medical establishment dragging its feet on this issue? Many millions might be suffering suffering – and dying – from heart disease, cancer, and other illness as a result of the medical establishment conserv– atism.” Germs could turn out to be more harmful than we expected. Could we be saving lives and improving the quality of life just by improving hygiene? Could we help prevent or at least slow down some of today’s chronic illnesses by simply changing our lifestyle habits — being more germ conscious — and by using a clean, sanitized, germ–free toothbrush every time we brush?

2 “Germs, not not genes, cause most diseases” diseases” – The Associated Press (January 7, 2001) Did you know that 90% of stomach ulcers are caused by a type of infectious bacterium? It’s true. And the same bacterium is now thought to also cause stomach and colon cancer. If you’re like most people, however, this might be the first you’ve heard about this. I was surprised when I learned this fact myself some years back. After all, physicians had been saying for decades that poor diet, stress, and aspirin overuse were the causes of stomach ulcers; back then the word bacteria was not even in the picture when it came to ulcers. Throughout history, germs have been drastic– ally underestimated in their ability to cause destruction and death. Germs have repeatedly been overlooked and rejected by the medical establishment as causes for disease. Why? Perhaps this is because germs are invisible to the human eye and it is hard for us to believe that something we cannot see can have the ability to cause great harm to our bodies.

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Whatever the case may be, the fact remains that microscopic germs can be, in fact, very harmful to our health. As scientists discover more about them and their connections to certain diseases and conditions, germs are turning out to be more dangerous and than we ever thought. In the past few years, several new studies and laboratory conclusions have pointed to germs as the instigators of many devastating non– acute diseases — chronic diseases that doctors used to think were caused by poor lifestyle and bad genes. What we are discovering is that the symptoms of long–term bombardment by germs are generally undetected until they turn into something devastating like heart disease or cancer later in life. The damage that germs can do is analogous to cigarette smoking, obesity, and lack of exercise. A little won’t kill you but year after year, decade after decade, the snowball causes an avalanche that buries you. Since scientists like Semmelweis, Pasteur, and Koch revolutionized modern medicine with their respective discoveries and germ theories; doctors and scientists have achieved medical advances in the last 50 years that have enabled the prolonging life and eradication of many infectious diseases. As a result, the experts thought that science and medicine had the “germ–thing” beat. What was left to worry about were health problems that both science and medicine believed weren’t instigated by germs; problems like heart disease, stroke, and diabetes. But all that is changing. The latest medical research is demonstrating that the primary causes of many chronic diseases are germs, and not lifestyle or genetics as previously believed. Not a week goes by where some new discovery isn’t made that implicates

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a virus or bacteria as a primary factor in the development or onset of illness. The traditional face of modern medicine is being forced to transform itself as more research and clinical data accumulate in support of this new germ–theory of disease. Based on this research, the medical establishment is having to re– examine its strategy for maintaining and improving the health of human beings, which has predominately been to concentrate on the early detection of a disease and the treatment of the disease. Medicine will have to take on a much more preventative position against the causes of illness, namely a strong position to prevent the long–term damage caused by silent viruses and bacteria. Hopefully, the medical establishment will show a faster response than it has demonstrated in the past. Old and New Discoveries – The New Causes of Disease As recent as 1982, Australian scientists Dr. Barry Marshall and Dr. Robin Warren shocked the medical community by announcing that most peptic ulcers are caused by a strain of bacteria called H. pylori (and not stress, stomach acid, aspirin overuse, or spicy foods, like doctors had believed for years). Before Drs. Marshall and Warren, everyone believed that bacteria couldn’t survive in the stomach’s acidic environment; everyone understood that ulcers were caused by stress, spicy foods, and physicians (ineffectively) treated their patients with medications that blocked acid production and prescriptions that included de–stressing exercises and less work. For decades the medical establishment had dealt with stomach ulcers this way; when Dr. Marshall and Dr.

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Warren came around, what they were suggesting, for many in the establishment, amounted to nothing less than medical heresy. Dr. Marshall recalls that when he was in medical school he was given the impression that everything had already been discovered in medicine, so from the perspective of the medical establishment, there was absolutely no need to question accepted “medical facts” that had been practiced for decades. So, unsurprisingly, when Marshall and Warren began to share their discovery with other doctors, they encountered much opposition. In fact, the vast majority of the medical profession, not only in their native Australia but across the globe, considered the scientists to be quacks. Dr. Marshall in particular was intensely ridiculed by his peers because of his refusal to back down. Marshall was so determined to prove his discovery that he made the rather drastic decision to use himself as the human guinea pig to test his theory. He prepared a concoction of live H. pylori and drank it. Marshall’s plan was to give himself a peptic ulcer then cure himself with antibiotic treatment. Sure enough, the infection induced by the H. pylori gave Marshall the results he was looking for — stomach pains, nausea, and vomiting — classic signs of gastritis and the early signs of an ulcer. Within a few days of drinking the H. pylori cocktail, Dr. Marshall’s stomach revealed marked inflammation — he had self–induced a full–blown stomach ulcer. Then he cured himself through antibiotic therapy, just as he had planned.

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Today, physicians and health organizations recognize H. pylori as the cause of more than 90 percent of ulcers and treat their patients accordingly. However, just prior to Marshall’s guinea pig test, one of America’s leading researchers laughed at the scientist and called Marshall’s idea “preposterous” (remember, this occurred in 1983, not 1893!) Marshall’s and Warren’s H. pylori discovery and their ensuing struggle to convince the inflexible medical establishment are noteworthy today in light of the latest medical research that implicates germs as the causes of other diseases that doctors once believed were caused by lifestyle and genetics. Marshall’s story is the most famous recent example of a common ailment for which an infectious germ has proven to be the cause of disease. I anticipate that there will be many more discoveries like this one that will significantly alter the way in which doctors and patients approach germs and their connections to common, chronic, and even fatal diseases. The H. pylori discovery also demonstrates how germs have been — and still are — overlooked and underestimated by medical professionals. For some time now — since the life–saving effect of vaccines and antibiotics have helped eliminate or slow down certain diseases — germs have simply been ignored as the culprits for most health problems, especially chronic ones. A standard medical textbook published in the 1970s says beneath a section called “Etiology of Stomach Ulcers” that “environmental factors… smoking…diet … drugs … aspirin … and psychonomic factors” are the primary causes of stomach ulcers.

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Ironically, the textbook makes no mention whatsoever of any chance that the ulcer might stem from a germ infection. Thanks to Drs. Marshall and Warren, we’re now wise to the fact that the culprit for stomach ulcers is the H. pylori bacteria. Further research has since taught us that H. pylori is the cause of many cases of stomach cancer. What’s amazing and inspiring about Marshall and Warren’s story is that their discovery reversed decades of medical practice in the treatment of a disease. The story of these two scientists also demonstrates the rigidity of the medical establish– ment to change their entrenched ways of thinking about disease. Only after deciding to carry out a rather extreme experiment by infecting himself with an ulcer–causing bacterium did the medical establishment start to come around to the idea that peptic ulcers might be caused by something other than abnormally high levels of stomach acid. Even after Marshall’s self–infection demonstration, it still took the medical community nearly a decade to start treating patients for H. pylori. A decade! How many people suffered or died during this time because of this rigid skepticism by the establishment? Are the causes of many chronic diseases actually brought about by germs that doctors never even thought about or even looked for? Germs that doctors never thought to blame? Germs like the ones that are on contaminated toothbrushes? There is no question that genes, lifestyle, and the environment can contribute to chronic diseases, but what if germs start the process or propel the progression of some or many prominent diseases? What if doctors and scientific researchers are looking

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in the wrong places for cures because they missed something about the causes? What if we have been unknowingly infecting and re–infecting ourselves with slow–to–kill toothbrush germs simply because doctors didn’t know, or are too stubborn to change their way of thinking regarding this oral hygiene habit? Cervical Cancer Question Let’s consider a disease that is diagnosed in 500,000 women each year — cervical cancer. Evidence that there is something infectious about this disease goes back a long time. In 1842, Italian scientist Rigoni Stern noticed that cervical cancer occurred frequently in prostitutes while it almost never affected celibate women. His observation led him to believe that this cancer was somehow sexually transmitted. Stern’s hypothesis went nowhere for another century until 1951 when a Danish epidemiologist named Clemmensen read Stern’s study and wrote that the findings were based on such sound research that the medical community would be well advised to follow– up on Stern’s work. A few decades later, a scientist at the German Cancer Research Center in Heidelberg, Harald zur Hausen, proved that the human papillomavirus (HPV) is definitively linked to cervical cancer. Then in 1999 an international group of scientists reported that virtually every case of cervical cancer stems from the sexually transmitted virus HPV. This finding marks the first time that a virus has been shown to account for every case of a particular cancer. Although genetics and other factors like smoking and childbirth play a role in the occurrence of cervical cancer in some women, there is little doubt

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that preventing the HPV infection all together would all but eliminate this type of cancer. Fortunately, the medical establishment now recognizes HPV as specific the cause and works to treat patients accordingly, but it’s a tragedy that Stern’s observations weren’t welcomed years ago. In the past 150 years, how many women died because of this unwarranted skepticism? Don’t get me wrong, I’m not out to discount the advances that medical science has made in the last century or discredit the discoveries that have been recognized. Surely doctors and scientists have made so many revolutionary discoveries that have helped to prolong life and enhance quality of life for millions of people, especially in the last 50 years. I’m just impatient for the establishment to take decisive action when it makes perfect sense. But the medical establishment’s lagging on the germ issue worries me, and it should worry you too. We’ve seen that common ailments like stomach ulcers and more devastating diseases like cervical cancer are caused by germs when doctors and researchers thought otherwise. Although these examples are somewhat isolated, what we know now about ulcers and cervical cancer serves as evidence that genes and lifestyle have been overestimated as contributors to disease and the best germ research lies ahead. There is one scientist in particular who is leading the way with this new germ research. Professor Paul W. Ewald, an author and professor of evolutionary biology, indicates that the concept of germs over genes is “a very simple argument that has been overlooked” and underestimated.

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A New Approach Professor Paul W. Ewald, an Amherst College Biology professor, is undoubtedly the leader of the modern germ theory. Ewald is the author of The Evolution of Infectious Disease and Plague Time: How Stealth Infections Cause Cancers, Heart Disease, and Other Deadly Ailments in which he outlines his belief that “infectious medicine has always been under– estimated” simply because “infectious diseases [and germs] are extremely diverse.” As he explains it, the range and capacity of infectious disease always turns out to be broader than originally considered. “Every ten years we keep adding to the list,” he says, but mainstream medicine continually overlooks the causes of the most enduring, widespread and harmful illnesses of humankind – microbes. Professor Ewald believes that germs could be the root of infectious and chronic diseases like heart disease, breast cancer, diabetes, and even schizophrenia – illnesses that were thought to have been caused by bad genes, poor diet, and unhealthy lifestyle. Surprisingly, what got Professor Ewald thinking about this revolutionary germ idea was a bad episode of diarrhea. About twenty–five years ago, the professor was on his way back from a Kansas field trip when, unfortunately, he was hit with an attack of diarrhea. His discomfort got him thinking about what many scientists now call the Germ Theory Part II, or what he calls “The New Germ Theory.” Was the diarrhea the havoc of a particular germ that was working on spreading itself? Or was the diarrhea part of his body’s attempt to flush away the germ?

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Professor Ewald was curious whether the diarrhea was the germ invader’s evolutionary adaptation or the evolved human defense against it. After some research back at the lab, Professor Ewald arrived at a startling conclusion – mainstream medicine is fixated on genes and lifestyle and overlooking the primary cause of the most enduring, widespread and debilitating diseases of humankind. Quite simply, Prof. Ewald believes that germs are the cause of heart disease, cancer, mental illness, and other chronic diseases – and I strongly agree. (Great ideas can spring from something as accidental as diarrhea.) The professor’s Germ Theory Part II presents a new outlook on the investigation of disease and the causes of disease. What he has learned is that heart disease, cancer, and chronic ailments may be caused by a lethal combination of poor lifestyle and germs instead of bad genes. The background of Ewald’s theory is constructed upon what we already know about germs – based on Part I of the Germ Theory of disease that was formulated by scientific mavericks like Pasteur, Koch, and Semmelweis. Over one hundred years ago, Part I propelled medicine out of the Dark Ages – an era that believed that such diseases were caused by “bad air” or “bad blood,” rather than by pathogenic germs transmitted by mosquitoes or by doctors’ unwashed hands. Koch tracked tuberculosis to an airborne germ, Mycobacterium tuberculosis, and in 1905 he won a Nobel Prize for his work.

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By the early 20th century, most of the common killer diseases – including smallpox, bubonic plague, diphtheria, the flu, whooping cough, yellow fever and tuberculosis – were understood to be caused by dangerous germs. Vaccines were devised against some and by the 1950s antibiotics could cure many other diseases caused by germs. By the 1960s and 1970s, the prevailing mood was one of great optimism because science believed that they had the germ problem solved. Ewald sarcastically quotes a 1972 edition of a classic medical textbook: “The most likely forecast about the future of infectious disease is that it will be very dull.” At least in the developed world, infectious disease no longer seemed threatening. Far scarier were the diseases that doctors thought were not infectious: heart disease, cancer, diabetes, and so on. Doctors rather arbitrarily said that these diseases were hereditary and/or environmentally induced illnesses. No one foresaw the devastation of AIDS or the serial outbreaks of deadly new infections such as Legionnaire’s disease, Ebola and Marburg Hemorrhagic fevers, antibiotic–resistant tuberculosis, “flesh–eating” staph infections, Hepatitis C, SARS, Rift Valley fever, and other dangerous infections. Today the infections caused by germs, as well as a handful of other lethal diseases like heart disease, continue to devastate the health of millions of people. Germs, Not Genes In his new germ theory, Professor Ewald portrays diseases and their microbe agents as players

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in a kind of primitive warfare. Viruses, bacteria and other microscopic creatures penetrate our body’s defenses. Once inside, they feast, multiply and then look for new bodies to overrun. These invasive actions are what manifest themselves as disease. Ewald’s Germ Theory Part II is also based around the evolutionary success of an organism relative to its competing organisms – the survival of the fittest. Genetic traits unfavorable to an organism’s survival or reproduction do not last in the gene pool for very long. Natural selection weeds them out. Consequently, any inherited disease or trait that has a serious negative impact on fitness must fade out over time, because the genes that cause the disease or trait will be passed on to fewer and fewer individuals in future generations. For example, if we allow germs and bacteria to continually invade our bodies without effectively fighting them off, our biological systems will evolve into more and more comfortable environ– ments for these bad bugs. Germs will make our bodies into their cozy homes in the form of chronic disease or chronic inflammation. Also important is Ewald’s observation that although humans try their best to evolve new defenses and invent new protections like antibiotics or vaccines, germs can breed new generations every 30 minutes, evolving rapidly to defeat science’s latest defenses. Ewald argues that new antibiotics are eventually bound to lose when put up against swiftly– evolving germs. According to Ewald, “There is a lot at stake here, because if people

drag their feet when it comes to investigating the possibilities that infections are causing

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these diseases and if they dismiss them without really having evidence that warrants dismissing them, then many people may die.” So is it germs, and not genes that cause most diseases? I believe this theory to be true and one day we will know for sure. But in the meantime, we have got to protect our immune systems. Because, well, lets take another look at Professor Ewald’s statement:

“…if people drag their feet when it comes to investigating the possibilities that infections are causing these diseases … then many people may die.” That is exactly why I am so passionate about bringing the problem of contaminated toothbrushes to light. The solution that I have invented is surprisingly simple and inexpensive. It is as easy as washing your hands and definitely more effective in that it kills greater than 99.9999% of all germs tested in major laboratory testing, but more on that later. For the skeptics out there, and I know there are many, let’s go with Professor Ewald and NOT dismiss the possibility that the germs from contaminated toothbrushes are a potential cause for chronic infection. We know germs can be bad, we know they can cause infection and make us sick — that is why we wash our hands. We also know that the sharp bristles of toothbrushes can allow potentially millions of germs to enter the bloodstream by making tiny cuts in the soft mucous membranes of our mouths. Shouldn’t we do our best to avoid the germs — or better yet, kill the germs on our toothbrush — and

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thereby protect our immune systems! Doesn’t it just make sense? A practicing dentist who writes for the Journal of the Canadian Dental Association states, “We

KNOW that toothbrushes and dentures can transmit disease,” and that the need for infection control is critically necessary (the “we” refers to the practicing dentists and oral healthcare professionals who subscribe to the journal). This dentist implores his readers to be more accepting of the need for “overkill” when it comes to infection control, and less reliant on tedious, clinical data and yet–to–be–sponsored research. He goes on to state that one of the biggest problems doctors and dentists face when it comes to infection control is knowing the risk of acquiring an infectious disease in a given situation. For instance, it is impossible to know if a patient will be infected by a virus or bacteria during a procedure or visit because (i) germs are impossible to see with the naked eye, and (ii) doctors have no way of knowing the current condition of the patient’s immune system, and (iii) it is unclear what germs might already be present inside a patient’s body. Physicians go to incredible lengths to sanitize their instruments and operating environ– ments, yet patients still face the risk of coming into contact with harmful germs. If such risks were known, they would help justify the importance of, or the need for, a particular infection control procedure (such as the daily sanitization of one’s toothbrush). Why not be more careful? Why not do everything we can to avoid infection? That, too, makes perfect sense.

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So many practitioners are so incredibly anal and are simply not satisfied without volumes and volumes of laboratory data and clinical tests to back up precautionary, preventative actions. However, certain things – at least for now – are impossible to test inside a lab. The process of gathering an exhaustive, accurate collection of bacteria, viruses, fungi, and parasites that exist in everyday life is an impossible task — there are far too many. According to David Relman, an Assistant Professor of Medicine, Microbiology and Immunology at Stanford University, only about one percent of all the bacteria in the world can be cultivated in a laboratory. This makes any kind of lab test that would prove, beyond a shadow of a doubt, the absolute necessity for infection control measures simply unfeasible and unrealistic. Given the fact that humans are nearly as diverse in their biological functions as the millions of types of germs that exist, clinical data that directly supports the need for “overkill” or “germ paranoia” in infection control simply isn’t out there. Relman says the reason that researchers fail to accept microbes as a cause for disease, thereby rejecting the need for more intense infection control, is because traditional research cannot pinpoint the microbes. For now, the Canadian dentist from the newsletter strongly asserts that it is better to be safe than sorry – and I couldn’t agree more. We can never know when we may be exposed to a potentially virulent microbe, and we cannot detect when the entrance of microbes into the body may be enhanced by breaks in the skin or mucous membranes (like the gums), and we do not know when our immune system’s ability to fight a given microbe may be low.

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Fast and Sneaky Germs are extremely sneaky and efficient over time. They’re impossible to see with the naked eye, they can jump from location to location with incredible speed, and they can maintain a stable position where they’re able to live comfortably and multiply rapidly while going undetected (like on our toothbrush bristles). So how can we combat an enemy with such furtive capabilities? And to make things more difficult, germs are literally everywhere. They are on everything we touch, eat, and inhale. In a proper environment, especially a humid one like your shower, a single bacterium call can sprout into 1 billion cells overnight. What can we do? I have been researching germs for a long time now, and I know that there are many types of microbes that are beneficial and necessary for our biological systems. So please don’t get that I’m suggesting that all microorganisms are dangerous. What I am concerned with, and what we are talking about here, are those germs that can be harmful to our bodies in both the long and the short term by having constant and easy access to our bloodstreams. We all know how it goes with a germ that causes acute symptoms: one minute you’re feeling healthy and the next minute you are flat on your back – or should I say flat on your stomach on the bathroom floor – with salmonella, E. coli, or some other infection. The scary part is that you don’t know when or how the germ enters your body until the damage from the infection is full–blown.

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Many infections go without any acute symptoms (the cold and flu viruses are examples of acute illnesses) until over decades they manifest into something so devastating that there are few solutions that don’t, at least for a period of time, drastically alter the way we live and how we view the quality of life. Not too long ago, I ran into a friend of my daughter’s at a restaurant. She told me that she had just returned to work after being out sick for about a month. Since she seemed perfectly happy and healthy, I asked what in the world could have made her so sick as to take her out for a full month. She told me that one day she started experiencing extreme pain in her abdomen. She went to her doctor, who suspected appendicitis. After an X–ray and some tests, the doctor found that she had a full–blown infection on one of her ovaries that was spreading to the uterus. The infection was caused by the bacteria Streptococci, the bacteria responsible for strep throat, which in many people is asymptomatic – meaning that most adults experience no symptoms when the bacteria invades the body. For some reason, the bacteria that infected my daughter’s friend had lodged itself in her ovary and after having no symptoms over a long period of time, this twenty–three year old had to have one ovary removed and may have to undergo hysterectomy surgery in the future. When I heard this story for the first time, I was not only shocked, but also frightened. How could this happen? This story also reminded me of an article that I read about lab–cultured toothbrushes. The testing laboratory cultured various used toothbrushes in studies that showed the presence of the

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Streptococci bacteria – like the bacteria that infected my daughter’s friend. Ten used toothbrushes were cultured from ten individuals. Staphylococci were found on all of the toothbrushes and Streptococci were present on all but one. Furthermore, the Journal of Dentistry for Children states, “Streptococcus and pathogenic microorganisms can be transferred readily when a toothbrush is used.” So, if Strep can appear on the bristles of your toothbrush, then why, you ask, are you not sick right now? Well, it’s as I mentioned before, germs are sneaky, they work covertly and over long periods of time. A unique combination of contaminations, under a certain set of conditions, can trigger a long–term, chronic, or immediate infection that can cause serious harm to your health, even something as simple as tooth cavities. How can we know when our immune system is particularly susceptible to a certain bug? We can’t know and that is why it’s so scary. Whether symptoms are manifested immediately or fail to appear for decades, infections set off by germs and bacteria can enter your bloodstream easily through the sharp bristles of your toothbrush. Therefore I am a strong advocate of an overkill position against germs, especially toothbrush germs. Let’s not be afraid to be too careful – this is our health we’re talking about. Fortunately, I am not alone. Health writer Debra Bruce and Harvard University Assistant Professor of Risk Analysis and Decision Science, Kimberly Thompson, have authored a book in connection with the Harvard School of Public Health that takes a look at the ways drug–resistant germs

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are threatening our long–term health. Overkill: How Our Nation’s Abuse of Antibiotics and Other Germ Killers is Hurting Our Health and What You can do About It, notes that despite the vast advances in medical knowledge and technology, drug resistant strains of tuberculosis, staphylococcus, pneumococcus, and other germs are appearing with increasing frequency and infecting us more than we know. Antibiotics, they say, provide a false sense of security. The authors therefore promote a more germ– conscious lifestyle and the development of beneficial prevention and infection control practices against germs. The toothbrush, they say, is an excellent place to start. Right now you are not likely to find any tedious clinical data, sponsored medical research or scientific textbook that will tell you that daily tooth brushings over decades with a contaminated toothbrush could be harmful to your health, but the evidence that hypothesizes it is out there, and so is the solution.

3 The Mouth as a Mirror “Oral health health means much more than healthy teeth…New teeth…New research is pointing to associations between chronic oral oral infections and heart and lung diseases, stroke, and low– low–birth– birth–weight, premature births.” – Oral Health in America: A Report of the Surgeon General In May of 2000 the Surgeon General of the United States issued the first–ever report of its kind documenting a “silent epidemic” in oral health that is affecting America. According to the Report, a series of both minor and severe dental and oral diseases quietly plagues millions of Americans, despite the dramatic improvements made in oral health care over the last fifty years. The most frequently occurring problem is periodontal disease (gum disease), which appears in strong association with other serious health risks. The evidence presented in the Surgeon General’s Report links chronic oral infections with serious chronic and systemic diseases affecting the entire body.

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We have long known that the mouth reflects overall health and well being, but as David Satcher, MD, PhD, (U.S. Surgeon General, 1998–2002) documents, recent research is showing just how much the condition of our mouths can affect our overall health. New studies have uncovered the links between chronic oral infections and diabetes, heart and lung disease, stroke, and low–birth–weight, and premature births. The Report states that if left untreated, “Poor oral health can be the Silent X– X–factor

promoting the onset of life–threatening diseases that are responsible for the deaths of millions of Americans each year.” The Surgeon General’s first–ever report on oral health was issued by the U.S. Department of Health and Human Services in 2000, but unfortunately, it seems that many doctors, dentists, patients still ignore the Surgeon General’s creed that a “person cannot be truly healthy without good oral health.” Despite our seemingly health–conscious culture (in which, ironically, over tens of millions of Americans are obese) attention to oral healthcare seems to be pushed aside. Americans are obsessed with weight– loss drugs and miracle prescriptions that will lower cholesterol, stabilize blood pressure, and relieve seasonal allergies, while the importance of maintaining a healthy mouth is low on America’s list of health priorities. According to a study conducted in Japan, nursing home residents who received adequate dental care were found to be less likely to contract pneumonia, and also less likely to die from infection if pneumonia occurred. Nursing homes in the United

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States are required to provide oral health care to their residents, but in most states dental hygienists cannot provide needed care such as dental cleanings because of restricted dental practice laws. I am sure dental practice laws are in place for important reasons, but limiting dental care available to nursing home residents seems to indicate that oral health, in general, is not important. What we are learning from the Surgeon General’s Report and numerous other studies, and what I am so passionate about imparting to you, is that oral health is tremendously important to overall health and well being – more so than you think. The American Dental Hygienists Association agrees that the signs and symptoms of many life–threatening diseases begin in the mouth and many of these problems can be prevented or abated by simply paying closer attention to the condition of our teeth, gums, and tongue and making oral health a strict priority. From the Horse’s Mouth When cowboys and farmers set out to buy a horse, they will always make sure to examine its mouth before purchasing the animal. A quick look inside the mouth of a horse (or the mouth of a human) can sum up the creature’s health history and can help predict how long it will live. This “horse–mouth test” is founded on the theory of focal infection, which says that an oral infection caused by harmful bacteria can affect other areas of the body. The idea started in the 1920’s in reference to infections that turn up far from the site of origin. Since then the theory has lost popularity, at least in the human world, but recently scientists are taking the focal–infection concept more

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seriously as they discover that small infections within the mouth may be contributing factors to some of the most serious diseases. Gum Disease – A Silent Epidemic Perhaps the most dangerous and most prolific kind of oral infection is periodontal disease (gum disease). Depending on which source you select, it is estimated that approximately 75% to 95% of Ameri– Ameri– can adults have some form of periodontal disease; and since the condition is usually painless in its primary stages, a majority of those affected do not even realize that they have it. Periodontal disease is a chronic infection caused by bacteria in the oral biofilm (dental plaque) that forms on surfaces within the mouth. It is generally grouped into two major types; the less severe of the two being gingivitis, which affects the gums, and the more critical stage being periodontitis, which may affect all of the soft tissue and bone surrounding the teeth. Gingivitis is alarmingly common in many adults. The condition begins as an inflammation of the gums that is usually manifested with a change in the color from normal pink to bright red, accompanied by swelling, bleeding, and often sensitivity and tenderness. At this stage there is little or no discomfort, so most folks do not even know they are carrying a bacterial infection inside their mouths. Most people with mild cases only exhibit the signs of inflammation in a select location in the mouth — like around the back teeth or on the underside of the front teeth — places that are impossible to see without

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dental instruments. When inflammatory bacteria cells are able to continually infiltrate the mucus membrane around the teeth, a chronic infection is created. The bacteria–ridden plaque present on tooth surfaces that are opposite the openings of the salivary glands then mineralizes to form calculus or tartar, which is covered by an unmineralized, well– well–protected Biofilm — a combination that can exacerbate local inflame– matory responses for decades. Still, a gingival infection may persist for months or years without ever being detected. Meanwhile, millions of pathogenic bacteria are thriving in their own sub–culture within and around the chronic infection(s) in the mouth. If left untreated, the bacterial plaque can spread and begin to grow below the gum line, which leads to full–blown periodontitis. The toxins from the plaque start to irritate the sensitive mucous membranes of the gums and stimulate a chronic, recurring inflammatory response in which the body literally turns on itself, and the tissues and bone that support the teeth are eroded and eventually destroyed. The most common form of adult periodontitis is described as “moderately progressing,” which is characterized by a gradual loss of attachment of the periodontal ligament to the gingiva and bone along with loss of the supporting bone. A second form is known as rapidly progressing, which is often resistant to treatment. Although the term “progressive” is used to describe periodontitis, oral health care specialists have found that the disease process may not be continuous but rather occurring in random bursts. While the chronic infection endures, inflammatory episodes occur randomly over time and at random

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sites in the mouth. Because of the unpredictability of these periodontal episodes, the disease is often difficult to treat during its later stages. What is important to realize about periodontal disease is that it is the kind of chronic infection caused by a harmful brand of oral bacteria and it is much more widespread than you think. You could have a mild case of gingivitis and not know it (unless you had the chance to visit your dentist or hygienist today) – the gingival infection could remain in your mouth for months, or years, or decades. If that doesn’t scare you, get ready for this — these kinds of chronic oral infections (gingivitis and periodontitis) could lead to serious, even deadly health problems that lie beyond the mouth. The Head of the Department of Health Policy and Health Services Research at the Boston University School of Dental Medicine, Raul Garcia, says,, “whichever way one analyzes the data, your risk of death increases three– three–fold if you have periodontal disease.” Having gum disease can increase the risk of death by three times? It’s scary, but it’s the truth. Furthermore, this bacteria is contagious and can spread from household member to household member, especially when toothbrushes are stored in that all–too–familiar, grimy community cup. (Remember, up to 95% of all adults suffer from some form of gum disease!) Periodontal disease is a chronic oral infection that can act as a source of sepsis, a toxic condition resulting from the spread of bacteria or the byproducts of bacteria from a local infection. Sepsis can be limited to a particular body part, like the

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mouth, or it can be widespread and result in secondary or focal infections in other areas of the body far away from the mouth. More specifically, a focal infection can be one that occurs as a result of the dissemination of harmful microorganisms (bacteria) throughout the body whose primary origin lies in the periodontal tissue. The Boston University School of Medicine states that “the oral cavity is a prime location for bacteria to become systemic, through bleeding that occurs when you brush your teeth.” Make no mistake about it, the germs that are in your mouth (and make their way onto your toothbrush and into your bloodstream when you brush) can be extremely toxic. What happens when a person has gum disease or a chronic oral infection is that a series of secondary, or focal infections arise that are caused by the noxious bacteria originating at the mouth infection (what is called the “focus” of the infection). Well accepted in the dental profession is the fact that any kind of oral surgery (where the gums or oral tissue is punctured) will produce a “bacteremia” and this may cause focal infections in other susceptible tissues, like the heart. What is less acknowledged in the world of dentistry is that existing in the mouth are other sources of sepsis such as periodontal infections. Substances that can spread from a focus of infection in the mouth include: • • • •

Bacterial organisms Viral organisms Fungal organisms Endotoxins produced by anaerobic organisms (anaerobic means living and active in the absence of oxygen)

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Current research also indicates that other toxins produced by anaerobic organisms are also released into the body including, but not limited to, hydrogen sulphide products and methyl mercaptans, both of which are highly poisonous. What this means is that toxic substances from chronic infections in the mouth can spread throughout the body and initiate secondary infections in distant or nearby tissue or organ. Furthermore, pathogenic (disease–causing) mouth germs may not only infect other tissues but poison the body with a mass number of harmful toxins from anaerobic organisms. They may be distributed throughout the body by blood circulation and lymphatic distribution by entering via the blood stream and/or along nerve fibers. An article published in the Journal of the American Dental Association discusses the problem of focal infections stating that,

“The concept of focal infection in relation to systemic disease is firmly established and the origin of many toxic or metastatic diseases may be traced to primary local or focal areas of infection.” The same article also states that there are two major mechanisms of focal infection: The first is an actual metastasis of organisms from a focus. The second is the spread of toxins or toxic byproducts from a remote focus to other tissues via the bloodstream. The infection may then multiply in the blood, setting up an acute chronic septicemia – an

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invasion of the bloodstream by virulent germs from a local seat of infection. Or the infection can be carried live to a suitable nidus – a place in the body where bacteria or other organisms lodge and multiply. There, they infect the surrounding tissues. In addition, they may produce a slow but progressive atrophy with replacement fibrosis in various organs of the body. What this means is that at any given moment, a series of highly noxious, highly infectious bacteria can be streaming though our bodies, lodging themselves in different places and branching off to cause other infections that may or may not have immediate acute symptoms, and which may result in chronic disease. Julie Parsonnet, an infectious disease specialist at Stanford University Medical School says,

“People talk about our bodies exposure to pesticides and chemicals – they’re nothing compared to microbes. Your gut is loaded with bacteria; your genitourinary tract, your skin, your mouth, your eyes. Our bodies contain at least ten times more microbial cells than human ones. We are walking Petri dishes, more microbe than man – and our relationship to microbes may be responsible for a huge amount of disease.” (Again it’s one thing to have germs in your gut, but it’s a far, far different thing to have them wandering around your bloodstream.)

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It should be noted that the vast majority of microbes are beneficial for our systems – some are even essential for our survival. But there are bad microbes, the ones that cause chronic infection, the ones that are usually manifested in oral infections and chronic toothbrush germs, and these germs have the ability to bypass our body’s natural immune mechanisms by injecting themselves directly into the bloodstream via sharp toothbrush bristles. Directly into the Bloodstream The Journal of Oral Surgery says, “the elimination of infection from human tissue is a necessary goal based on fundamental biological principles. It is even more essential in an environment in which the natural defense mechanisms of the body are unable to function.” This is exactly what happens when toothbrush bristles coated with germs cause microscopic cuts in your gums and tongue. We may not realize it, but each time we brush, we are abrading the soft tissues of our gums with toothbrush bristles allowing the bacteria on our toothbrushes and within our mouths to directly enter the bloodstream and thereby bypass our natural defense mechanisms. Think about it: how often have you seen blood or pinkish discharge in the sink while brushing your teeth? While blood may not appear in your sink every time you brush, you can be sure that every time you use a toothbrush, the bristles on your trusty toothbrush can be making microscopic cuts in your gums. This can happen every time, whether you see the evidence in the sink or not. You see, the tooth–

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brush is actually an FDA–registered medical device comprised of hundreds of pointy, jagged needles (called toothbrush bristles). These needles literally cause tiny lacerations in your gums, puncturing the soft mucous membranes ever so slightly and only for nano–seconds before the membrane repairs itself. In an article from USA Today, a professor of oral pathology at the University of Oklahoma Health Sciences stated that the rounded bristles of your toothbrush become pointed, “like tiny little needles” in as little as two weeks of use. Research shows that the sharp tips cause tiny lacerations in the gums that allow infections to enter the body. I can’t stress this enough – we can literally be injecting toothbrush germs directly into our blood– streams every time we brush if our toothbrushes are contaminated. The toothbrush is used two to three times a day to remove dangerous germs and break up the bacteria–ridden plaque that causes gum disease, cavities, and chronic infections. Where do you think the germs go after we brush? If you are not sanitizing your toothbrush already, the bacteria, viruses, fungi, rotting food particles, and parasites can remain on your toothbrush. They’re too small to be seen with the naked eye, but believe me, they are there. They are joined by other bugs from neighboring toothbrushes, dirty hands, coughs and sneezes, and germs from the aerosol spray dispersed in the air when the toilet is flushed in addition to anything else that may be airborne from the sewer line or ventilation ducts. This group of germs then waits on the bristles of your trusty toothbrush to be transmitted to your blood–

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stream and then to vital organs and tissues through the cuts made in your gums the next time you brush. This is a potentially dangerous process because the direct contamination through the cuts in the gums allows the germs to bypass the body’s natural immune defense mechanisms and go straight into the bloodstream. An article by contemporary dental pioneer and health visionary, Dr. Robert Gammal, BDS, FACNEM, entitled “Focal Infection or Not” pinpoints the key issues as they relate to Focal Infection Theory and the current dental establishment train of thought. Dr. Gammal states:

“In recent years there has been a reawakening of the dangers of oral infections and their potential disastrous effects on systemic health…[I]f the dental profession were to accept the reality of Focal Infection (and the potential sources of this oral infection), we would have to reassess some of the fundamental treatment concepts being taught and practiced in dentistry…With the resurgence of an interest in this area, there is also a blatant resistance by the dental profession of the reality of Focal Infection Theory. Both the Australian Dental Association and the universities have stated that Focal Infection is a concept dating back 150 years and one which has been disproved by recent research. This supposed research has never been cited by either the Australian Dental Association or the universities…This attitude flies in the face of published scientific research some of which is even published in the dental

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journals. In 1996 the Journal of Periodontology devoted a whole issue to this subject relating periodontal disease to a variety of systemic diseases which included coronary heart disease, diabetes and low birth weight babies. Quintessence International is one of the most highly respected dental journals in the world. They state in 1997: ‘The detrimental effect of focal infection on general health has been known for decades. Chronic dental infections may worsen the condition of medically compromised patients’… It is well accepted in the profession that any form of oral surgery will produce a bacteremia and that this may cause infections in susceptible tissues, especially the heart. The substances that are spread from such a focus of course include the bacterial, viral and fungal organisms that survive in such foci. It will also include the endotoxins produced by anaerobic organisms in the foci. Current research indicates that other toxins produced by anaerobic organisms are also released into the body – these include hydrogen sulphide products and methyl mercaptans, both of which are highly poisonous products. What this means of course is that a dental focus of infection may not only infect other tissues but also poison the body with a variety of toxins… Distribution of organisms and their toxins throughout the body is by various routes: blood circulation through out the body, lymphatic distribution locally and then to blood stream, retrograde axonal transport – transport along nerve fibers and back to the brain...”

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Published case reports show the following diseases and disease states among those directly related to oral germ infections: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Mediastinitis Maxillary sinusitis Cavernous sinus thrombosis Pharyngeal cellulites Cardiac problems Necrotising facititis Necrotising mediastinitis Superior Orbital Fissure syndrome Proptosos Opthalmoplegia Light reflex interference Blindness Endopthalmitis Lung abscess Aspiration pneumonia Brain abscess Meningitis Acute Hemiplagia Psychotic episodes Metastatic Paraspinal abscess Gasarion ganglion Trigeminal neuralgia Endocarditis Septicemia Myocardial infection Deuodenal ulcers Splenic abscess Leg abscess Blood disorders Immune reactions Inflammatory bowl disease

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• • • • • • • • •

Low birth weight Infertility Toxic shock Arthritis Rheumatic changes Infection of artificial joint prosthesis Kidney damage Brain tumors Atypical facial pain

Simply put, all areas of the body can be affected by the presence of oral germ infections and all parts of the body can be negatively affected by chronic germs on toothbrush bristles. Kill those Nasty Germs! Professor Ewald says that humans can turn the tables in their favor by favoring benign germs and making life really tough on dangerous germs. “Better sanitation blockades the worst strains of cholera, which ride the water supply to find new human hosts,” he says. The Amherst professor/author goes on to say, “When there’s no easy route, evolution gives the advantage to the more friendly cholera germs – those that survive longer inside the human without being lethal.” We can follow Professor Ewald’s advice for “better sanitation” by sanitizing our toothbrushes each time we brush – thereby providing no easy route for toothbrush germs to make their way into our bloodstreams. In so doing, we favor the mouth germs that are actually actually good for us, and help eliminate the evolution of the bad ones.

4 Healthy Mouth, Healthy Heart, Healthy Body “Studies show that bacteria and yeast microbes usually found only in the mouth can enter the bloodstream, a process that is associated with with significantly increased heart disease risk.” – University of Southern California Health Report “The oral cavity is the prime location for bacteria to become systemic, through bleeding that occurs when you brush your teeth. Such infection triggers triggers inflammation which unleashes a cascade of molecular events that build up plaque and choke off arteries.” – Boston University School of Medicine (as reported in the Wall Street Journal) The Wall Street Journal recently reported that scientists attending the Interscience Conference on Antimicrobial Agents and Chemotherapy presented evidence that links the bacteria responsible for periodontal disease with a higher risk of heart attack and cardiovascular disease. According to the

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scientists, the oral bacteria behind gum disease can promote the build–up of artery–clogging plaque, a process known as atherosclerosis, which leads to heart attacks. In a study supported by the National Institutes of Health, Dr. Caroline Genco, associate professor at the Boston University School of Medicine inserted the bacteria Porphyromona gingivalis (the bacteria responsible for gum disease) into the gums of mice who were genetically prone to developing heart disease. Genco then traced the bacteria as it spread from the mouth to the bloodstream and ultimately to the aorta, where it caused inflammation and the accelerated buildup of plaque in the artery walls. The coronary reaction observed in Dr. Genco’s mice confirms that the route from the mouth to the heart is one vulnerable to bacterial invasion – in both humans and mice. Dr. Genco says, “The oral cavity is a prime location for bacteria to become systemic, through bleeding that occurs when you brush your teeth.” This means that when toxic bacteria from chronic oral infections like periodontal disease reach the bloodstream, more infections can occur which trigger a chronic inflammatory response. This chronic chronic inflammation can instigate a sequence of molecular events ultimately leading to the buildup of artery– artery– clogging plaque resulting in a heart attack, stroke, or some other form of heart disease. The Number One Cause Cause of Death Heart disease is the number one killer of men and women in the United States – claiming more lives than all forms of cancer and AIDS combined. The

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most recent statistics show that more than 64,000,000 Americans have one or more forms of cardiovascular disease and almost 1,000,000 people die from it each year. Almost 13,000,000 people alive today have already suffered one or more heart attacks and one out of every 2.6 deaths can be attributed to cardiovascular disease — that’s nearly 39% of all deaths! Our doctors and health care professionals tell us that maintaining a healthy lifestyle is the essential key to lowering the risk of acquiring the disease. Regular exercise, managing stress, and eating foods low in cholesterol and saturated fat are the things we can do to protect ourselves. Meanwhile physicians prescribe cholesterol–lowering drugs to help us reduce the plaque obstructing our arteries. Unfortunately, many of us don’t heed our doctor’s good advice until it’s too late. We stick to our under–exercised, over–satiated lifestyles, relying on drugs to make us better. But a Los Angeles Times article reported that many of the latest drugs used to lower cholesterol and reduce the risk of heart disease simply aren’t working. A study of 3,000 people at high risk of developing heart disease, but who had not yet acquired the disease found that treatment with a statin drug did not significantly reduce their risk of heart disease. What the drugs did do, however, was increase their risk of developing cancer by 25%. The article concludes that the emphasis on prescription drugs as treatment (more like a temporary cure) for heart disease demonstrates that the U.S. may be spending more than $500 billion each year on medical care that may not be helpful and even potentially harmful to health.

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Clearly, we are fighting a difficult and challenging battle. Heart disease is still killing us, despite the drugs and the efforts to change lifestyle, and it doesn’t seem to be slowing down. So what are we to do to protect ourselves? Heart Disease: The Fatal Truth Heart disease, also known as coronary heart disease (CHD) is a condition characterized by the narrowing and clogging of the arteries with a fatty, glue–like substance called atheroma. According to the American Heart Association, a process known as atherosclerosis is the overwhelming cause of heart disease. During this process, the inner lining of the artery walls becomes furred with a thick plaque made up of fatty deposits of cholesterol, cell waste, and other pathogenic substances. As this occurs, the arteries become narrowed and obstructed. The blood and oxygen supplied to the heart becomes restricted, so the heart cannot get the oxygen that it desperately needs. This causes some people to experience angina (chest pain). Atherosclerosis also leads to the occurrence of a heart attack, where the blood supply to the heart muscle is interrupted or temporarily stopped because of a blood clot in the coronary artery. So, the cause of heart disease is the process known as atherosclerosis, but what causes the buildup of plaque in the arteries? What is it that triggers this process? What causes a piece of plaque to break off and float down the bloodstream? The old adage “you are what you eat” certainly holds true when it comes to the instigation of heart disease. Any doctor will tell you that a diet high in

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saturated fats — fast food, French fries, red meats, cookies, and other processed foods — is likely to result in the accumulation of fatty plaque within the artery walls. At the present time, the United States is battling a dreadfully serious obesity problem, which is certainly linked to the high occurrence of heart disease (64% of Americans are overweight and 30% are clinically obese). This is a given, however, numerous studies now demonstrate that we are facing a serious germ problem — a “silent epidemic” of germs, which, like obesity, can also be associated with a high occurrence of heart disease. Researchers at Harvard Medical School have shown the atherosclerotic plaque found in the arteries of heart disease patients to contain DNA specific to Porphyromonas gingivalis, the bacteria responsible for periodontal disease. The Harvard researchers actually found traces of the pathogenic oral bacteria within the sticky artery–clogging material. The American Dental Hygienists Association has cited various studies that demonstrate the connection between heart disease and the key bacteria responsible for periodontal disease. A recent study by Belgian scientists discovered that the toxic by–products of gum infections — natural bacterial poisons called endotoxins — are also released into the bloodstream, where they travel to the heart and cause blood vessel injuries that promote clots. Further studies show that the most common strain of bacteria in dental plaque may cause blood clots. When blood clots escape into the bloodstream,

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they may increase the risk of heart attacks or other cardiovascular events like strokes. More seriously, the bacteria from periodontal disease are known to contribute to the pathogenesis of atherosclerosis. The evidence is clearly out there that shows bacteria is responsible at least in part for the onset of heart disease, but obviously not everyone has caught on. There’s Always Skeptics It comes as no surprise that the idea of oral bacteria as a cause of heart disease has not been accepted by many in the medical establishment. Many physicians and scientists laughed at their colleague Dr. Barry Marshall when he announced his discovery that H. pylori bacteria are responsible for most stomach ulcers. After all, the appearance of ulcers had long been attributed to things like stress, poor diet, and aspirin overuse, and for years doctors had treated their patients according to this firmly established belief. But as it turns out, everyone was wrong, except Dr. Marshall. Physicians, healthcare professionals, and even government health agencies have been telling us for years that elevated cholesterol, high blood pressure, lack of exercise, and a diet high in saturated fat will surely lead to an increased risk of heart attacks and eventually heart disease. No one said anything about germs. That is, until now. The reason that the germ connection has not been taken up into practice is because doctors have been treating patients according to the guidelines established by earlier research and medical knowledge — the out–of–date knowledge that does not implicate oral bacteria with heart disease. Sadly, it may take decades for the transition to take

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place. How many people have to suffer or die in the interim? Mouth Germs and the Heart – How the Connection Works So, how can bacteria cause heart attacks? Harvard researchers believe that chronic infection, such as periodontal disease causes inflammation that often goes unnoticed by patients (internal inflammation is symptom–less and is often impossible to detect). Ironically, inflammation is usually a helpful reaction when it sends an army of white blood cells to fight an infection, but the Harvard Medical School report claims that the inflammatory cells secrete a substance called C–reactive protein (CRP) that actually promotes atherosclerosis. Some of the research has shown that men with high levels of CRP had three times as many heart attacks as those with the lowest levels, which goes along with the findings of a study by the University of Buffalo that found people with gum disease had three times the risk of heart attack over a 10 year period. Other research proves that acute periodontitis is a cause of low–level inflammation all over the body. Scientists at the University of Buffalo believe that the chemicals produced by the immune system’s reaction to periodontal disease – the inflammatory response – spill over into the bloodstream through cuts in the gums. Then the chemicals make their way to the liver to produce proteins that inflame the arterial walls and clot the blood. Atherosclerosis and, ultimately, heart attack may result.

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Another study cited in Scientific American examined 50 plaques scraped out of human arteries. Out of the 50 plaques, 72% contained “known” periodontal pathogens. (Note: There are over 500 “known species” of bacteria in the mouth and many, many more that have yet to be discovered.) Also observed were two other pathogens that have been linked to atherosclerosis: cytomegalovirus, which infected 38% of the plaques, and Chlamydia pneumoniae, which appeared in 18%. Numerous studies over the past few decades have established over and over that harmful bacteria can exist in the blood. Especially bacteria that originates in the mouth. Research has also estab– lished that antibodies against oral bacteria can be found in the bloodstream. We know from the work of Dr. Caroline Genco that pathogenic oral germs travel from the mouth to the arteries and ultimately to the aorta along an infection–sensitive pathway. The USC Health Newsletter from Winter 2003 said that microbes found only in the mouth can enter the blood stream and increase the risk of heart disease. Without a doubt, oral germs enter the bloodstream and instigate a molecular chain reaction that can result in atherosclerosis and heart disease. But how are the germs getting into the bloodstream? Dr. Genco believes that pathogenic mouth germs gain access directly to the bloodstream through tiny cuts made in the gums when brushing. As I explained earlier, the toothbrush is made up of hundreds of sharp little needles (known as toothbrush bristles) that cause microscopic cuts in the gums while brushing. You may not know it, but the bristles actually splay (like split ends on a bad hair day) and

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get sharper and more jagged with each use, allowing for a higher frequency of cuts and more opportunity for germs to enter the bloodstream. The vast majority of the time, you have no idea that you are abrading the soft tissues of your mouth because you don’t see blood when you rinse. Additionally, a typical unsanitized toothbrush is literally covered with millions of bacteria, viruses, fungi (molds and yeasts), food particles, and parasites. Germs can jump from one toothbrush to another toothbrush, and toothbrushes have been shown to be contaminated with E. coli bacteria and fecal coliforms because of the germs released when flushing the toilet. In a USA Today article, a professor of oral pathology at the University of Oklahoma Health Sciences Center states,

“Every time you put your trusty toothbrush in your mouth, chances are that you are giving a gang of nasty germs a free ride into your system.” When we abrade the soft tissue of our gums with the needle–like bristles of our toothbrush the delicate membrane of the gums is microscopically punctured. In nanoseconds, the mucous membrane closes up and repairs itself (at least it does in a healthy mouth). Despite the short time it takes for the transfer, each time you brush you are briefly exposing your bloodstream to dangerous germs that make their way through the body, instigating inflammatory responses and causing molecular reactions that ultimately can find their way to the arteries, the heart, and other vital organs and tissues.

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So are we to now blame germs for the high incidence of heart disease? Should maintaining a healthy diet and keeping an exercise routine no longer be a concern? Of course not. But the latest heart research shows a strong connection between heart disease and oral bacteria, and we must pay serious attention before it’s too late. And we must ask, “Why is medical conservat– ism ignoring the germ issue?” There is no doubt that maintaining a healthy lifestyle is important for your heart, but is this conservatism telling us it is okay to brush with contaminated toothbrushes – toothbrushes that may be responsible for the presence of harmful bacteria in our bloodstreams? The answer is yes and no. By not taking a strong, clear stand and sitting on the fence, the medical establishment is saying that it’s okay to use your own contaminated toothbrush but it’s not okay to share toothbrushes with other people. In fact, the U.S. Centers for Disease Control (CDC) actually has a Fact Sheet entitled, Infection Control: The Use and Handling of Toothbrushes (that should at least tell you that the CDC believes that infection from your toothbrush is a possibility). I’ll give you the bulk of what the CDC has to say all at once, and then I’ll break it down sentence by sentence. Here’s what the CDC currently says:

“To date, the Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use, although people with bleeding disorders and

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those severely immuno–depressed may suffer trauma from toothbrushing and may need to seek alternate means of oral hygiene. The mouth is home to millions of microorganisms (germs). In removing plaque and other soft debris from the teeth, toothbrushes become contaminated with bacteria, blood, saliva, oral debris, and toothpaste. Because of this contamination, a common recommendation is to rinse one’s toothbrush thoroughly with tap water following brushing. Limited research has suggested that even after being rinsed visibly clean, toothbrushes can remain contaminated with potentially pathogenic organisms… To date, however, no published research data documents that brushing with a contaminated toothbrush has led to re– contamination of a user’s mouth, oral infections, or other adverse health effects… The CDC goes on to say: •

•

•

Do not share toothbrushes. The exchange of body fluids that such sharing would foster places toothbrush sharers at an increased risk for infections, a particularly important consid– eration for persons with compromised immune systems or infectious diseases. After brushing, rinse your toothbrush thoroughly with tap water to ensure the removal of toothpaste and debris, allow it to air–dry, and store it in an upright position. If multiple brushes are stored in the same holder, do not allow them to contact each other. Do not routinely cover toothbrushes or store them in closed containers. Such conditions (a

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humid environment) are more conducive conducive to bacterial growth than the open air. Replace your toothbrush every 3–4 months, or sooner if the bristles appear worn or splayed. This recommendation of the American Dental Association is based on the expected wear of the toothbrush and its subsequent loss of mechanical effectiveness, not on its bacterial contamination. contamination. A decision to purchase or use products for toothbrush disinfection requires careful consideration, as the scientific literature does not support this practice at the present time. Toothbrushing in group settings should always be supervised to ensure that toothbrushes are not shared and that they are handled properly. The likelihood of toothbrush cross contamination contamination in these environments is very high, either through children playing with them or toothbrushes being stored improperly. In addition a small chance exists that toothbrushes could become contaminated with blood during brushing. Although the risk for disease transmission through toothbrushes is still minimal, it is a potential cause for concern. Therefore, officials in charge of toothbrushing programs in these settings should evaluate their programs carefully. Recommended measures for hygienic toothbrushing in schools: •

Ensure that each child has his or her own toothbrush, clearly marked with

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identification. Do not allow children to share or borrow toothbrushes. To prevent cross contamination of the toothpaste tube, ensure that a pea–sized amount of toothpaste is always dispensed onto a piece of wax paper before dispensing any onto the toothbrush. After the children finish brushing, ensure that they rinse their toothbrushes thoroughly with tap water, allow them to air–dry, and store them in an upright position so they cannot contact those of other children.”

So what exactly is the CDC saying? I’m not quite sure they know. Let’s look at some of their statements. First:

“To date, the Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use, although people with bleeding disorders and those severely immuno–depressed may suffer trauma from toothbrushing and may need to seek alternate means of oral hygiene.” Though the CDC says it’s “unaware of any adverse health effects,” “people with bleeding disorders and those severely immuno–depressed may suffer trauma from toothbrushing and may need to seek alternated means of oral hygiene.” Aren’t these statements in opposition to each other? Do they make sense? Second:

“The mouth is home to millions of microorganisms (germs). In removing plaque

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and other soft debris from the teeth, toothbrushes become contaminated with bacteria, blood, saliva, oral debris, and toothpaste…Limited research has suggested that even after being rinsed visibly clean, tooth– tooth brushes can remain contaminated contaminated with potentially pathogenic organisms.” Correct me if I’m wrong, but didn’t the CDC state that “toothbrushes can remain contaminated with potentially pathogenic organisms”? The last time I looked up the definition of pathogenic it was defined as “causing or capable of causing disease.” Third:

“To date, however, no published research data documents that brushing with a contaminated toothbrush has led to recontamination of a user’s mouth, oral infections, or other adverse health effects.” Maybe the CDC will take a look at my book as proper documentation on the subject, but probably not. Most likely, the CDC will require a $50 million double– blind independent university study to definitively prove that a “clean” toothbrush is better than a “dirty” toothbrush. Fourth: “Do not share toothbrushes. The exchange of body fluids that such sharing would foster places toothbrush sharers at an increased risk for infections, a particularly important consideration for persons with compromised immune systems or infectious diseases.”

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If contaminated toothbrushes aren’t dangerous, then what did the CDC just say? Fifth:

“If multiple brushes are stored in the same holder, do not allow them to contact each other…Do not routinely cover toothbrushes or store them in closed containers. Such conditions (a humid environment) are more conducive to bacterial growth than the open air.” Isn’t the CDC saying that your toothbrush could have other people’s germs on them? And isn’t the CDC saying that based on a “humid environment,” or any environment for that matter, bacterial growth is likely to occur? Sixth:

“Replace your toothbrush every 3–4 months, or sooner if the bristles appear worn or splayed. This recommendation of the American Dental Association is based on the expected wear of the toothbrush and its subsequent loss of mechanical effectiveness, not on its bacterial contamination.” The CDC goes with the ADA’s recommendation that you replace your toothbrush “every 3–4 months, or sooner…based on the expected wear of the toothbrush and its subsequent loss of mechanical effectiveness, not on its bacterial contamination.”

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So obviously the ADA has some standard for “wear of the toothbrush” and “mechanical effect– iveness,” but what is the ADA’s, or CDC’s, standard for “bacterial contamination?” How much bacteria is too much? To me this is a ridiculous question. Do dentists and doctors have a standard for “bacterial contamination?” I think not. The only standard dentists and doctors have is one called “germ free.” Seventh:

“A decision to purchase or use products for toothbrush disinfection requires careful consideration, as the scientific literature does not support this practice at the present time.” The CDC says that they do not recommend toothbrush disinfection or sanitization because “the scientific literature does not support this practice at the present time.” Well, when will the “scientific literature” support a “clean toothbrush” over a “dirty toothbrush?” Eighth:

“The likelihood of toothbrush cross– contamination in these environments [group settings] is very high, either through children playing with them or toothbrushes being stored improperly…After the children finish brushing, ensure that they rinse their toothbrushes thoroughly with tap water, allow them to air– dry, and store them in an upright position so they cannot contact those of other children.”

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Hasn’t the CDC, in their discussion about “group settings,” clearly described just about any household where more than one person lives? So then isn’t the possibility of cross–contamination of germs in family settings also very high? Ninth:

“To prevent cross contamination of the toothpaste tube, ensure that a pea–sized amount of toothpaste is always dispensed onto a piece of wax paper before dispensing any onto the toothbrush.” Bravo, the CDC has noted a little known fact — the community toothpaste tube can transmit germs! Everyone shares the toothpaste tube. Therefore, when someone’s contaminated toothbrush comes into contact with the tip of the toothpaste tube, those germs are then left on the tip of the tube for the next user to enjoy. Hello, cross–contamination and the transmission of germs from person to person! (Wax paper? Who uses wax paper with toothpaste?) It’s clear, the medical establishment hasn’t given this serious threat enough consideration or sponsored research in this serious subject matter. (In my opinion, there is no need to research the subject further because a germ–free toothbrush is the obvious correct medical answer.) Even our own directors of public health in the United States haven’t given any mandate recommending that people use sanitized toothbrushes every time they brush. (But the law requires restaurant employees to wash their hands.) Perhaps it is time that someone took notice — because heart disease isn’t the only thing we have to worry

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about. Oral germs are also being connected to other health problems and life–threatening illnesses like stroke, diabetes, low birth weight and premature babies, in addition to a long list of chronic degenerative diseases. Can You Catch a Stroke Just Like Catching a Cold? Researchers at the University of Buffalo surveyed the health histories of 10,000 people between the ages of 25 and 75. They found that 35% of those who had gum disease were also likely to have suffered a severe stroke. To help explain these results, Dr. John Marler of the National Institute of Neurological Diseases and Strokes says that oral bacteria can cause fatty deposits in the large carotid arteries in your neck. If these deposits, or clots break loose and travel through the bloodstream into the brain, they can lodge there blocking blood flow to the brain and initiating a stroke. Generally speaking, a stroke is a type of cardiovascular disease affecting the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When this happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die. Needless to say, the brain is an extremely complex organ that controls millions of bodily functions. The brain allows us to speak, move, feel, love, dream, and most importantly, think. Certain parts of the brain are in charge of executing different functions, like vision, memory, or speech. When a stroke occurs, blood flow is interrupted to one or more

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parts of the brain, causing the part of the body that the brain controls to break down. The effects of a stroke depend on the location of the obstruction and the extent of the brain tissue affected. Sometimes strokes can end up with rather mild ramifications, but certain cases of stroke can be enormously devastating. Paralysis, severe vision problems, memory loss, speech and language problems and changes in behavioral style are some of the effects of a stroke. According to the American Stroke Association, every 45 seconds someone in America has a stroke, and every three minutes someone dies from one. Stroke is the third cause of death in America, claiming more than 700,000 lives each year and holding its position as the number one cause of long– term disability. While some of the most frequently cited risk factors associated with stroke are high blood pressure, smoking, diabetes mellitus, obesity and physical inactivity and high blood cholesterol, scientists are discovering that germs may also play a crucial role, particularly bacteria originating in the mouth. Comparable to the studies that have been done linking heart disease with oral bacteria, various research projects have used similar findings to connect pathogenic mouth bacteria to the occurrence of stroke in individuals. The American Academy of Periodontology referenced a study that found fatty deposits in the carotid arteries of stroke victims to contain the oral bacteria associated with inflamed gums. The material in the carotid arteries leading to the brain

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accumulates in the same way that plaque builds up in the coronary arteries. Pathogenic bacteria enter the bloodstream, trigger a molecular reaction, and promote the build–up of artery–clogging substances. When this happens in the arteries in the neck that lead into the brain, a stroke can occur. Furthermore, chronic infection in the mouth can prompt inflammation in other parts of the body, like the arteries. Harvard researchers found that the inflammatory cells cause C–reactive proteins to occur in the bloodstream, which is known to accelerate atherosclerosis. It is easy to see that the connection between oral germs and stroke is not unlike the link between oral germs and heart disease. It is therefore no surprise that the way in which bacteria enter the bloodstream to cause a heart attack is no different from the way in which oral germs enter the bloodstream to induce a stroke. Tiny cuts made in the gums by toothbrush bristles when you brush allow toothbrush germs to directly enter the bloodstream. Dr. Genco from the Boston University School of Medicine has confirmed that pathogenic germs enter the bloodstream through microscopic lacerations made in the gums while brushing. It seems to me that by simply brushing with a clean, sanitized, toothbrush that is greater than 99.9999% free of all bacteria, viruses, and fungi the risk of harmful germs entering the bloodstream is significantly reduced. When we are facing a situation where oral germs have the potential to instigate the occurrence of a stroke, heart attack, or other illness, it just makes sense to do everything possible to protect

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our bodies from germs and the long–term inflam– matory damage that germs can create. And there are even more reasons to protect yourself from oral germs… Diabetes It is unclear if periodontal disease and chronic oral germs cause diabetes, but it is clear that pathogenic germs from chronic mouth infections can make managing the disease more difficult. The bacterial infection caused by periodontal disease weakens the body’s ability to manage its insulin levels, which can greatly upset a diabetic’s blood sugar levels. This can result in devastating complications, such as blindness, paralysis, or death. The Surgeon General’s Report on Oral Health mentions periodontal disease in association with diabetes. Generally speaking, the goal of diabetic care is to lower blood glucose levels to safe levels. According to the report, some investigators have reported a connection between diabetes and periodontal disease, proposing that not only are diabetic patients more susceptible to periodontal disease, but the presence of periodontal disease affects glycemic control. But there are some researchers and organiza– tions out there that are looking to oral germs, like the ones associated with gum disease, as the possible instigator of diabetes. The American Dental Hygienists’ Association confirms that severe perio– dontal disease can increase the risk of developing diabetes. Researchers at the University of Buffalo are saying that gum disease may be more important than

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obesity or age as a factor in the onset of diabetes in adults. While there is still much more to be discovered about the connection between periodontal disease, chronic oral infections, and diabetes, for now it seems that the best thing to do is to protect yourself from chronic mouth infections by choosing not to infect and re–infect yourself with pathogenic oral bacteria each time you brush. The possibility exists that brushing with a germ–infested toothbrush can instigate or worsen periodontal disease, and therefore increase the risk of diabetes, heart disease, or stroke. It’s far better to be safe than sorry, especially when it comes to chronic disease that can permanently effect your life or even destroy your life. Sanitize your toothbrush. Wipe out the risk of chronic infection and re–infection. I’ve made it easy with my solution. Premature and Low– Low–Birth Weight Babies Recent local and national news segments have been following the tiniest surviving premature baby in medical history, a little girl named Madeline Mann, as she turns 15 and enters high school. Doctors are saying that her development into a normal teenager is nothing less than a miracle. When she was born, Madeline was only 9.9 ounces, weighing less than a can of soda. Today, 90% of newborns survive after 27 weeks of pregnancy, but most preemies face major handicaps like blindness and mental retardation as a result of their early births. Madeline, it seems, is a rare exception in her normal development. Her doctors reported in their correspondence to medical journals

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that “extremely low birth–weight, miracle newborns can propagate false expectations.” Most preemie babies, if they survive, face serious health problems later. Researchers are now discovering how oral bacteria can cause premature and low–birth weight babies. Scientists at the American Academy of Periodontology have found that women with gum disease are 7 to 8 times more likely to give birth to premature or low birth weight babies. What happens is that inflammation from low grade gum disease causes the body to release inflammatory chemicals, which are linked to premature birth. The American Dental Hygienists’ Association confirms that the microorganisms known to cause periodontal disease are transferred through the mother’s bloodstream to the fetus, a process which has been found to increase the risk of premature birth. Additionally, the Surgeon General’s Report on Oral Health documents that as a consequence of a chronic oral bacterial infection, adverse pregnancy outcomes may result. Toxins or other products generated by periodontal bacteria in the mother may reach the bloodstream, cross the placenta, and harm the fetus. I don’t think that I need to mention again how these toxic germs are entering the bloodstream. Research has also shown that the response of the maternal immune system to infection (in the mouth or elsewhere) elicits the continued release of inflammatory mediators, growth factors, and other

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potent cytokines, which may directly or indirectly interfere with fetal growth and delivery. It seems as if these oral germs will stop at nothing! We’ve determined how germs from tooth– brush bristles can contribute to the appearance of chronic oral infections (including periodontal disease). We have seen how the noxious bacteria from oral infections can reach the bloodstream through cuts in the gums from toothbrush bristles. And we have seen how the appearance of these bad germs in our bloodstreams can dramatically increase the risk of heart disease, stroke, diabetes, adverse pregnancy outcomes, and other chronic diseases as well as acute illnesses. I’ll admit that at first glance, all of this seems like pretty bad news. After all, we’ve got to brush our teeth. How are we to combat these germs that will stop at nothing to invade out bodies, bypass our immune systems, and complicate our health and the health of those we love? If you’re like me, you will see the connection of these diseases with oral germs in a positive, optimistic way. Because we can kill these germs on our toothbrushes! We can protect ourselves and our most vulnerable internal pathways by simply making sure that we brush our teeth, gums, tongues, and soft tissues with a clean, sanitized toothbrush. And believe it or not, having a sanitized, germ–free toothbrush available every time you brush is easier and safer than you can imagine. I guarantee it.

5 Inflammation: “The Secret Killer” Killer” “Most of the time, inflammation is a life saver that enables our bodies to fend fend off various disease causing bacteria, parasites, and viruses… The instant deadly microbes slip into the body, inflammation marshals a defensive attack… Once in a while, however, the process doesn’t shut down on cue… inflammation becomes chronic rather than transitory. When this occurs, the body turns on itself with aftereffects that seem to underlie a wide variety of diseases.” – Time Magazine, Magazine, “The Secret Killer” February 23, 2004 It is a well established fact that chronic oral infections can significantly, if not certainly, increase the risk of acquiring or worsening serious health problems like heart and lung disease, diabetes, stroke, and premature or low birth weight. According to the American Diabetes Association, approximately 90% of adult Americans have or will have gum disease some time in their lives. No wonder the U.S. Surgeon General ominously describes chronic oral infections as the nation’s “Silent Epidemic!”

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Perhaps there is some solution to this problem that has yet to be widely discussed and acknowledged by physicians. Maybe there is some explanation or key elucidating the link between deadly illnesses like heart disease and on–going health problems like gum disease — one elusive medical theory that could explain why chronic oral infections are tied together with heart disease, stroke, lung disease, diabetes, etc. The buzzword in science and medicine today and the piece that may solve the puzzle is a 12–letter word called inflammation. Inflammation has become one of the hottest areas of medical research. According to a recent Time Magazine article, inflammation has suddenly emerged as the most talked about topic in medicine and medical research. Hardly a week goes by without the publication of another study uncovering a new way that inflammation does harm to the body. Ironically, just a few years ago “nobody was interested in this stuff,” according to Dr. Paul Ridker, a cardiologist at Brigham and Women’s Hospital. In February 2004, Time Magazine reserved its coveted cover to a story it labeled “THE SECRET KILLER: The surprising link between INFLAM– MATION and HEART ATTACKS, CANCER, ALZHEIMER’S and other diseases.” The ensuing article reveals how many experts now strongly believe that inflammation could be the elusive “Holy Grail” of medicine that could help illuminate previously unknown connections between certain chronic diseases like gum disease and life–threatening diseases like heart disease.

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In the first stages of their research, scientists discovered that what makes inflammation so significant is its inherent close connection to the human immune system. The process of inflammation is a basic end–result of our biological defense system, which is what links it to a wide variety of diseases. Inflammation – A Fire Within The probative and provocative question being asked by researchers worldwide is: “Could the same process that repairs the body after minor injuries like splinters, paper cuts, and mosquito bites lead to major illnesses like heart disease, strokes, Alzheimer’s, cancer, diabetes, and many other chronic degenerative diseases?” The process of inflammation is what causes swelling and redness around a wound. Inflammation is a vital part of what your body naturally does to fend off infections from disease–causing germs, viruses, fungi (molds and yeasts), and parasites. The immune system is incredibly adept at detecting any kind of material that is non–self (and therefore potentially harmful). When something is picked up by the immune radar, the immune system launches a defensive attack that lays waste to both the invading agent(s) and any tissue that might have been infected. When the body is hurt, the immune system manufactures chemical signals that tell cells to multiply without dying (e.g. skin closing over a cut), and other chemicals spur the growth of brand new blood vessels which feed the damaged and recovering tissue.

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Inflammation typically ends when the body is healed. However, every once in a while the process malfunctions and fails to shut down, making inflammation chronic rather than transitory. The programming problem, so to speak, can be caused by a genetic predisposition or it can result from something like high blood pressure, poor diet, or smoking. Problems also arise from relentless bombardment by pathogenic microbes as a result of daily infection and re–infection by dirty toothbrush bristles, and these lingering, low–level infections aren’t easily defeated. Whatever the reason, the body turns on itself, stuck in a steady injury and repair cycle that results in the constant presence of powerful, inflammatory immune cells throughout the body. Scientists say that what makes this dangerous are the aftereffects, which can have a broad range of degenerative and even life– threatening consequences that underlie several serious diseases. Time Magazine’s coverage of this newly sensational area of health research linked inflammation with heart disease, diabetes, cancer, Alzheimer’s disease, and arthritis, to name a few. The Immune Response – Our Body’s Intrinsic Lifeline To better understand what is going on with inflammation – and how this condition may be linked to your toothbrush – it helps to know more about the body’s immunological response. I am always amazed when I learn about different biological processes that occur within our bodies every second of every day – something as simple as breathing in air from the outside is actually a highly complex series of actions and reactions

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occurring within and among thousands of cells, nodes, nerves, and organs. What a beautifully intricate wonder the body is, and the immune system is a vital part of that beauty. When the body is subjected to any kind of trauma or invaded by a foreign microbe, a cascade of events is automatically triggered to help the body fight off the pathogens or recover from injury. Immediately, thousands of cells are called to action and various glands are signaled to release just the right amount of chemicals and hormones – and all of this happens on a microscopic level without you ever knowing. Right now you probably aren’t giving your immune system enough credit and recognizing its magnificent contributions to health and quality of life. Most of us only take notice of our immune systems when we happen to be sick, when the immune system isn’t working as optimally as it normally does, like when some bug has slipped by its complex defense shield. The rest of the time, we don’t think about our immune systems, which are working twenty–four hours a day, seven days a week, battling any kind of pathogenic germ(s) or parasite that we might have eaten, inhaled, or been injected with directly into our bloodstreams. We just don’t give our immune system enough credit for the remarkable effort it puts forth into preparing our bodies to fight off invaders. In addition to fighting off harmful bacteria and other pathogens, your immune system is also busy pre–stationing millions of specialized sentinel cells all over that serve to alert the immune system to the presence of any

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microbial trespassers. As soon as your skin is punctured by a splinter or cut by the edge of an envelope, these sentinel cells instantaneously detect any bacteria that may have come along for the ride. A special group of sentinel cells called mast cells then excrete histamine, an important bodily chemical that makes tiny blood vessels nearby “leaky.” This allows for small amounts of plasma to be released, which slows down invading bacteria and paves the way for other faraway immune defenses to more readily come to the rescue. At the same time, another group of sentinels, called macrophages, launch an immediate counter– attack, pouring out chemicals called cytokines that signal for reinforcements. It’s not too long before the site of the infection is flooded with tons of immune cells that are busy destroying pathogens and damaged tissue. This sequence is the body’s general response to any kind of attack – it’s what you might call our body’s “innate immunity.” As complicated as the process sounds, organisms as simple as starfish are known to defend themselves from infection this way. More complex creatures like human beings have also developed a suped–up immunological reaction in addition to the inherent immune response. Our enhanced immune response is highly precision–guided defense system that helps direct and intensify the general response and creates specialized antibodies made to target specific kinds of bacteria and viruses. Both the general and advanced immunological defenses work together to fight pitched battles until all of the invading germs are annihilated. Then in a

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final, intense bout of activity, a last wave of cytokine chemicals is released, the inflammatory process recedes and the healing process begins (or it should). When operating properly, this is what the inflammation process does for us; silently protecting us from infection. Without it, we would probably die shortly after birth, our bodies literally consumed by bacteria, viruses, and fungi. Inflammation is a lifesaver, but researchers are discovering that it also has the potential to cause serious harm. According to Time Magazine, the problem begins when for one reason or another, the inflamm– inflamm atory process persists and becomes chronic. The final effects of chronic inflammation vary from minor to life–threatening and researchers believe that it depends a lot on where in the body the runaway reaction takes hold. Interestingly, the first to recognize the more serious consequences of inflammation were heart doctors. They were among the first to become aware of inflammation’s part in the onset and progression of cardiovascular disease. Is Your Heart on Fire? Dr. Richard M. Fleming is a researcher, internist, cardiologist, and author of the book Stop Inflammation Now! A Step by Step Plan to Prevent and Reverse Inflammation. He is among the first physicians to seriously study inflammation and its implications on the health of the heart. And because everything in the body is bound in one way or another to the immune system, Dr. Fleming extended his knowledge of inflammation and heart disease to how

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inflammation can have a serious effect in instigating or advancing other diseases in other parts of the body. In his book, Dr. Fleming recalls that when he started working with the American Heart Association in 1976, the general belief at the time was that heart disease occurred as a direct result of cholesterol, smoking, high blood pressure, obesity, lack of activity, being male, family history and diabetes. Unfortunately Fleming says, “take medication, lose weight, stop smoking, or get other parents was where the advise tended to end.” “The focus,” Dr. Fleming says, “was more on adding medication and performing surgeries than on treating the underlying problem; we were treating the symptoms and not the cause.” To further complicate things, researchers are now learning that drugs designed to lower cholesterol actually do not do very much to help people at high risk of heart disease. In fact, some studies have shown that some people’s cholesterol levels actually increased after being placed on medication, Fleming says. A July 25, 2004 article in the Los Angeles Times states that “treatment with a statin [cholesterol– lowering] drug did not significantly reduce the risk of heart disease” in a study of 3,000 people between the ages of 70 and 82. Instead, the article says, statin drugs were found to increase the risk of developing cancer by 25%! High cholesterol has been the physician’s standard indicator of heart disease for years, in addition to high blood pressure, obesity, and smoking. These factors were thought to stimulate conditions for

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the development of cholesterol plaques inside the arteries, which bring about blockages that cause heart attack. Fleming notes that although various risk factors were taken into account, high blood cholesterol was considered the key. The way that doctors saw it, the reason was simple: when a patient’s blood cholesterol went up, plaques formed and heart disease emerged. When it went down, the plaques receded and the illness was reversed. This is how doctors approached heart disease. They saw it primarily as the result of elevated blood cholesterol. But Fleming says that many of the facts and statistics associated with heart disease seem to contradict the cholesterol–causing heart disease approach. For instance, almost half of the people who suffer from heart attacks each year have what doctors describe as “normal” cholesterol levels, according to the National Heart Lung and Blood Institute (NHLI). Many of those who died from a heart attack were discovered later upon autopsy to have shockingly small cholesterol plaques in their coronary arteries. Time Magazine reports that the most dangerous plaques aren’t necessarily very large. Furthermore, studies have shown that at–risk people who took cholesterol–lowering medication and lowered the fat content of their diets in order to lower cholesterol continued to suffer significant heart disease, and many died from heart attacks. Dr. Tim Church of the Cooper Institute explains in Fleming’s book that “The traditional risk factors – family history, diabetes, smoking, hyper–

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tension, and cholesterol – explain less than half of the heart disease cases.” Evidently, something yet to be discovered or acknowledged was causing artery deposits to burst, triggering clots that cut off the coronary blood supply. Prescribing medications to control cholesterol and advising patients to make important lifestyle changes just weren’t working in the battle against heart disease. In the 1990’s Dr. Fleming, among others, realized that the missing piece in the heart disease puzzle was the human immune system. One afternoon, he recalls listening to a sales pitch from a pharmaceutical representative about a new drug for treating asthma. As Fleming tells it,

“The medication was an interleukin inhibitor and it worked by relaxing the smooth muscles in the airways of the lungs. And then it dawned on me – there are smooth muscles in the blood vessels of the body. What if interleukins, messengers that communicate inflammation in the body played a role in the relaxation or failure to relax the smooth muscles in the blood vessels?” And so the connection between heart disease and immunological inflammation was devised. For years we have believed that high levels of blood cholesterol were almost solely responsible for artery–clogging plaques. However, as Fleming explains, what is really happening is our immune cells are frantically consuming decaying LDL cholesterol and homo– cysteine particles (a kind of amino acid) inside artery

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walls. The immune system recognizes the LDL cholesterol and homocysteine as potential threats and sends out its army of immune cells. As the immune cells consume the oxidized LDL cholesterol and homocysteine, they become bloated and eventually amalgamate to form a “fatty streak” inside the artery wall. Over time, more and more immune cells are sent to the arteries and the fatty streak grows larger, forming a boil filled with cholesterol and other debris. The boil grows larger and eventually protrudes into the artery passageway. This is what is called atherosclerosis, which as we know, leads to heart attack. The immune cells, in their blind efforts to protect the body from harm, continue to amass inside the arteries, continually attempting to devour the plaque, making the plaques unstable. This is particularly dangerous because the plaque–formed boil is more likely to erupt, launching its harmful contents into the arteries and leaving an open wound in the artery wall. The body’s natural reaction to any open wound is to form a clot, or a scab over the wound’s opening. This covering over the wound can become so large that it can block the flow of blood to the heart or brain, causing a heart attack or stroke. It didn’t take long for other physicians and researchers to catch on. Another physician who has been a part of some of the groundbreaking work on inflammation is Dr. Paul Ridker, a cardiologist at Brigham and Women’s Hospital. Like Fleming, Dr. Ridker had a hunch that something apart from high levels of blood cholesterol was responsible for heart disease.

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To test his theory, he devised a simple blood test that could indicate the presence of inflammation in his patients. As reported in the Time Magazine article called “The Secret Killer,” Ridker decided to test for C–reactive protein (CRP), a molecule produced by the liver in response to an inflammatory signal. (Remember, the liver is an immunological organ.) During an acute illness, a person’s CRP levels quickly shoot from less than 10 mg/L to 1,000 mg/L or more. But what concerned Ridker were low, constant levels of CRP within patients – less than 10 mg/L – a level that indicates only a slight level of inflammation. Indeed, the difference between normal and elevated levels is so small that it must be measured by a specially designed test called a high– sensitivity CRP test. In the mid–1990s, Ridker and his colleagues were able to show that healthy middle–aged men with the highest CRP levels were three times as likely to suffer from a heart attack in the next 6 years as those with the lowest CRP levels. Further research has determined that having a CRP level of 3.0 mg/L or higher can triple one’s risk of heart disease. In contrast, people with extremely low levels of CRP – less than 0.5 mg/L – rarely have heart attacks. While LDL cholesterol is still a significant factor in heart disease, Ridker and other scientists believe that inflammation is what causes the cholesterol to accumulate, harden, and eventually burst within artery walls. As the level of LDL cholesterol increases in the blood, the immune system’s macrophages are alerted to the presence of something that doesn’t belong and quickly try to clean

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out the cholesterol. Somehow, the cytokine signals begin driving the inflammation process instead of turning it down, and the plaque becomes unstable. “Inflammation, therefore, contributes to the propensity of artery plaques to rupture and cause heart attack,” Ridker explains. Basically, this is what happens when inflammation reaches the arteries — a constant, entirely self–sufficient injury and repair process driven by the immune system takes place, which results in the non–stop presence of hard–working “inflamed” immune cells throughout the body. Time Magazine reports that this situation can also produce stroke, diabetes, Alzheimer’s, rheumatoid arthritis, and cancer. Stroke – Brain Attacks Like a heart attack, a stroke can happen when the blood flowing through the arteries is restricted by a blockage of some kind. Also similar to a heart attack is the way in which inflammation can instigate the buildup of plaque inside the walls of the carotid arteries leading to the brain. As plaque accumulates in the arteries, the arteries become obstructed, which can restrict the flow of blood to the brain, resulting in a stroke. This kind of stroke where blood flow to the brain is restricted is called an ischemic stroke. Inflammation is also involved in the occurrence of strokes in the way that it assists in the blocking of the arteries, causing them to burst or hemorrhage. This is known as a hemorrhagic stroke. In cases of both ischemic and hemorrhagic strokes, the brain is permanently damaged because the normal blood flow

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and therefore the normal supply of oxygen to the brain cells is interrupted or stopped. Strokes caused by blockages – ischemic strokes – are so similar to heart attacks that physicians call them “brain attacks.” In the same way that inflammation causes the buildup of plaques in the coronary arteries to bring on a heart attack, inflammation generated by the presence of bacteria or excess cholesterol causes arterial plaques to amass, harden, and eventually cause the obstruction of blood flow to the brain, causing a stroke. Inflammation packs a double punch, so to speak, when it comes to heart disease and stroke. First, inflammation initiates the process of arterial plaque development and then makes plaque more fragile and more likely to burst from clots. This is why stroke and heart attack can occur so suddenly, because inflammation can work silently and virtually undetected. And the arteries do not have to be entirely clogged with plaque – all you need is inflammation to make one plaque fragile enough to burst at the wrong time. But now that doctors are learning more about inflammation, the “secret cause” of heart attacks and stroke, they can start implementing preventative measures and developing procedures to combat inflammation. While we can never completely eliminate inflammation – remember, it is a critical part of our immune function – we can develop ways to reduce its chronic occurrence inside our bodies.

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Since the inflammatory process is so intimately bound to the immune system and its essential functions are triggered in response to a bacterial invasion, I believe the best way to decrease inflamma– inflamma tion is to protect ourselves from infection, especially chronic infections that last last for long periods of time, chronic infections including gum disease! In fact, infection control could be even more important than you think, as inflammation is also linked to diabetes, Alzheimer’s disease, rheumatoid arthritis, and even cancer! And when analyzed, isn’t inflammation exactly what happens when you brush your teeth and abrade the soft membranes of your mouth with dirty toothbrush bristles? Don’t these mucous membranes go through the very same process that repairs the body after injury that is analogous to the damage caused by a splinter or a paper cut? A New Way to Look at Diabetes Early in the twentieth century, doctors were desperate to find an effective treatment for diabetes, so they tried giving their patients high dosages of aspirin–like compounds called salicylates (this is before Dr. Frederick Banting isolated insulin in the 1920s). Sure enough, the salicylate reduced patients’ sugar levels, but not without serious side–effects that included a constant ringing in the ears, headaches and dizziness. Today we treat diabetics by providing insulin injections for those people whose body’s are unable to produce the hormone (type I diabetes), or treating those patient’s whose bodys’ resist the hormone and consequently halt its production (type II diabetes).

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But doctors have been re–examining the salicylate approach for clues as to how diabetes develops. What they have found is that the disease is actually a complex interplay between inflammation, insulin, and fat – either in the diet or in large folds under the skin. Fat cells, believe it or not, behave a lot like immune cells, spewing out inflammatory cytokines, especially during periods of weight gain. While the role of inflammation in diabetes is still unclear, the case for a central part is getting stronger. Time Magazine reports that Dr. Steve Shoelson, a senior investigator at the Joslin Diabetes Center in Boston, has bred a strain of mice whose fat cells are “supercharged inflammation factories.” As they gain weight, the mice become less efficient at utilizing insulin and go on to develop diabetes (this is exactly what happens in human beings). What is interesting is that Dr. Shoelson says that “we can reproduce the whole syndrome just by inciting inflammation.” This suggests that a well–timed intervention in the inflammatory process might reverse some of the effects of diabetes. If inflammation is ignited in response to invasion by bacteria, could controlling our bodys’ exposure to infection help us maintain the correct utilization of insulin? Right now, the answer is unclear, but the evidence strongly suggests that protecting the immune system so as to reduce inflammation is undoubtedly more beneficial than not doing anything at all. This seems especially significant when we consider the fact that people with diabetes are much more likely to have chronic oral infections and gum disease than people without diabetes – and treating gum disease (a chronic

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infection) helps people with diabetes control their blood sugar, thereby improving their insulin sensitivity. Aspirin for Alzheimer’s? Alzheimer’s? Similar to the way in which doctors noticed the progress of diabetics who were treated with anti– inflammatory medication, doctors have observed the decelerated development of Alzheimer’s in elderly patients who were taking anti–inflammatory drugs for arthritis or heart disease. Time Magazine reports that the immune sys– tem may mistakenly see the characteristic plaques and tangles in the brains of Alzheimer’s patients as damaged tissue that needs to be repaired or cleared out. If so, the natural inflammatory reaction would be causing more harm than good. Using anti– inflammatory drugs may limit, or at least delay inflammation and any resulting damage to the brain. Better yet, taking infection–control precautions to permanently reduce inflammation throughout the entire body – especially in elderly patients – may be even more beneficial. Cancer – The Wound the Never Heals Many people are surprised to learn that cancer begins its lethal course from our body’s normal cells; only something happens to change our normal cells into dangerous, reproducing cancerous cells. Actually, many things have to happen. Scientists generally agree that a cell must undergo ten or more mutations for it to become capable of progressing into cancer. Cells mutate for a number of reasons, including

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chronic irritation and inflammation, in reaction to various elements such as exposure to toxic chemicals, assault by a virus, or bacteria damage from environmental factors such as the sun’s UV radiation, or the aging–process itself. The body may view persistent insults (like mouth abrasions) as wounds that need to be healed, according to Michael Thun, head of epidemiological research at the American Cancer Society. But here’s the problem, the more cells that make copies of themselves, the more probable the cells are to make mutations that can lead to cancerous tumors. Researchers are exploring the possibility that mutation and inflammation are mutually reinforcing processes that, if left unchecked, can transform normal cells into potentially deadly tumors. In short, inflammation may be the process that launches the mutation of a normal cell into a cancerous one. How might this happen? Well, one of the most powerful weapons produced by the immune system’s macrophage cells are oxygen free–radicals. These potent molecules destroy just about anything and everything that crosses their path – particularly DNA. An assault on a DNA molecule by one of these free– radical assassins that does not completely kill the cell could lead to a genetic mutation that is left to continually grow and divide. According to Lisa Coussens, a cancer biologist at the Comprehensive Cancer Center at the University of California at San Francisco, the abnor– mal growth is still not a tumor but it registers as non– self when scanned by the immune system. When the immune system launches its reactionary response, it

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brings along with its immune cells growth factors and proteins that call other inflammatory cells. Coussens explains that “those things come in and go ‘heal, heal, heal.’ But instead of healing, you’re ‘feeding, feeding, feeding’” the abnormal cell growth. Dr. William Joel Meggs, author of The Inflammation Cure says that “any assault on the body that results in long– long–term inflammation is capable of causing cancer.” This is because the different cells involved in the inflammatory process are known to cause cellular mutations that predispose a cell to becoming cancerous, and helping precancerous cells to become cancerous by fostering angiogenesis, where the cancerous cells are nourished by “confused” immune cells. While still many components need to be explored, it is clear that maintaining a healthy inflammatory balance within your system is vitally important to overall health. But how is all of this related to gum disease and your dirty toothbrush? Well, remember that Dr. Fleming explains inflammation as a condition in which the immune system sends out immune cells to fight an infection or excess quantities of toxins in the blood, including excess cholesterol, mutated cells, or bacteria. Chronic inflammation can therefore be brought about when immune cells are sent out to fight off bacterial infections, especially persistent, chronic oral infections like gum disease.

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Inflammation – When it Turns Chronic We know how inflammation operates on a cellular level, both when it is working optimally and when it malfunctions. But what is it that makes this helpful mechanism turn destructive? What makes inflammation turn from a transitory reaction into a chronic, and therefore harmful reaction? Dr. William Joel Meggs, author of The Inflammation Cure says that the most popular theory on what causes inflammation in general is the response–to response to–injury to injury hypothesis. Chronically occurring occurring inflammation can therefore arise as a result of some kind of constant, recurring injury on the system. Meggs says that environmental irritants like air pollution or pesticides, behavioral factors like smoking or poor diet, one’s genetic predisposition, and bacterial infection can all act as instigators to chronic inflammation. This means that a number of factors – both within and outside of your control – can cause inflammation to malfunction and transform from a beneficial, lifesaving response, to a degenerative, chronic response. The most important of these contributing factors I believe is infection, especially infections that are recurring and chronic. Since inflammation is the body’s reaction to infection, it is reasonable to believe that any kind of infection from bacteria — especially recurring instances of infection — could help inflammation to turn chronic. If you think about it, this is exactly what you are doing when you brush your teeth. The hundreds

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of thousands of germs nestled within the bristles of your toothbrush make their way directly into the tissues in your mouth and then into your bloodstream through cuts made in your gums and tongues while brushing. This happens every day, twice a day (or more!). If we take a minute to consider gum disease, which is a kind of chronic bacterial infection, it is easy to see how this condition can contribute to systemic inflammation turned chronic. A chronic infection like gum disease can undoubtedly affect the way in which your body’s inflammatory reaction performs. When left untreated, it can persist as a chronic, ongoing infection in our mouths. Remember, gum disease is caused by an infectious, contagious bacterium that invades the delicate soft tissue of our gums – and inflammation is what causes our gums to become red and inflamed. Dr. Meggs notes that our gums are the most visible indicators of an inflammation imbalance in our bodies and “we would be wise to pay attention” — because an inflammation imbalance in the mouth has the potential to cause inflammatory problems in many other areas of the body, like the arteries. Because it is intimately linked to the the immune system, inflam– inflam mation affects the entire body, not just individual parts. When one area of the body is experiencing a chronic bout of inflammation, other parts of the body are also implicated. While Dr. Meggs warns us to take notice of any possible inflammation in our mouths, we would also be wise to stop reinfecting ourselves each day with pathogenic, (gum) disease–causing bacteria, viruses,

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and fungi from our toothbrush bristles, as these germs may too induce an inflammatory response that turns chronic. A Web of Connections Research on inflammation is uncovering a fascinating network of interconnections between various diseases that we never dreamed would be inter–related. Inflammation can explain the connec– tion between chronic oral infections and heart disease, stroke, and diabetes, to name just a few. The same inflammatory factors that cause heart attacks are also suspected to cause stroke, diabetes, gum disease, premature birth and many other seemingly unrelated disorders. This is because chronic inflammation in one area of the body can affect the rest of the body, and when we treat inflammation in one part of the body, other parts of the body also become healthier. And it’s why the former U.S. Surgeon General, C. Everett Koop said, “You are not healthy without good oral health.” So if we eliminate the germs on our toothbrush bristles by sanitizing our toothbrushes prior to every use, then we can bring a final end to chronic infection and re–infection from germs on our toothbrushes, and hopefully help to prevent, or at least minimize, chronic mouth infections like gum disease. Putting an end to chronic mouth infections will eradicate the need for a chronic inflammatory response in the mouth, and thereby reduce inflammation throughout the body. Remember, the mouth is the body’s prime gateway for bacterial invasion and infection. Why not do everything we can to prevent recurring instances of infection directly at the source?

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Now that we know exactly “who” the “SECRET KILLER” is, we can imprison him for life, at least as it pertains to chronic toothbrush germs and its relationship to what the Surgeon General has described as the “SILENT EPIDEMIC.” Let’s protect our immune systems by giving them a permanent vacation from toothbrush germs that we self–inject into our bloodstreams multiple times per day. I’ll say it again, “It just makes sense.” Here’s how…

6 Finally, the Natural Solution has Arrived! The Revolutionary, Patented Germ Terminator Steam/Dry Heat Toothbrush Sanitizer (An FDA 510(k)– 510(k)–Cleared Medical Device) I am confident that the research compiled for this book has helped enlighten you as to why it is so critically important to brush with a clean, germ–free toothbrush every time you brush for the rest of your life. I hope that you are now aware and conscious of the facts. Particularly that, although you may not be showing signs of illness right now, chronic brushing with germ–infested toothbrushes may be responsible for you or someone you care about becoming sick in the future. I’ve informed you how the bristles of your toothbrush can allow pathogenic germs to gain direct access into your bloodstream and how your dirty toothbrush could be the cause of silent, chronic infections, gum disease, and gingivitis, and ultimately for the corresponding chronic inflammation in your mouth, arteries, vital organs, and tissues. If you are not brushing with a sanitized toothbrush, your trusty

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toothbrush may be causing more harm than good to your health. At least you now have the information so that you can make an informed decision as to whether you want to go on using a “dirty” toothbrush or switch to a “clean,” sanitized toothbrush. Regardless of your decision, I am grateful that you have listened to my theory with an open mind. Now, I’m not trying to suggest that a dirty toothbrush will explain all of your health problems, if you have any at the present time (which I hope you don’t), but what I want to impart to you is that using a contaminated, germ–infested toothbrush simply cannot be beneficial to your oral health or your total health — and it may be, perhaps, a silent factor in the onset of many serious health problems. What I have done with this book is present as much of the evidence as I could, without boring you to death, that supports the possibility and probability that toothbrush germs are a “serious threat” to your long–term health. But why, you ask, hasn’t your doctor told you about this? Or if you have already asked your doctor, why is he or she among other medical and dental establishment experts who believe that a dirty toothbrush is okay to use every single time you brush? In response to these questions, it is my belief that many people are not willing to accept the reality of the toothbrush–germ problem, because the problem has never been “scientifically” addressed, and it’s always easier to maintain the status quo than to

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change an age–old habit no matter how bad it is. It may also be because toothbrush germs are not typically associated with acute illnesses like the flu, colds, and bouts with diarrhea, though they should be. Speaking of unpleasant bowel movements, how many cases of diarrhea are caused by rotting food particles and E.coli germs found on toothbrushes? (We will probably never know.) We’ve been using and reusing our toothbrushes day in and day out for as long as we can remember and most of us, at least those of us under the age of 50, don’t appear to be that sick. So why would the establishment bother to “fix something that isn’t broken?” Well, there is something “broken” that needs to be fixed for the good of our health. We all know that the toothbrush is a necessary device. In fact, it’s so important that when a 2003 survey conducted by the Lemelson–MIT Invention Index at the Massachusetts Institute of Technology asked which of five inventions Americans could not live without, the toothbrush emerged as the undisputed champ, beating out the car, the personal computer, the cell phone, and the microwave — in that order, as the most prized innovation. From the five choices which included the toothbrush, the automobile, the personal computer, the cell phone and the microwave – more than a third of teens (34%) and almost half of adults (42%) cited the toothbrush. The automobile ranked a close second, getting votes from 31% of teens and 37% of adults. Of the remaining choices, teens ranked the personal computer third (16%), the cell phone fourth (10%) and the microwave last (7%). Adults deemed the remaining choices equally important; the personal computer (6%), microwave oven (6%) and the cell phone (6%) each tied for third place. Because of the

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MIT survey, the toothbrush finding received incredible attention because it showed that the public recognizes that great inventions don't have to be complicated. "Those of us here (at MIT) know the simple things are very, very important," said Merton Flemings, an inventor with 29 patents to his name who runs the Lemelson–MIT Index. "It surprises us that other people who are not scientists recognize that too." Aside from its simplicity, perhaps we find this invention so important because we use it every day. In fact, we pretty much have to use the world’s most important invention if we want to maintain good oral health. And up until now, there has not been a means by which we can effectively, easily, and safely sanitize this indispensable medical device. There is, of course, the steam autoclave that physicians and dentists use to steam sterilize their instruments, but an autoclave would obliterate your toothbrush and autoclaves cost thousands of dollars. That is one big reason why no one has cared to address the problem — because there was no solution! As I stated previously, another reason is that the health problems associated with brushing with a germ–infested toothbrush do not instigate immediate, acute symptoms (except for the flu, cold, or bouts of diarrhea that are typically thought to have come from somewhere else). You’re not sick right now, so brushing with a dirty toothbrush must be okay, right? Wrong! The damage from daily brushing with a contaminated toothbrush can take years or decades to manifest into serious health problems — and because no one, until just now, has ever come up with a

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simple, sensible, and safe solution, I think it’s still too early to expect any kind of edict from the medical establishment that warns the general public that contaminated toothbrushes are a real health risk. I believe a public health “warning” will have to be driven by someone like Oprah who has everyone’s ear from a common–sense perspective. Maybe then the CDC or the ADA will listen and take action. You see, many doctors resist this kind of change because it could alter the way in which they treat their patients and seriously modify the information and advice that they give to the people who visit their offices. The renowned scientist, Max Plank, explains this kind of inflexibility nicely:

“Important scientific innovation rarely makes its way to gradually winning over its opponents. What does happen is that its opponents gradually die out and the growing generation is familiar with the new idea from the beginning.” Changing a well–established habit like brushing with a germ–contaminated toothbrush can take genera– tions. The respective stories of Dr. Ignac Semmelweis and Dr. Barry Marshall serve as real life examples of this. Listen to what one doctor had to say about new theories and ideas that could modify his existing practices,

“When I have to add those things to what I already have on my plate, I will. In the meantime, I have enough to worry about.”

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At what point will this doctor decide when he “has to” change his medical practices and revise the information and recommendations that he gives his patients? How many people will become sick or even die… slowly, before any changes are made? What will it take? This is exactly why it is so important to “be your own doctor,” so to speak. Go in for that second opinion, question your physician and his approach to a particular problem, educate yourself, read the latest health newsletters, eat right, exercise, and do everything possible to protect your immune system. Learn as much as you can about the latest health research and what you can do outside of the doctor’s office to improve your health and enhance your quality of life. Your health and well being in many ways is entirely up to you, and that is probably why you have decided to read this book. Not all doctors and scientists within the medical field are so rigid in their thinking. Just look at the groundbreaking work of Dr. Fleming, Dr. Meggs, and Dr. Ridker. But for the most part, the medical community has proved to be rather stiff and archaic in its willingness to accept new theories, change existing practices, and alter its ways of thinking about disease. Probably the biggest reason that the medical establishment has not taken up my toothbrush–germ theory whole–heartedly is because (i) it’s brand new, and (ii) there hasn’t been a safe, effective, and affordable solution to the problem, until now.

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Remember, your toothbrush is unbelievably filthy! Surveys show that people hold onto their toothbrushes like old friends. You probably under– stand by now how dirty and germ–ridden it is, but honestly, when was the last time you unremorsefully replaced your trusty toothbrush with a new one? According to a survey by Colgate–Palmolive, if you live in America you have probably kept yours for around 9 months! (Australians replace their toothbrushes after about 8 months and people in Japan exchange theirs every 3 months. Believe it or not, people in some European countries keep their toothbrushes on average for 2 years!) If hundreds of thousands of germs can accumulate on your toothbrush after just one brushing, reproduce in a humid environment lavished with food particles, and attract other airborne germs, imagine how many disgusting germs are nestled in the damp nooks and crannies of your toothbrush bristles after a long 9 to 24 months of use! Furthermore, in humid environments, like your bathroom shower, a single bacterium cell can sprout into 1 billion cells overnight. And with the increased popularity of electric and sonic powered toothbrushes and the very fact that the replacement brush–heads for these powered toothbrushes are so much more expensive than regular toothbrushes, I believe that the data will soon show that people hold onto these brush–heads even longer than regular brushes. So, obviously, powered brush–heads need to be sanitized as well. Maybe more so because of the greater risk for abrasion and micro–cuts on oral soft tissues from the extreme

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bristle velocity and rapid oscillations of these powered toothbrushes. What’s amazing is that as early as the 1920s scientists had already recognized the propensity of toothbrushes to be significant germ carriers. Let’s go back to the New Haven Department of Health article that stated: “The toothbrush, after one use, is never a

sanitary instrument, and what pathogenic germs it must contain when used day after day!” The toothbrush, the article goes on to say, “is a menace.” Interestingly, even though scientists have known the toothbrush is “never sanitary,” no one thought to implicate this instrument as a possible cause of disease. If you think about it for a minute, this makes perfect sense. The toothbrush is used day in and day out, twice a day or more, as a tool to remove plaque and bacteria from the teeth, gums, and tongue. Then where do the germs go? Some of them are expelled into the sink when rinsing, but most of them, stay lodged on and in between the tiny bristles of your toothbrush and in the nooks and crannies where the bristles fit into the toothbrush head. Rinsing with tap water is not effective in killing germs. That’s why dentists and physicians don’t rinse their instruments in tap water and use them on their next patients. It’s really a no–brainer. The germs remain on your toothbrush in addition to the germs from airborne and direct contamination until your next brushing where they re–renter your mouth (and infect your

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bloodstream though tiny cuts in the gums) and are then joined by more new germs that have accumulated in your mouth since your last brushing. Scientists have known for decades that the toothbrush is unclean – it’s simple to understand. The Dirtiest Room in the House In addition to the germs already existing in the mouth that end up on the bristles of your toothbrush and breed and multiply, millions of germs and bacteria can assemble on your toothbrush from its everyday storage environment, the bathroom. The typical household bathroom is popularly known as “the dirtiest room in the house.” Whether the bathroom in your house is the most filthy area of your home or you take care to neurotically clean it every 2 to 3 days (and it’s still the “germiest” room in the house), there is no doubt that loads of germs, blood, and other bodily fluids are flying around as a result of hand–washing, toilet–flushing, bathing, shaving, or any of the other grooming and personal hygiene activities that we carry out inside this little room. The bathroom is so dirty that the Chicago Dental Society recommends storing your toothbrush in an entirely different room of the house! Some of you may have heard about the scientist from the University of Arizona, Dr. Charles Gerba, PhD, who conducted an experiment to measure the levels of bacterial and viral contamination within a typical bathroom. He tested for germs and bacteria by positioning different pieces of absorbent gauze around the bathroom and measuring the levels of bacteria evident on them after each toilet flush.

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What he found was that contaminated water droplets travel in an invisible cloud 6 to 8 feet up and out from the area of the toilet, so the areas of the bathroom that are not directly adjacent to the toilet are contaminated. This is what Gerba calls the “aerosol effect.” The “bacterial mist” has also been shown to stay in the air for at least two hours after each flush, maximizing its chance to float around and contaminate damp surfaces in the bathroom. And this doesn’t even take into consideration certain variables including, but not limited to, room design, ventilation ducts, fans, and proximity of sewer lines to the sewer lines of neighbors (e.g. an apartment or condominium complex). As it turns out, the toilet is not the only location in the bathroom to exhibit high concentrations of disgusting bacteria and viruses. Surprisingly, the highest incidence of nasty bathroom germs occurs within and around the sink! That’s right, the sink! The same place where you wash your face and hands, and brush your teeth each day! What happens is that germs find their way into and around the sink when we wash our dirty hands and they can “fly” in there from an aerosol cloud when we flush the toilet. Also because of the constant presence of water in and around the sink this provides an excellent environment for microorganisms to grow and breed. Thus, sinks tend to have the highest concentration of microbial colonies. Dr. Gerba created an anecdote to accurately illustrate the bacterial situation within the bathroom,

“If an alien came from space and studied bacterial counts, he would probably conclude

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that he should wash his hands in your toilet and crap in your sink.” Gerba goes on to say that the alien would certainly not put your toothbrush in his mouth. Because of its uncovered, open–air position in the bathroom, its perpetual moistened state, and its daily buildup of germs from your mouth and from the air, toothbrushes are the perfect places for bacteria, viruses, and fungi to reside. How many of us rest our toothbrushes on the surfaces of a dirty sink, or how many of us have had our toothbrush slip into the same dirty sink or even on the floor? If you are like most people, the toothbrush is conveniently stored on or next to the sink, contained within the infamous “community cup” holding the toothbrushes of every person in the household. It’s here in the decorative and grimy family toothbrush cup that toothbrushes can actually share germs. This convenient storage habit is why the Journal of the Canadian Dental Association has stated that “toothbrushes can transmit disease.” In technical terms, this is described as “cross– contamination.” Most of us would never think of sharing our toothbrushes – not even with family members or significant others. Why? Well, some things are just considered sacred, things that we simply don’t share out of tradition or social mores. But aside from all that, there are actually good reasons to be selfish with your toothbrush.

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According to the Academy of General Dentistry,

“Toothbrushes can become heavily contamin– ated with oral microorganisms. Because most families store toothbrushes in a common storage place, airborne bacteria can move from toothbrush to toothbrush, passing opportunistic infections like periodontal disease and the common cold.” Still, no matter how much of a “germ freak” you may call yourself or how often you clean your bathroom and practice techniques to limit the toilet “aerosol effect” and control the amount of sink germs that reach your toothbrush, unfortunately, there is virtually no escaping toothbrush germs in the normal course of business. Even new toothbrushes aren’t safe. A study published in the Journal of the Oklahoma Dental Association found that 4 out of 5 (80%) brand new toothbrushes from one manufacturer were contaminated right out of the box. Think about it: you don’t reuse the same piece of dental floss day in and day out. Nowadays floss is made from durable synthetic fibers, capable of being used more than once – yet none of us would think to reuse dental floss! What makes us think that the microorganisms that are collected on dental floss are so different from the particles accumulated on your toothbrush? Or is it that the toothbrush is much more expensive than a piece of floss so we just deal with the germs? Instead of buying a new toothbrush each time you brush, as they are getting more and more expensive and some are contaminated anyway, why

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not sanitize your toothbrush and kill the germs? Finally, there is a safe, simple and completely effective solution to this dirty problem and it makes perfect sense. After all, I invented it. Now that there is a way to solve this dirty little problem, you can easily use a clean, sanitized toothbrush, and thereby protect your immune system from all of the nasty germs living on your toothbrush bristles. When you hear it steam, you know it’s clean… So, what is the solution to the toothbrush– germ problem? How can we safely and effectively kill all of the germs on our toothbrushes AND ensure that no germs find their way into the delicate bristles of our toothbrushes in between brushings? There are actually a few methods floating around out there, but only one is the safest, most reliable, and most effective: the Germ Terminator Toothbrush Sanitizer. Using the Germ Terminator is hands–down the best way to make sure that your toothbrush is completely germ free. The GT (as my kids call it) uses the proven power of steam to kill all germs, bacteria, viruses, fungi (molds and yeasts) and any other disgusting microbes that may have collected on your toothbrush. Most importantly, the Germ Terminator also provides a clean, germ–free environment where your toothbrush can be safely stored until the next time you use it. Doctors and dentists wouldn’t think of using one of their instruments without steam–sterilizing them first. Mothers, you wouldn’t re–use the nipple from a baby bottle or a thermometer without boiling it or steaming it, would you? Of course not! Why?

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Because we all know that high–temperature steam combined with the proper timed duration of steaming, is virtually the only way to successfully kill all potentially pathogenic germs and microbes. That’s exactly what dentists and physicians do to sterilize their instruments. The Germ Terminator is entirely unique with its patented steam–sanitization and germ–free storage system. Using the pre–measured GT cup, you just add a little water to the GT. The Germ Terminator generates a burst of continuous germ– killing steam that safely, efficiently, and effectively wipes out greater than 99.9999% of all germs tested in major laboratory testing with absolutely no germs detected after any test! Again, all you need to do is add water! I’ve heard about other methods for cleaning your toothbrush, like soaking it in bleach, hydrogen peroxide, or Listerine, boiling it in a pot on the stove, placing it in the dishwasher, exposing it to ultra– violet light radiation or ozone, and some people even think that just leaving it out to dry will effectively get rid of all the germs. A few of these techniques might work to kill some germs, but they are either essentially ineffective and/or potentially hazardous to your health. Chemicals & Disinfectants Everyone trusts bleach as an effective household disinfectant. We use it to clean our kitchen floors, countertops, stoves, or bathroom sinks. But bleach can be poisonous to humans. Chlorine bleach is highly irritating to the skin, eyes, nose, and throat,

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and if mixed with other chemicals, it can even act as a potential carcinogen. Soaking your toothbrush in a bleach concentrate or even a mixture of bleach and water is more dangerous than not doing anything at all to clean your toothbrush! Additionally, soaking your toothbrush in bleach can damage the bristles, causing them to become more sharp and stiff, making brushing more injurious to the gums, even painful. Remember, what ever is on the bristles of your toothbrush can be injected directly into your bloodstream. And trust me, you don’t want bleach in your bloodstream. On the surface, mouthwash containing alcohol seems like a safer alternative to bleach. Some folks that I have talked to soak their toothbrush heads in an antiseptic mouthwash like Listerine in between brushings. While a long Listerine soak might help to kill some germs, it won’t kill many of them, and what prevents germs from “flying” into and breeding in a cup of mouth–rinse? According to the CDC, this practice actually may lead to cross–contamination of toothbrushes if the same disinfectant solution is used over a period of time, or if it’s used by multiple users. Additionally, leaving alcohol in a cup has proven hazardous to young children who are attracted to colorful liquids. Many cases have been cited where young children have ingested such open containers containing alcohol and some of which have resulted in damage to their brains. In February 2004, a Cincinnati news station WCPO aired an independent “watchdog” segment in which they tested the “Listerine soak” against the

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Germ Terminator to determine which one has the greater ability to kill toothbrush germs. Three used toothbrushes were taken to the Cincinnati Health Department where they were tested for their bacterial content. One of the toothbrushes was left to dry in the air, a second rinsed in Listerine, and a third steam– cleaned by the Germ Terminator. The air–dried toothbrush exhibited heavy bacterial growth but, surprisingly, the air–dried brush displayed fewer germs than did the Listerine–rinsed toothbrush. The Listerine–toothbrush showed heavy bacterial growth on its Petri dish, while the Germ Terminator “worked perfectly,” leaving its Petri dish “smooth, clean, with not a single germ colony growing.” (That was a great, unexpected, and unsolicited “in–the–news” boost for the GT!) Boil it in a Pot! You could also try boiling your toothbrush in boiling water before using it, but who wants to do that every single time you brush? Plus, immersing your toothbrush in boiling hot water for several minutes can severely damage the handle and the bristles of the brush rendering it unusable. A small household experiment conducted by dentist Mary Zolnowski– Casey, DDS, published in JADA, found that boiling toothbrushes was an effective way to clean them, but the procedure, while time–consuming and incon– venient, left the brushes bent and warped and the bristles frayed and sharp. This dentist found the dishwasher to be a somewhat effective home–remedy, but who has time to run their toothbrush through the wash cycle prior to every single toothbrushing? And where would one store their toothbrush in between brushings after taking it out of the dishwasher or the

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water pot that would not leave it exposed to airborne– germ contamination? Ultraviolet (UV) Light Radiation Some toothbrush sanitizing devices use ultraviolet light (“UV radiation”) to kill germs. One UV–radiation device works by exposing toothbrushes to ultraviolet radiation within an enclosed chamber which contains a UV radiation light bulb. The user places a toothbrush into the device and presses the start button. The device then activates the ultraviolet radiation for several minutes and then shuts off. Sounds easy enough, but there are problems with UV radiation including the warning label, which states that UV radiation is hazardous to the eyes and to the skin. Ultraviolet radiation kills cells, including germ cells, by damaging their DNA. That’s what radiation does. To help us understand what happens on a molecular level, Anne Rammelsberg, a chemistry professor at Millikin University, explains that UV light radiation initiates a reaction between two cellular molecules of thymine, one of the bases that make up DNA. What is left after the damage is a thymine dimer, a molecule consisting of two identical, simpler molecules. These remaining molecules attempt to repair the damage by removing the two bases and filling in the gaps with new nucleotides. When the damage inflicted by the UV light radiation is extensive, however, the repair process can break down. The longer the cells are exposed to the ultraviolet light, the more thymine dimmers are formed in the DNA and the greater the risk of an incorrect repair or a “missed” repair. If a cellular

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process is disrupted because of an incorrect or incomplete repair, the cell cannot carry out its normal functions. At this point, depending on the extent of the damage, the cell will die, or the cell mutates into a precancerous, cancerous cell, or a “super bug.” This last portion of the UV process is what concerns me most. Ultraviolet light is extremely powerful – up to 10,000 times the intensity of the sun – and it has the power to permanently alter or mutate cells, that’s what radiation can do. Each day we hear more about the potential of “super bugs” to wreak havoc on our bodies and resist antibiotics. If UV light has the ability to mutate healthy cells, it probably has the ability to mutate germs cells too. You wouldn’t want to infect yourself with germs in the first place, let alone “super germs” mutated by ultraviolet light radiation! Furthermore, color pigments and/or rubber handles greatly impede the effectiveness of UV radiation. In a nutshell, if the UV radiation can’t shine on them, micro–organisms cannot be killed. Therefore, UV radiation–type devices specifically require the use of clear–plastic toothbrushes so that the light radiation can shine through as much as possible. Thus, anything that isn’t perfectly transparent on a toothbrush acts like SPF sun–block on the skin to prevent the harmful mutagenic properties of the sun’s UV radiation. No clear toothbrush is 100% transparent and therefore UV radiation cannot effectively kill all of the germs on your toothbrush. Additionally, if the strength of the UV radiation is not successful in killing a specific germ, then the

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reduced strength of the radiation could allow a particular germ to mutate, potentially creating a bug with altered DNA or even a type of “super bug” that could be even more pathogenic than the original bug. When I was in college, I worked for Miller Brewing Company in their biochemistry department. Miller was a great company with great people. They were a lifesaver for me at that time in my life because my job there basically put me through school. While I was there one of my projects was to mutate a certain type of yeast that would improve yeast function in the beer brewing process. The new, mutated yeast would hopefully both increase the rate of fermentation and prolong the lifespan of the yeast. In the biochemistry lab, I produced hundreds of mutations of the yeast. What did I use to produce the mutations? UV light radiation. I varied the mutation by subjecting the original yeast to varying amounts of UV light radiation. Therefore, I have first hand knowledge that UV radiation can mutate organisms, and that to me is scary when it comes to toothbrush germs. I would never want to inject germs into my system, let alone a mutated germ or “super bug!” Furthermore, the capacity of UV radiation to kill toothbrush germs is limited to only those areas of the brush that the light radiation can directly reach. The bristles of your toothbrush are tightly bound together at the bottoms, leaving dark areas in between where germs can hide and the radiation is unable to reach. If your bristles become worn or frayed after a few weeks of use, then the areas of the bristles exposed to the UV radiation can become even more limited.

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A Better Way… These methods that I have just mentioned are not safe, simple, or effective solutions to the problem at hand. I have spent the past few years developing the safest, most effective and easy–to–use system to sanitize and store toothbrushes. Using the natural, time–tested power of steam, the same steam that dentists and physicians use (just not under pressure), I’ve created a device to ensure that a safe, clean, and completely sanitized toothbrush is available every single time you brush. The Germ Terminator uses a worldwide patented and patents–pending process to kill germs with the scientifically–effective and time–tested utilization of steam combined with an integrated automatic drying process. The GT works so perfectly because it is so beautifully simple; there are no chemicals, no drawn out procedures, no hassles, no ultraviolet light radiation, nothing toxic to the system, and no buttons to break or jam, all you do is add water. There is no better way to successfully kill greater than 99.9999% of the germs on your toothbrush and store your toothbrush in a clean, germ–free environment until the next time you brush. The Germ Terminator is an FDA–registered, 510(k)–Cleared Medical Device. It works to kill germs by steaming and drying them. Your toothbrush is then stored in a sanitized clean chamber so it remains germ free until its next use. All you need to do is to fill the GT’s water reservoir with a convenient pre– measured cup of water. This turns on the “steam” mode automatically. After all of the water is vaporized, the “dry” mode is also activated

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automatically. Your sanitized toothbrush stands ready for your next brushing within a warm, germ– free storage chamber for your next brushing. Proof that it really works To test the Germ Terminator, I brought it to several major independent microbiology laboratories to find out if it worked as well as I planned. The first test at an independent laboratory used the morning toothbrushings from human test subjects. These toothbrushings were pooled together in an aqueous solution and dipped for 5 minutes under mild agitation. Confirming what numerous studies have already demonstrated, the untreated toothbrushes exhibited live bacterial levels that the independent lab stated were “too numerous to count.” Then the toothbrushes were placed in the Germ Terminator and sent through the steam cycle and the dry–heat cycle. After treatment with the GT, tested separately with the toothbrush bristles facing down and again with toothbrush bristles facing up, the laboratory was unable to detect any live bacteria whatsoever (described as “complete inactivation”) inactivation” when tested at 30 minutes, 4 hours and 12 hours after beginning the steam cycle. These results were exactly the kind of results that I knew the Germ Terminator would produce! The next step in the testing process was to take the Germ Terminator to two of the largest and most respected FDA–registered laboratories in the United States in order to test representative groups of bacteria, viruses, fungi (molds and yeasts). In

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accordance with Good Laboratory Practice Regulations and strict protocols, these independent labs performed specific tests to determine the effect that the Germ Terminator had on toothbrushes that had been heavily inoculated with the following representative species of bacteria, viruses, and fungi, including molds and yeast: 1. E. Coli 2. Staphylococcus aureus 3. Salmonella choleraesuis 4. Listeria monocytogenes 5. Porphyromonas gingivalis (Periodontal Disease) 6. Neisseria meningitidis (Meningitis) 7. Candida albicans (Thrush) 8. Herpes Simplex Virus – Type 1 (HSV–1) 9. Human Immunodeficiency Virus – Type 1 (HIV) 10. Influenza A Virus (Common Flu Virus) 11. Rhinovirus (Common Cold Virus) 12. Hepatitis C Virus 13. Streptococcus mutans (Dental Caries) These tests involved contaminating tooth– brushes with at least 1,000,000 colony–forming units

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of each of the above listed microorganisms per toothbrush. Once again, the GT performed perfectly. The Germ Terminator produced the complete kill–rate results that I had anticipated and expected. After treatment with the GT, not a single microorganism was detected after any test. Again, complete inactivation was achieved! In each analysis, the extreme sensitivity of the tests allowed the laboratories to conclude that the reduction of each germ tested was greater than 99.9999%, 99.9999% which is otherwise known as a greater than 6–log reduction. A test with a sensitivity of greater than 6–log reduction means, for example, that if the lab began testing with a microorganism population of one million, it would be able to confirm at the end of the test that not even one microorganism was detectable if such a result was achieved. Each of the 6–log reduction tests conducted resulted in greater than a 99.9999% reduction in the bacterial, viral, fungal, yeast, and mold populations for which the independent labs tested. Furthermore, in each of the lab tests, no microorganisms whatsoever were detected on any of the toothbrushes that were treated with with the Germ Terminator. The next step was to submit the test results to the United States Food and Drug Administration as part of the Germ Terminator’s FDA 510(k) –Medical Device application. I was very proud! My invention, The Germ Terminator Steam/Dry Heat Toothbrush Sanitizer, was the very first product of its kind that had ever been submitted to the FDA as a medical

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device. 9 months later, we received 510(k)–clearance from the FDA! That was an awesome day! It is important to remember, however, that as crucial as it is to effectively kill toothbrush germs, it is equally important to provide a sanitary environ– ment in which your toothbrush can be stored in between brushings. What good is it to eliminate all of the germs on your toothbrush only to leave it out in the open–air, exposed to loads of disgusting airborne germs from the bathroom and from neighboring toothbrushes? Always remember, your toothbrush is a magnet for germs! I designed the GT with this in mind, so I made sure that the Germ Terminator had a dry–heat, germ– free clean chamber that guards each toothbrush against microbial contamination from any outside source, including the bathroom and germs from other toothbrushes. I call it “the no– no–germ zone.” Once a toothbrush has been sanitized in the GT, it remains sanitized in the clean chamber until the next toothbrushing. How does the GT’s sanitary storage chamber keep the germs away? (You probably go at least 6 to 12 hours in between brushings, right?) The specialized clean storage compartment is kept germ– free by the dry heat mode, which is effective in killing germs, but more importantly, provides for upward air movement (since hot air rises) so that microorganisms will not settle inside the chamber or on your toothbrush. It also leaves your toothbrush nice and warm until the next time you use it. The independent laboratories proved that upon removing toothbrushes from the GT’s clean chamber 12 hours after they had

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been sanitized, absolutely no microorganisms were detected on any toothbrushes after any test. A Star is Born – The Germ Terminator in the Media Since the Germ Terminator’s outstanding performance in major independent laboratory testing, the news media has jumped at the opportunity to inform its audiences about the outrageous amount of germs that can live on toothbrush bristles and how we can best go about destroying them. ABC News Los Angeles did a television report on toothbrush germs warning viewers that “If you’re not careful, you could be spooning a brush full of bad bacteria into your body.” As a safe and effective solution, the news station presented the Germ Terminator, “a new device that steam cleans and dries your toothbrush with a germ–casualty–rate greater than 99.9999%!” Since then, CNBC, CNN, CBS Channel 8 News Las Vegas, FOX News San Diego, FOX News Denver, ABC News Las Vegas, WCPO Cincinnati, and other stations have all reported on the effectiveness of the Germ Terminator as a natural, safe, and easy way to sanitize your toothbrush and protect your immune system from millions of pathogenic germs. I’m thankful and grateful for the television news coverage, but I still believe more people need to be educated. We’ve only hit the tip of the iceberg. That’s why I’ve written this book. Toothbrush germs are a serious health problem, and as more media outlets report on the issue, hopefully people will begin to change this dirty personal–hygiene enigma by

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using the Germ Terminator. Up until recently, very few people talked about chronic inflammation. Now, scientific research is showing that inflammation and its bacterial instigators can negatively affect overall health and the quality of our lives. Finally, there is a solution. It just makes sense… Now that we know there is a safe and completely effective solution to the “toothbrush problem,” it just makes sense to take advantage of this opportunity to protect your immune system and your long–term health. With all of the abuse that our bodies are subject to in the modern age as a result of air pollution, ozone depletion, chemicals, and “super bugs,” it is more important than ever to do everything feasible to protect our immune systems. Brushing with a clean, steam–sanitized toothbrush is something that you can do, something that you ought to do, to protect your immune system every time you brush. With numerous worldwide patents and patents pending, my invention, the Germ Terminator, is the most effective, natural, simplest–to–use and safest device ever created to sanitize your toothbrush. It takes only seconds of your time and it might be one of the most significant health decisions you can make for you and your family. It just makes sense. When it comes to something you put in your mouth, the bottom line is — CLEAN has got to be better than DIRTY. How can anyone argue with that logic?

Afterword "There is no prescription more valuable than knowledge." – C. Everett Koop, M.D. U.S. Surgeon General (1981–1989) In this book, though I’ve said a lot, it astonishes me how much more I could say on this topic — a subject that affects nearly everyone. The amount of research that has been published on the subjects of focal infection, toothbrush contamination, causes of disease and theories of causation, the mouth–body connection, inflammation, hygiene, et al, is stagger– ing, and to a large degree, overwhelming. I haven’t spent a lot of time discussing acute illnesses in this book because I felt that it was more important to stress the long–term consequences of the toothbrush–germ problem. But here’s a perfect example of an “acute” illness (that most of us, unfortunately, have experienced) from the Merck Manual on the subject of Traveler’s Diarrhea. Merck states:

“Traveler’s diarrhea may be caused by any of several bacteria, viruses, or parasites. However, E. coli is the most common cause. E. coli organisms are commonly present in the water supplies of areas that lack adequate water purification. Infection is common in persons traveling to some areas of Mexico and Latin America, the Middle East, Asia, and

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Africa. Travelers often avoid drinking local water but become infected by by brushing their teeth with an improperly rinsed toothbrush…” toothbrush The Merck Manual states that people “become infected by brushing their teeth with an improperly rinsed toothbrush…” After reading that, a dirty toothbrush gives a whole new meaning to the word diarrhea! This is only one example of an acute health problem that can be instigated by the “dirty– toothbrush problem.” And while acute problems like diarrhea are important to discuss, what concerns me so much more are the chronic, long–term health problems that are linked to toothbrush germs. Here at Germ Terminator, we’ve been building our toothbrush–awareness snowball on TV and radio for many months now and the probative questioning, debate, or controversy (whatever you’d like to call it) is really starting to get the media’s attention. In July 2004, The New York Times broke with an article entitled, “Really? THE CLAIM: Toothbrushes can spread disease.” Here’s a brief excerpt of what the NY Times stated:

“THE FACTS: everything in the medicine cabinet, toothbrushes might seem the least harmful. Most dentists would disagree. Bacteria thrive on toothbrushes, which provide them with ample food and water. And toothbrushes sit in your home’s most germ– laden room: the bathroom. Researchers have found that streptococcus, staphylococcus, influenza and herpes simplex I,

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among other pathogens, toothbrushes…

can

survive

on

Bacteria and viruses on one brush can easily spread to another. Sharing your brush with someone else has been shown to cause sickness… The bottom line: Toothbrushes are the perfect environment for germs and should be replaced often.” I agree with everything that the NY Times has to say until they get to the very end. Let’s look at the NY Times articles last sentence,

“Toothbrushes are the perfect environment for germs and should be replaced often.” Replaced often? How often? Every 3 to 4 months as the American Dental Association advises? Given what you now know, does that make sense? What if dentists cleaned their instruments once every 3 to 4 months? What if we cleaned our silverware only once every 3 to 4 months? Here’s one great example of the challenge to changing the status quo of this unhealthy personal “hygiene” habit of using a dirty toothbrush. It comes from a dentist. Subsequent to the NY Times article, a dentist wrote the following letter to the editor. Here’s what the dentist said:

“To the Editor: Re the “Really?” column on toothbrushes (July 27): If reusing toothbrushes was detrimental to health, we would see more disease in healthy individuals who reused toothbrushes. Obviously we don’t.

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So in healthy people, if one rinses off the brush and lets it dry before reuse, the brush should last until it wears out. In these brushers the microbes are indigenous to their own, balanced oral environment. No sense in polluting the planet with good toothbrushes. And money is better spent on checkups.” (Talk about knowing what Dr. Semmelweis and Dr. Marshall went through.) Let’s analyze the dentist’s statements: First, the dentist said, “If reusing toothbrushes was detrimental to health, we would see more disease in healthy individuals who reused toothbrushes. Obviously we don’t.” This dentist doesn’t even take into consideration chronic oral infections, gum disease, and chronic inflammation systemic to the entire body. Does this dentist practice in a community where everyone is perfectly healthy and lives outside of the fact that 90% of adults suffer from some form of gum disease? Does the dentist even know about the health of his patients outside of the state of their oral cavities? Does the dentist know the C–reactive protein levels or Interleukin–6 levels of his patients showing the overall systemic inflammation levels in their bloodstreams? The answers to all of these questions are blatantly obvious, the dentist doesn’t have a clue. Second, the dentist went on to say, “So in healthy people, if one rinses off the brush and lets it dry before reuse, the brush should last until it wears out.” Let’s analyze. So what does the dentist recommend that “unhealthy” people do with their contaminated toothbrush? What is his sanitization

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standard for how long one should “rinse” their toothbrush? What is his standard for how long one should “dry” their toothbrush? What is his standard for variations of existing “humidity” in the bathroom? What is his standard for when the brush has “worn out?” Does a person have to look at the bristles of the brush under a 60x microscope to find out? In the dental world, the only standard that I know of pertaining to dental instruments is “germ–free.” Why shouldn’t that same standard apply to toothbrushes? Third, the dentist states: “In these brushers the microbes are indigenous to their own, balanced oral environment.” Indigenous to their own, balanced oral environment? From an overall, universal, “Earthly” point of view, aren’t all bacteria, viruses, fungi, and parasites “indigenous to their own balanced oral environment?” Of course they are, but I’m talking about keeping these germs and their corresponding endotoxins out of our bloodstreams! They clearly don’t belong there! Finally, let’s look at the dentist’s last statement, “No sense in polluting the planet with good toothbrushes. And money is better spent on checkups.” I’m not talking about polluting the planet with “good toothbrushes.” I’m talking about sanitizing the toothbrushes we have prior to every toothbrushing. “And money is better spent on checkups?” Sure, I’m a strong advocate of checkups with your dentist, its money well spent, but why can’t we have sanitized toothbrushes with Germ Terminators in addition to having regular checkups with our dentists? Furthermore, what good are check–ups if we continue to infect and re–infect our gums and soft oral tissues with harmful bacteria?

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In its February 2004 article, "The Secret Killer," Time Magazine included a section called, "What You Can Do" to minimize the damaging effects of inflammation. In this section, Time Magazine listed ONLY 4 areas to fight inflammation. These 4 included: DRUGS (aspirin, statins, beta blockers and ACE inhibitors), EXERCISE, DIET (low fat, with plenty of fruits and vegetables), and ORAL HYGIENE. So its fact, oral hygiene can help reduce chronic inflammation! Since "hygiene" is defined as the "conditions or practices of cleanliness conducive to health," what can oral "hygiene" possibly mean when people use “dirty” germ–contaminated toothbrushes? We’ve got to change the way we think about toothbrushes. You can help me in my mission by sharing this book with the people that you care about and asking them to share it with their network of friends and family. We’ve got to take this mission out–of–the–box because traditional methods of public health education have proven to be ineffective. Donald Kemper, the CEO of Healthwise said,

"Americans are confused about their health care. Good medical information is as important to good health as surgeries, medical tests and medicines.” With this book, you have accurate, evidence– based information about the benefits of a clean toothbrush and the impact that oral health has on total health. A clean toothbrush is not a radical idea, but rather a sensible one. By eradicating the use of dirty toothbrushes, together we will have implemented an important and visionary advance in global health, and that’s a great thing. So when you

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ask someone if they know how many germs they have on their toothbrush and they give you the typical response, which is (i) “That’s disgusting,” then (ii) they giggle, and (iii) they say, “I guess that’s OK since they’re my germs.” You can now give them this book and they can make an informed decision as to whether they want to continue using a “dirty” toothbrush or make the switch to a “clean” one. You’ve done your part. If you’re a health care professional, I really need your help in advancing this cause because history has also shown that information alone is not good enough. People need the support, guidance, and good advice from health practitioners in order to change their health habits. Because of various news reports, there are many people out there who are confused about the potential negative effects of “being too clean.” One such example is the topic of keeping our children from the ages of 0 to 6 “too clean.” Some research is saying that by limiting children’s exposure to germs, their immune systems do not develop as well later on in life and therefore, as adults, they are subject to more allergies and other problems associated with a weaker immune system. Folks, this has absolutely nothing to do with the issues of dirty, contaminated toothbrushes. In this book I have repeatedly discussed the fact that germs don’t belong in our bloodstream. We have E. coli in our guts but when we put the same E. coli in our bloodstreams, we can die. You can never be “too clean” when it comes to your bloodstream. Additionally, some people are confused with the issue of “overkill” when it comes to germs. This issue

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of overkill relates specifically to the overuse of drugs like antibiotics and chemical disinfectants that don’t do the job in killing 100% of germs. In this arena, you really don’t have overkill, you have “underkill” which allows germs to evolve beyond the control of antibiotics and chemicals and become “super bugs” that are dangerous because we have no way to contain them. Chemicals kill germs by inactivating, precipitating, oxidizing, or otherwise disrupting proteins, cell membranes, lipids, or other cell structures. UV light radiation destroys or distorts nucleic acids and is typically used only on the surfaces of objects because of shadowing problems. Both chemicals and UV radiation can allow germs to evolve or mutate which can create germs with super strength. Steam blows germs apart and doesn’t allow for mutations to occur. Steam is the very best way to kill germs and that’s why dentists and doctors use steam. (Ozone has been used as a method of killing germs but generally only in commercial applications like public water treatment. I don’t recommend it because it’s “hazardous to humans when inhaled” — it carries that very warning label. Personally speaking, I took one small breathe of it [ozone] and I ended up with a cough that persisted for the next 4 days.) If you’re a dentist, physician, hygienist, scientist, researcher, microbiologist, professor, or infectious disease specialist, please help this mission. As ridiculous as it seems to me, the CDC and other health associations need “scientific literature” to support the practice of using a “clean” toothbrush. Whatever you can supply will be helpful to our cause. One of my heroes is the former Surgeon General whom I believe to be one of the greatest

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public health communicators in modern history. Because I believed in him so much, it was a personal goal of mine to have him let the public know that this issue was critical to overall health. I know of no greater credible public health figure that could have carried our torch in this mission. It was spectacular for me when he agreed to endorse my mission and recommend the Germ Terminator as one of the best ways to improve oral health. After reaching this agreement, I waited for months to move forward with the former Surgeon General. I printed 50,000 brochures with his endorsement and signature based on our meeting of the minds. Finally, 3 months later he wrote back telling me that his lawyers said his endorsement may be in conflict with a potential agreement that he had with another company in some other field of health. I was heartbroken because the former Surgeon General was someone I felt could have helped change this dirty toothbrush habit with his message to the public. I wrote back again and again, but that was the last I ever heard from him, he never replied. My reasons for telling you this is to let you know that even the former Surgeon General of the United States believes in a clean toothbrush, although as of right now, I am without his formal endorsement. Until I find another well–known health expert to carry the torch, I will carry it proudly, but if you know someone who has the credibility of the former Surgeon General, and would be passionate about this mission, please e–mail me at [email protected]. Being sick costs too much, both financially and in the quality of our lives. The Centers for Disease Control says that “an ounce of prevention keeps the

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germs away.” With the Germ Terminator you will kill greater than 99.9999% of all germs on your toothbrush, including bacteria, viruses, and fungi. And if you can spare a few extra minutes and even though your toothbrush is sanitized, steam your toothbrush just prior to brushing, the GT’s steam will make the bristles extra soft, which will further minimize soft tissue abrasion. Your gums and your dentist will appreciate you for it. In summary, germs can cause illnesses that range from common ailments like the cold or flu, to disabling conditions such as meningititis and E. coli poisoning, to deadly diseases like Hepatitis and HIV, to diseases linked to chronic inflammatory diseases like heart disease, stroke, lung disease, diabetes, Alzheimer’s, arthritis, Parkinson’s, chronic fatigue, and many other chronic degenerative diseases. If you believe in the mouth–body connection that I’ve presented, many of those diseases can be prevented through an amazingly simple and extremely inexpensive method. I’ve named it the Germ Terminator. The world is filled with good germs that we need as well as bad germs that can make us sick or make us die. The recent SARS virus created a worldwide sense of fear and anxiety of just how vulnerable we can be to some germs. The lesson is simple — we need to do everything we can to protect ourselves against the “bad” bacteria and “bad” viruses that really pose a threat to our health. We need to keep them out of our bloodstreams and keep them from causing chronic, silent, symptom–less, and undetected inflammation throughout our bodies. Chronic inflammation is the “secret killer.”

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As of this printing, I am 42 years old. I want to live a long, healthy, productive life for as long as I can. I want that for my family and friends and I want that for you, too. Thanks for reading and being a part of my mission. God’s blessings to you and your family.

References Introduction Bock KA, Bock SB, Faass N. The Germ Survival Guide. New York: McGraw Hill, 2003 Chicago Dental Society. Dental Experts Warn: Change Toothbrushes More Often [Internet]. Chicago: Chicago Dental Society; 2002 [cited 2002 Mar11]. Available from: http://www.chicagodentalsociety.org Health News [television broadcast]. CNN Headline News. CNN. Atlanta 2003 Jan 29 Morgan J. Your Toothbrush May be a Biohazard. USA Today. 2000 April 27 Osborne O. The Toothbrush. New Haven Department of Health Monthly Bulletin; 1925 October; 10: 7. Also available from http://info.med.yale.edu/newhavenhealth/documents/historical/monthly/toot hbrush.html Petty T. Accepting the Need for “Overkill” in Infection Control. J Can Dent Assoc; 66:186-7 Verran J, Leahy-Gilmartin A. Investigations into the microbial contamination of toothbrushes. A Pilot Study. Microbios 1996; 85:231-238 Chapter 1: The Toothbrush Germ Theory Alvarez L. British Hospitals Struggle to Limit Superbug Infections. New York Times 2004 Aug 14; sect A: 5 (col. 1) Aniñen O, Fargo M. Semmerlweis’ Discovery and its Finnish Follow-up. Acta Physiol Hung;90(2):83-95. Also available from http://generalanaesthesia.com/semmelweis.html Bellis M. History of Antiseptics. About.com [Internet] [cited 22 May 2004]. Available from: http://inventors.about.com/library/inventors/ blantisceptics.html Break Step Bridge, Toothbrush Surprise, Rowing Water Skier [television broadcast]. Myth Busters. The Discovery Channel. 2004; season 1, episode 12 Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Oral Health Resources. Infection Control: The Use and Handling of Toothbrushes [Internet]. Atlanta: National Center for Chronic Disease Prevention and Health Promotion; 2002 [cited 2003 July 12].Available from: http://www.cdc.gov/OralHealth/infection_control/ fact_sheet/toothbrushes.html

References - 153

Chicago Dental Society. Dental Experts Warn: Change Toothbrushes More Often [Internet]. Chicago: Chicago Dental Society; 2002 [cited 2002 Mar 11]. Available from: www.chicagodentalsociety.org Firfer H. People’s Hand-Washing Tales a Whitewash, Study Says 2000 Sept 18. CNN News [Internet]. CNN News [cited 2004 Sept 28]. Available from: http://www.cnn.com/2000/HEALTH/09/18/handwashing/ Gorman C. Wash those hands! How doctors and nurses can make you sick – and what you can do about it. Time Magazine 2004 March 29: 81 Hyde B. American Society for Microbiology Reveals that as Many as Thirty Percent of Travelers Don’t Wash Hands After Using Public Restrooms At Airports; 2003 Sept 15. American Society for Microbiology [Internet]. Chicago: American Society for Microbiology [cited 2004 Sept 23 2004]. Available from: http://www.asm.org Krauss C. Bacteria that strikes the elderly spreads in Canadian hospitals. New York Times 2004 Aug 9; Sect A: 2 (col 3) Margan D. Toothbrush Tests: Not So Sparking Clean. MSN A Current Affair Online [Internet] 2001 Sept 7 [cited 2003 July 12]. Available from: http://aca.ninemsn.com.au/stories/ 740.asp Margan D. Putting Toothbrushes Under the Microscope. MSN A Current Affair Online [Internet] 2001 Sept 7 [cited 2003 July 12]. Available from: http://aca.ninemsn.com.au/factsheets/741.asp Morgan J. Your Toothbrush May be a Biohazard. USA Today 2000 April 27 Tierno P. Cleaning Tips. A Microbiology Professor Offers Advice on Keeping Away Germs. ABC News [Internet] 2004 [cited 2004 Sept 14]. Available from: http://www.abcnews.com Thompson KM, Bruce D. Overkill: How Our Nation’s Abuse of Antibiotics and Other Germ Killers is Hurting Your Health and What You Can Do about It. Rodale Pr: 2002 Underwood A. HealthCare–Hospital Horrors. Newsweek Magazine. 2004 Aug 2: 12 Verran J, Leahy-Gilmartin A. Investigations into the microbial contamination of toothbrushes. A Pilot Study. Microbios 1996; 85:231-238 Warren D, Goldschmidt M, Thompson M, Adler-Storthz K, Keene H. The effects of toothpaste on the residual microbial contamination of toothbrushes. J Am Dent Assoc 2001 Sept; 132:1241-1245 Webb D. You May Not Be as Clean As You Think You Are. Wall Street Journal. 2003 Nov 5; Sect D:2 (col 2)

154 – The Toothbrush Germ Theory

Chapter 2: Germs, Not Genes Cause Most Diseases Ewald P. The Evolution of Infectious Disease. Oxford: Oxford Univ Pr; 1994 Garcia A, Bi J. Cervical Cancer. Emedicine.com [Internet] 2004 [cited 2004 Aug 24]. Available from: http://www.emedicine.com/med/topic324.html Hendricks M. Pinpointing the Cause of Cervical Cancer. John Hopkins Magazine [Internet] 2000 [cited 24 Aug2004]. Available from: http://www.jhu.edu /~jhumag/0400web/40.html Kozai K, Iwai T, Miura K. Residual Contamination of Toothbrushes by Microorganisms. J Dent Child. 1989 May-Jun; 56(3):201-204 Livini E. Do germs, not genes, cause most diseases? Rev. of Plague Time: How Stealth Infections Cause Cancers, Heart Disease and other Deadly Ailments, by Paul W. Ewald. New York: The Free Pr; 2000. Also released as Plague Time: The New Germ Theory of Disease. First Anchor Books; 2000. ABC Health News [Internet] 2003 [cited on 2003 Jan 7]. Available from: http://www.rubella.net/ Vaccinosis/Germs.htm MacCorquodale D. Notes Washed Up In A Bottle. American Association of Public Health Physicians [Internet] 2002 [cited on 2004 Aug 24]. Available from: http://aaphp.org/bottle/ 23nov02cervical_cancer.html National Institutes of Health. National Institutes of Health Publication on the Investigation of Stomach Ulcers and H.pylori [Internet]. 1994 February; epub from NIH. Publication No. 95-38 [cited 2004 Sept 29]. Available from: http://www.ukans.edu/ ~micro/ulcers.htm Petty T. Accepting the Need for “Overkill” in Infection Control. J Can Dent Assoc; 66:186-7 Purvis A. Cancer from germs: A Stomach Bug is Linked to Gastric Tumors and Ulcers. Time Magazine; 1991 Oct 28 Stevenson LG. Britannica Guide to Nobel Prizes, Robert Koch [Internet] 1997 [cited 2004 Aug 24]; Encyclopedia Britannica. Available from: http://www.britannica.com/nobel/micro/325-28.html Sweet M. Smug as a Bug. The Sydney Morning Herald; 1997 Aug 2 Taji SS, Rogers AH. The Microbial Contamination of Toothbrushes. A Pilot Study. Aust Dent J 1998; 43(2): 128-130 Thompson KM. Overkill: How Our Nation’s Abuse of Antibiotics and Other Germ Killers is Hurting Your Health and What You Can Do About It. Rodale Pr; 2002 Zur Hausen H. Cervical Carcinoma and Human Papillomavirus: On the Road to Preventing a Major Human Cancer. J Nat Cancer Inst 2001 Feb; 93(4):252-253

References - 155

Chapter 3: The Mouth as a Mirror American Academy of Periodontology [Internet]. Chicago: American Academy of Periodontology; 2004 [cited 2004 Aug 20]. Available from: http://www.perio.org American Diabetes Association [Internet]. Alexandria (VA): American Diabetes Association; 2004 [cited 2004 Aug 5]. Available from: http://www.diabetes.org/type-1-diabetes/mouth-care.jsp Anton P. Oral Health-Total Health: Know the Connection. American Dental Hygienists’ Association [Internet] 2003 [cited 2003 Jan 9]. Available from http://www.adha.org/media/backgrounders/total_health.htm Chase M. Bacteria Behind Gum Disease Are Linked to Heart Attack Risk. Wall Street Journal 2002 Sept 30 Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. Oral Health in America: A Report of the Surgeon General. 2000 Sept Gammal R. The Dangers of Focal Teeth Infections. Worldwide Health Center [Internet] 2003 Jul 28 [cited 2004 Aug 2]. Available from: http://www.worldwidehealthcenter.net/articles-262.html Henig EF, Derschowitz T, Shalit M, Toledo E, Tikva P, Aviv T. Brain Abscess Following Dental Infection. Oral Surg Oral Med Oral Path 1978 Jun; 45(6):955-958 Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Asherio A, Willett WC. Poor oral health and coronary heart disease. J Dent Res 1996 Sept; 75 (9):1631-6 Joshipura KJ, Ascherio A, Rimm E, Douglass CW, Willett WC. The relation between tooth loss and incidence of ischemic stroke. Circulation 1999; 99:1121 Livini E. Do germs, not genes, cause most diseases? Rev. of Plague Time: How Stealth Infections Cause Cancers, Heart Disease and other Deadly Ailments, by Paul W. Ewald. New York: The Free Pr; 2000. Also released as Plague Time: The New Germ Theory of Disease. First Anchor Books; 2000. ABC Health News [Internet] 2003 [cited on 2003 Jan 7]. Available from http://www.rubella.net/Vaccinosis/Germs.htm Mechanisms of Focal Infection. J Am Dent Assoc. 1951 Jun; 42(6):619-633. Millman C. The Route of all Evil – Bad Diseases Can Start in Your Mouth. Men’s Health; 2001 Feb 14. Also in abcnews.com [Internet] 2001 [cited 2002 Mar 13]. Available from: http://www.abcnews.go.com Morgan J. Your Toothbrush May be a Biohazard. USA Today 2000 April 27

156 – The Toothbrush Germ Theory

Ross P. Do Germs Cause Cancer? Forbes Magazine 1999 November 15 Scannapieco FA. Position paper of the American Academy of Periodontology: periodontal disease as a potential risk factor for systemic diseases. J Periodontol 1998 Jul;69(7):841-50 Scannapieco FA, Mylotte JM. Relationships between periodontal disease and bacterial pneumonia. J Periodontol 1996 Oct;67 (10 Suppl):1114-22. Scott B. The Mouth/Body Connection Grows Stronger. The American Dental Hygienists’ Association [Internet]; 2002 [cited 2002 Jun 25]. Available from: http://www.adha.org/news/systemic_disease_update.html Strobel G. Show Me Your Mouth, I’ll Tell You About Your Heart. Harvard Medical School Focus [Internet] 1998 June 19 [cited 2003 Aug 19]. Available from: http://focus.harvard.edu/1998/June19_1998/ complete.html Surviving Sepsis [Internet]. Land O Lakes (FL): Surviving Sepsis, International Sepsis Forum; 2004 [cited 2004 Aug 3]. Available from: http://www.survivingsepsis.org Chapter 4: Healthy Mouth, Healthy Heart, Healthy Body Abramson J. Drug Guidelines Fatten Bottom Lines. Los Angeles Times 2004 Jul 25 American Heart Association [Internet]. Dallas: American Heart Association; 2004 [cited 2004 Aug 17]. Available from: http://www.americanheart.org American Stroke Association [Internet]. Dallas: American Stroke Association, Division of the American Heart Association; 2004 [cited 2004 Aug 18]. Available from http://www.strokeassociaiton.org Anton P. Oral Health-Total Health: Know the Connection. American Dental Hygienists Association [Internet media release] 2003 [cited 2003 Jan 9]. Available from: http://www.adha.org/media/backgrounders/total_heal th.htm Associated Press. Tiniest Preemie now just a “Normal Teen.” CNN News [Internet] 2004 Aug 19 [cited 24 Aug 2004]. Available from: http://www.cnn.com/2004/HEALTH/conditions/08/19/ tiniestpreemie.ap/index.html Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996 Oct;67 (10 Suppl):1123-37 Beck JD, Offenbacher S, Williams R, Gibbs P, Garcia R. Periodontics: a risk factor for coronary heart disease? Ann Periodontol 1998 Jul;3(1): 12741 Chase M. Bacteria Behind Gum Disease are Linked to Heart Attack. Wall Street Journal 2002 Sept 30 Cao J, Thach C, Manolio T, Pasty B, Kuller L, Chaves P, Polak J, Sutton-Tyrrell K, Herrington D, Price T, Cuchman M. C-Reactive Protein, Carotid Intima-

References - 157

Media Thickness, and Incidence of Ischemic Stroke in the Elderly. Circulation 2003; 108:166. Cohen DW, Friedman LA, Shapiro J, Kyle GC, Franklin S. Diabetes mellitus and periodontal disease: two-year longitudinal observations. I. J Periodontol 1970 Dec;41(12):709-12 Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. Oral Health in America: A Report of the Surgeon General. 2000 Sept DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ 1993 Mar; 306(6879):688-91 Di Rado A, Nalick J. Long in the Tooth. University of Southern California Health Magazine. 2002 Winter: 13 Donley T. Gum Disease Can Kill More than Your Smile. American Academy of Periodontology [Internet]. Chicago: American Academy of Periodontology; 2004. Available from: http://www.perio.org Genco RJ. Periodontal disease and risk for myocardial infarction and cardiovascular disease. Cardiovasc Rev Rep 1998;19 (3):34-40 Genco R, Chadda S, Grossi S, Dunford R, Taylor G,Knowler W, Pettitt D. Periodontal disease is a predictor of cardiovascular disease in a Native American population. J Dent Res 1997 Mar; 76 (Spec No):14-519 (abstract 3158) Gibbs R. The relationship between Infections and Adverse Pregnancy Outcomes: An Overview. Ann Periodontal 2001; 6:153-163 Gibson F, Genco C et al. Innate Immune Recognition of Invasive Bacteria Accelerates Atherosclerosis in Apoplipopretein E-Deficient Mice. Circulation 2004; 109:2801-2806 Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998 Jul;3(1):51-61 Grossi SG. Treatment of Periodontal Disease and Control of Diabetes: an Assessment of the Evidence and Need for Future Research. Ann Periodontal 2001 Dec; 6(1): 138-145 Herzberg MC, Meyer MW. Dental plaque, platelets, and cardiovascular diseases. Ann Periodontol 1998 Jul; 3 (1):151-60 Herzberg MC, Brintzenhofe KL, Clawson CC. Aggregation of human platelets and adhesion of Streptococcus sanguis. Infect Immun 1983 Mar; 39 (3):145769 Janket S, Qvuarnstrom M, Maurman J, Baird A, Nuutinen P, Jones J. Asymptomatic Dental Score and Prevalent Coronary Heart Disease. Circulation 2004; 109:1195-1100

158 – The Toothbrush Germ Theory

Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Asherio A, Willett WC. Poor oral health and coronary heart disease. J Dent Res 1996 Sep; 75(9):1631-6 Joshipura KJ, Ascherio A, Rimm E, Douglass CW, Willett WC. The relation between tooth loss and incidence of ischemic stroke. Circulation 1999; 99:1121 Karow J. Taken to Heart- Brushing Your Teeth May be Good for Your Ticker. Scientific American [Internet] 2001 [cited 2002 Jan 1]. Available from: http://www.sciam.com/2001/0501scicit5.html Kjellman O, Henriksson CO, Berghagen N, Andersson B. Oral conditions in 105 subjects with insulin-treated diabetes mellitus. Sven Tandlak Tidskr 1970 Feb; 63(2):99-110 Li L, Messas E, Batista E, Levine R, Amar S. Porphyromonas gingivalis Infection Accelerates the Progression of Atherosclerosis in a Heterozygogous Apolipoprotein E-Deficient Murine Model. Circulation 2002; 105: 861-867 Libby P, Ridker P, Maseri A. Inflammation and Atherosclerosis. 2002; 105:135.

Circulation

Mattila KJ, Nieminen MS, Valtonen VV, Rasi VP, Kesaniemi YA, Syrjala SL, Jungell PS, Isoluoma M, Hietaniemi K, Jokinen MJ. Association between dental health and acute myocardial infarction. BMJ 1989 Mar 25;298 (6676):779-81. Mattila KJ, Valtonen VV, Nieminen M, Huttunen JK. Dental infection and the risk of new coronary events: prospective study of patients with documented coronary artery disease. Clin Infect Dis 1995 Mar; 20(3):588- 92 Millman C. The Route of all Evil – Bad Diseases Can Start in Your Mouth. Men’s Health; 2001 Feb 14. Also in abcnews.com [Internet] 2001 [cited 2002 Mar 13]. Available from: http://www.abcnews.go.com Morgan J. Your Toothbrush May be a Biohazard. USA Today 2000 April 27 Murrah VA. Diabetes mellitus and associated oral manifestations: a review. J Oral Pathol 1985 Apr;14(4):271-81. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996 Oct; 67(10 Suppl):1103-13. Offenbacher S, Jared HL, O¹Reilly PG, Wells SR, Salvi GE, Lawrence HP, Socransky SS, Beck JD. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol 1998 Jul; 3(1):233- 50. Oliver RC, Tervonen T. Periodontitis and tooth loss: comparing diabetics with the

References - 159

general population. J Am Dent Assoc 1993 Dec;124 (12):71-6. Oliver RC, Tervonen T. Diabetes‹a risk factor for periodontitis in adults. J Periodontol 1994 May;65 (5 Suppl):530-8 Pinson M, Hoffman WH, Garnick JJ, Litaker MS. Periodontal disease and type 1 diabetes mellitus in children and adolescents. J Clin Periodontol 1995 Feb; 22(2):118-23. Prevention Newsletter. Dental Floss Could Save Your Life, Gum Yuck Hurts Hearts. 2002 July: 158 Ridker P. C-Reactive Protein. Circulation 2003; 108:c8 Ringelberg ML, Dixon DO, Francis AO, Plummer RW. Comparison of gingival health and gingival crevicular fluid flow in children with and without diabetes. J Dent Res 1977 Feb; 56(2):108-11. Romero B, Chiquito C, Elejalde L, Bernardoni C. Relationship Between Periodontal Disease in Pregnant Women and the Nutritional Condition of their Newborns. J Periodontal 2002; 73:1177-1183 Rylander H, Ramberg P, Blohme G, Lindhe J. Prevalence of periodontal disease in young diabetics. J Clin Periodontol 1987 Jan;14(1):38-43. Semenciw R, Morrison H, Mao Y, Johansen H, Davies JW, Wigle D. Major risk factors for cardiovascular disease mortality in adults: results from the Nutrition Canada Survey. Int J Epidemiol 1988; 17:317-24 Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 1990 Oct;121 (4):532-6 Strobel G. Show Me Your Mouth, I’ll Tell You About Your Heart. Harvard Medical School Focus [Internet] 1998 June 19 [cited 2003 Aug 19]. Available from: http://focus.harvard.edu/1998/June19_1998/complete.html Sznajder N, Carraro JJ, Rugna S, Sereday M. Periodontal findings in diabetic and nondiabetic patients. J Periodontol 1978 Sep;49(9):445-8 Szpunar SM, Ismail AI, Eklund SA. Diabetes and periodontal disease: analyses of NHANES I and HHANES. J Dent Res 1989;68(SI):164-438 (abstract 1605). Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, Pettitt DJ. Severe periodontitis and risk for poor glycemic control in patients with non- insulin-dependent diabetes mellitus. J Periodontol 1996 Oct;67(10 Suppl):1085-93. Willerson J, Ridker P. Inflammation as a Cardiovascular Risk Factor. Circulation 2004; 109:II-2 – II-10

160 – The Toothbrush Germ Theory

Wu T, Trevisan M, Genco R, Dorn J, Falkner K, Sempos C. Abstracts of the 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. Circulation 1999; 99:1109-1125 Chapter 5: The Secret Killer Abramson J. Drug Guidelines Fatten Bottom Lines. Los Angeles Times 2004 Jul 25 American Diabetes Association [Internet]. Alexandria (VA): American Diabetes Association; 2004 [cited 2004 Aug 24]. Available from: http://www.diabetes.org American Stoke Association [Internet]. Dallas: American Stoke Association. A Division of the American Heart Association; 2004 [cited 2004 Aug 24]. Available from http://www.strokeassociation.org Blake G, Rifai N, Buring J, Ridker P. Blood Pressure, C-Reactive Protein and Risk of Future Cardiovascular Events. Circulation 2003; 108:2993 Blaschke F, Bruemmer D, Yin F, Takata Y, Wang W, Fishbein M, Okura T, Higaki J, Graf K, Fleck E, Hsueh W, Law R. C-Reactive Protein Induces Apoptosis in Human Coronary Vascular Smooth Muscle Cells. Circulation 2004; 110:579-587 Fleming R. Stop Inflammation Now! New York: G.P. Putnam’s Sons; 2004. Fleming R, Boyd L, Forster M. Reversing Heart Disease in the New Millennium – the Fleming Unified Theory. Angiology 2000; 51:617-629 Harvard Women’s Health Watch. Your Heart Attack Risk: Inflammation Counts. 2003 Feb Kjellman O, Henriksson CO, Berghagen N, Andersson B. Oral conditions in 105 subjects with insulin-treated diabetes mellitus. Sven Tandlak Tidskr 1970 Feb;63(2):99-110. Lehr H, Sagban TA, Kirkpatrick CJ. Atherosclerosis – progression by nonspecific activation of the immune system. Med Kiln 2002; 97: 229-235 Libby P, Ridker P, Maseri A. Inflammation and Atherosclerosis. Circulation 2002; 105:1135 Manouchehr-Pour M, Bissada NF. Periodontal disease in juvenile and adult diabetic patients: a review of the literature. J Am Dent Assoc 1983 Nov;107 (5):766-70. Meggs WJ. The Inflammation Cure. Chicago: Contemporary Books; 2003 Miller LS, Manwell MA, Newbold D, Reding ME, Rasheed A, Blodgett J, Kornman KS. The relationship between reduction in periodontal inflammation and diabetes control: a report of 9 cases. J Periodontol 1992 Oct;63(10):843-8.

References - 161

National Heart, Lung, and Blood Institute [Internet]. Bethesda: National Heart, Lung, and Blood Institute; 2004. Available from http://www.nhlbi.nih.gov Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996 Oct;67 (10 Suppl):1103-13. Offenbacher S, Jared HL, O¹Reilly PG, Wells SR, Salvi GE, Lawrence HP, Socransky SS, Beck JD. Potential pathogenic mechanisms of periodontitis associated pregnancy complications. Ann Periodontol 1998 Jul;3(1):233-50. Pearson T, Mensah G, Alexander RW, Anderson JL, Carmon R, Criqui M, Fadl Y, Fortmann S, Myers G, Rifai N, Smith S, Taubert K, Tracy R. Markers of Inflammation and Cardiovascular Disease. Circulation 2003; 107: 499. Ridker P. C-Reactive Protein. Circulation 2003; 108:c108 Schindler T, Nitzsche E, Olschewski M, Magosaki N, Mix M, Prior J, Facta A, Solzbach U, Just H, Schelbert H. Chronic Inflammation and Impaired Coronary Vasoreactivity in Patients with Coronary Risk Factors. Circulation 2004; 110:1069-1075 Schmidt MI, Duncan BB, Sharrett AR, Lindberg G, Savage PJ, Offenbacher S, Azambuja MI, Tracy RP, Heiss G. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet 1999 May 15;353: 1649-52. Stauffer B. The Secret Killer. Time Magazine 2004 Feb 23: 38-46 Chapter 6: Finally, the Solution Has Arrived! Academy of General Dentistry [Internet]. Is Your Family Sharing too Much? Toothbrushes Harbor Hidden germs During Cold and Flu Season. Chicago: Academy of General Dentistry [cited 2003 July 12]. Biohazard on Your Toothbrush? [television broadcast]. ABC 7 News. KABC- TV, Los Angeles. 2002 Sept 26 Bock K, Bock S, Faass N. The Germ Survival Guide. New York: McGraw Hill; 2003 Chicago Dental Society. Dental Experts Warn: Change Toothbrushes More Often. Chicago: Chicago Dental Society [Internet] 2002 [cited 2002 Mar 11]. Available from http://www.chicagodentalsociety.org Fame or Shame: “Germ Terminator” [television broadcast]. Fox News Denver. KDVR-FOX, Denver. 2004 Jul 12 Fleming R. Stop Inflammation Now! New York: G.P. Putnam’s Sons; 2004 Gerba CP, Wallis C, Melnick. Microbiological Hazards of Household Toilets: Droplet Production and the Fate of Residual Organisms. Ap Micro 1975 Aug; 30(2):229-237

162 – The Toothbrush Germ Theory

Glass RT, Carson SR, Barker RL, Peiper SC, Shapiro S. Detection of HIV proviral DNA on toothbrushes: a preliminary study. J Okla Dent Assoc 1994 Winter; 84(3):17-20 Germ Terminator Sterilize Toothbrushes? Toothbrush Sterilizer Put to the Test [television broadcast]. FOX 6 Morning Show. FOX, San Diego. 2002 Jan 16 Germ Terminator Toothbrush Has 99.99% Kill Factor [television broadcast]. Channel 8 Eyewitness News. CBS. KLAS-TV, Las Vegas. 2003 July 29 Health News [television broadcast]. CNN Headline News. CNN. Atlanta. 2003 Jan 29 Matarese J. Toothbrush Germs. WCPO Cincinnati News [television broadcast]. WCPO, Cincinnati. 2004 Feb 24 Meggs WJ. The Inflammation Cure. Chicago: Contemporary Books; 2003 Morgan J. Your Toothbrush May be a Biohazard. USA Today 2000 April 27 Osborne O. The Toothbrush. New Haven Department of Health Monthly Bulletin; 1925 October; 10: 7. Also available from http://info.med.yale.edu/newhavenhealth/documents/historical/monthly/too thbrush.html Petty T. Accepting the Need for Overkill in Infection Control. J Can Dent Assoc 2000; 66; 186-187 Ridker P. C-Reactive Protein. Circulation 2003; 108:c81 Stauffer B. The Secret Killer. Time Magazine 2004 Feb 23: 38-46 Todar K. The Control of Microbial Growth. Madison: University of Wisconsin Pr; 2000 Wilde C. Hidden Causes of Heart Disease and Stroke. Valley Village (CA): Abigon Press, 2003 Zolnowski-Casey M. An Infection Control Procedure that is the Patient’s Responsibility. J Am Dent Assoc 1998; 129:616-617 Additional Resources Abrahams JJ, Glassberg RM. Dental disease: a frequently unrecognized cause of maxillary sinus abnormalities. AJR Am J Roentgenol (1996 May) 166(5):1219-23 Aldous JA, Powell GL, Stensaas SS. Brain abscess of odontogenic origin: report of case. J Am Dent Assoc (1987 Dec) 115(6):861-3 Alves J.A., Barrieshi K, Walton RE, Wertz P, Wilcox L, Drake D. J Dent Res 1996; 75 (special issue):373 abstract 2847).

References - 163

Andersen WC, Horton HL. Parietal lobe abscess after routine periodontal recall therapy. Report of a case. J Periodontol (1990 Apr) 61(4):243-7 Andra A. Massive infection of odontogenic origin (author's transl): Zentralbl Chir (1978) 103(8): 527-32 Andrews M, Farnham S. Brain abscess secondary to dental infection. Gen Dent (1990 May-Jun): 38(3):224-5 Asikainen S, Alaluusua S. Bacteriology of dental infections. Eur Heart J (1993 Dec) 14 Suppl K:43-50 Balogh G, Afra D, Inovay J. Endocranial abscess: complication of dental extraction. Rev Stomatol Chir Maxillofac (1972 Apr-May) 73(3):205-9 Bayer D, et al. Trigeminal Neuralgia an overview. Oral Surg. Oral Med Oral Pathol. 1979:48:393-9 Becarevici V. Acute delusion psychosis (acute delusion crisis) secondary to a dental infection. Rev Med Suisse Romande (1988 Mar) 108(3):257-62 Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996 Oct;67(10 Suppl):1123-1137 Berard R. Special characteristics of infection spread in temporary molars. Actual Odontostomatol (Paris) (1973 Dec) 27(104):707-18 Bergouignan H, Benoit P, Boussagol P, Brun G. Neuralgic syndrome of dental origin simulating an essential facial neuralgia. Rev Odontostomatol Midi Fr (1969) 27(2):124-5 Bermanowa G, Pietrowa N, Lalek A, Bujalska H. Dental focal infection in eye diseases (preliminary report). Czas Stomatol (1969 Oct) 22(10):923-6 Bianchi MA, Rosenberg SL, Murphy JB. Cervical necrosis and sinus tract formation secondary to a dentoalveolar infection: report of a case. J Oral Maxillofac Surg (1986 Nov) 44(11):894-6 Bonapart IE, Stevens HP, Kerver AJ, Rietveld AP. Rare complications odontogenic abscess: mediastinitis, thoracic empyema and cardiac tamponade. J Oral Maxillofac Surg (1995 May) 53(5):610-3

of

an

Bridgeman A, Wiesenfeld D, Hellyar A, Sheldon W. Major maxillofacial infections. An evaluation of 107 cases. Aust Dent J (1995 Oct) 40(5):281-8 Chidzonga MM. Necrotizing fasciitis of the cervical region in an AIDS patient: report of a case. J Oral Maxillofac Surg (1996 May) 54(5):638-40

164 – The Toothbrush Germ Theory

Chuikin SV. Immunological aspects of the effect of inflammatory diseases of the maxillofacial area on the brain. Stomatologiia (Mosk) (1989 May-Jun) 68(3):32-5 Churton MC Greer ND Intracranial abscess secondary to dental infection. N Z Dent J (1980 Apr) 76(344):58-60 Claesson et al. Production of volatile sulfur compounds by various Fusobacterium species. Oral Microbiol. Immunol. 5:137-142.(2080068) Cogan IC. Necrotizing mediastinitis secondary to descending cervical cellulitis. Oral Surg Oral Med Oral Pathol (1973 Sep) 36(3):307-20 Colmenero Ruiz C, Labajo AD, Yanez Vilas I, Paniagua J. Thoracic complications of deeply situated serous neck infections. J Craniomaxillofac Surg (1993 Mar) 21(2):76-81 Cordier J, Vexler C, Watrin E, Barisain P. Ocular inflammation of dental origin. Bull Soc Ophtalmol Fr (1965 Mar) 65(3):221-2 Cros P, Freidel A, Parret J. 3 studies on general infections with dental etiology and bacteriological proofs. Ann Odontostomatol (Lyon) (1969 Sep-Oct) 26(5):189-93 Cadenat H, Marcopoulos A, Gely P, Fabie M, Combelles R. 2 new cases of Melkersson-Rosenthal's syndrome. Rev Stomatol Chir Maxillofac (1971 Sep) 72(6): 635-42 Carter TB, Blankstein KC, White RP. Severe odontogenic infection associated with disseminated intravascular coagulation. Gen Dent (1992 Sep-Oct) 40(5):428-31 Currie WJ, Ho V. An unexpected death associated with an acute dentoalveolar abscess-- report of a case. Br J Oral Maxillofac Surg (1993 Oct) 31(5):296-8 Debelian GJ, Olsen I, Tronstad L. Systemic diseases caused by oral microorganisms. Endod Dent Traumatol (1994 Apr) 10(2):57-65 Droz D, Koch L, Lenain A, Michalski H. Bacterial endocarditis: results of a survey in a children's hospital in France Br Dent J (1997 Aug 9) 183(3):101-5 Economopoulos GC, Scherzer HH, Gryboski WA. Successful management of mediastinitis, pleural empyema, and aortopulmonary fistula from odontogenic infection. Ann Thorac Surg (1983 Feb) 35(2):184-7

References - 165

Elsner R, Koch H. Errors and dangers in treatment of odontogenic infections with antibiotics. Quintessenz (1977 Oct) 28(10):137-40 Esgaib AS, Silva AC, Meira EB, Kassab GE, Salvestro E, de Souza MM, Steinberg O, Lyra R, Ghefter M. Mediastinitis following dental infection: report of 2 cases. Rev Paul Med (1986 Sep-Oct) 104(5):283-5 Esgaib AS ,Ghefter MC, Lyra R, Guidugli RB, Trajano AL, Ferreira SM. Mediastinitis after cervical suppuration. Rev Paul Med (1992 Sep-Oct) 110(5):227-36 Essioux H, Burlaton J, Legros J, Daly JP, Molinie C, Laverdant C. Recurrent suppurative meningitis of dental origin in Behcet's disease. Actual Odontostomatol (Paris) (1982) 36(139):355-60 Fleischhacker H, Stacher A. On the effect of dental focal infection on the course ofhematologic diseases. Osterr Z Stomatol (1969 Jun) 66(6):210-4 Fromm G., et al Trigeminal Neuralgia. Current concepts regarding etiology and pathogenesis. Arch Neurol 1984;41: 1204-7 Gallagher DM, Erickson K, Hollin SA. Fatal brain abscess following periodontal therapy: a case report. Mt Sinai J Med (1981 Mar-Apr) 48(2):158-60 Garatea-Crelgo J, Gay-Escoda C. Mediastinitis from odontogenic infection. Report of three cases and review of the literature. Int J Oral Maxillofac Surg (1991 Apr) 20(2):65-8 Gawrzewska B, Wedler A, Fijal D. Results of studies on the removal of active infectious foci in the treatment of diseases caused by odontogenic focal infections. Czas Stomatol (1976 Dec) 29(12):1099-103 Genco R. Current View of Risk Factors for Periodontal Disease; J. Periodontol Oct 1996 George W, Brian A, et al. Severe Periodontitis and Risk for poor Glycemic Control in patients with Non-Insulin Dependant Diabetes Mellitus J. Periodontol Oct 1996 Ghanassia R. Septicemia of dental origin. Inf Dent (1975 Mar 27) 57(13):29-32 Glavind L, Lund B, Löe H. The relationship between periodontal state and diabetes duration, insulin dosage and retinal changes. J Periodontol 1968 Nov;39(6):341-7. Gonnon F, Perrin-Fayolle M. Incidence of the bucco-dental infections on acute and chronic bronchopulmonary infections. Ligament (1978) 16(129):25-32

166 – The Toothbrush Germ Theory

Gotte P. Death after a dental infection. Minerva Stomatol (1979Jul-Sep) 28(3):241-3 Gray RL. Peripheral facial nerve paralysis of dental origin. Br J Oral Surg (1978 Nov) 16(2):143-50 Guittard P, Ducasse JL, Jorda MF, Eschapasse H, Lareng L. Mediastinitis caused by odontogenic anaerobic bacteria. Ann Fr Anesth Reanim (1984) 3(3):216-8 Harris M. Dental infection and the eyes. Dent Health (London) (1966 Jul-Sep) 5(3):47-50 Harsanyi L, Schweitzer K. The focus of dental infection. Adatok a fogaszati goc kerdesehez. Fogorv Sz (1991 Dec) 84(12):369-74 Hedstrom SA, Nord CE, Ursing B. Chronic meningitis in patients with dental infections. Scand J Infect Dis (1980) 12(2):117-21 Heilelman JF, Dirlam JH. Severe cellulitis of dental origin with gas-producing bacteria. J Indiana Dent Assoc (1982 May-Jun) 61(3):11-3 Heimdahl A, Mattson T, Dahllöf F, Lonnquist B, Ringden O. The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation. Oral Surg Oral Med Pathol 1989;68:711-6. Hendler BH, Quinn PD. Fatal mediastinitis secondary to odontogenic infection. J Oral Surg (1978 Apr) 36(4):308-10 Henig EF, Derschowitz T, Shalit M, Toledo E, Tikva P, Aviv T. Brain abscess following dental infection. Oral Surg Oral Med Oral Pathol (1978 Jun) 45(6):955-8 Herzberg MC, Meyer MW. Effects of oral flora on platelets: possible consequences in cardiovascular disease. J Periodontol 1996 Oct;67(10 Suppl):1138-1142 Hess JC, Victor M. Relation between rheumatology and endodontics. Ligament (1978) 16(129):19-21 Hollister MC, Weintraub JA. The association of oral status with systemic health, quality of life, and economic productivity. J Dent Educ (1993 Dec) 57(12):901-12 Horiba et al. Oral Surg. Oral Med. Oral Path. 1991 Vol 71 Hunter N. Focal infection in perspective. Oral Surg Oral Med Oral Pathol (1977 Oct) 44(4):626-7

References - 167

Huurman PM. Root canal therapy and focal infection. Dtsch Stomatol (1965 Dec) 15(12):938-40 Iida M, Yamaguchi Y. Remission of rheumatoid arthritis following periodontal treatment. A case report. Nippon Shishubyo Gakkai Kaishi (1985 Mar) 27(1):234-8 Ingham HR, Kalbag RM, Tharagonnet D, High AS, Sengupta RPm Selkon JB. Abscesses of the frontal lobe of the brain secondary to covert dental sepsis. Lancet (1978 Sep 2) 2(8088):497-9 IM Dhanarajani PJ. Cervical cellulitis and mediastinitis caused by odontogenic infections: report of two cases and review of literature. J Oral Maxillofac Surg (1995 Feb) 53(2):203-8 Janicke S, Kettner R, Kuffner HD. A possible inflammatory reaction in a lateral neck cyst (branchial cyst) because of odontogenic infection. Int J Oral Maxillofac Surg (1994 Dec) 23(6 Pt 1):369-71 Kicinski J. Tooth infection as a course of puerperal sepsis. Pol Tyg Lek (1971 Jul 5) 26(27):1047-8 Klammt J. Life endangering complications of acute odontogenous infections in the era of antibiotics. Dtsch Gesundheitsw (1969 Sep 4) 24(36):1695-8 Kruchinskii GV, Korsak AK, Myshkovskii VA, Ryneiskii SP. Experience with the diagnosis and treatment of secondary odontogenic mediastinitis. Stomatologiia (Mosk) (1989 Nov-Dec) 68(6):15-7 Lachard J, Cremieu A, Jars G, Ged S, Kaplanski P. 4 cases of Osler's disease. Rev Stomatol Chir Maxillofac (1970 Jul-Aug) 71(5):405-10 Larik ML, van Zanten TE, van der Waal I, van der Kwast WA. Lung disease resulting from osteomyelitis of the mandible. Ned Tijdschr Tandheelkd (1978 Nov) 85(11):428-30 Latronica RJ, Shukes R. Septic emboli and pulmonary abscess secondary to odontogenic infection. J Oral Surg (1973 Nov) 31(11):844-7 Lee SH, Kim JS, Kwack DH, Jung Y. A case report of odontogenic infection leading to fatal mediastinitis. Taehan Chikkwa Uisa Hyophoe Chi (1989 Mar) 27(3):279-86 Levine TM, Wurster CF, Krespi YP. Mediastinitis occurring as a complication of odontogenic infections. Laryngoscope (1986 Jul) 96(7):747-50 Levinson SL, Barondess JA. Occult dental infection as a obscure origin. Am J Med (1979 Mar) 66(3):463-7

cause

of

fever

of

168 – The Toothbrush Germ Theory

Lieberman MB. A life-threatening, spontaneous, periodontitis-induced infective endocarditis. J Calif Dent Assoc (1992 Sep) 20(9):37-9 Loesche WJ. Association of the oral flora with important medical diseases. Curr Opin Periodontol (1997) 4:21-8 Lutsik LA. Streptococcal chroniosepsis complicated by meningoencephalitis with a fatal outcome. Stomatologiia (Mosk) (1979 Nov-Dec) 58(6):55-6 Madeira AA, Lopes GV. Study of the hematological changes in thirty patients with chronic dental infection, before and after surgical treatment (author's transl). Arq Cent Estud Fac Odontol UFMG (Belo Horiz) (1976 Jan-Dec) 13(1-2):177-88 Marchan Carranza E, Gijon Rodriguez J, Mantes German I. Septic pulmonary embolism secondary to dental focus. Lemierre's syndrome. (letter; comment) Arch Bronconeumol (1994 Nov) 30(9):473-4 Mark E, et al. Exploratory Case Control Analysis of Psychosocial Factors and Adult Periodontitis J. Periodontol Oct 1996 Marks PV, Patel KS, Mee EW. Multiple brain abscesses secondary to dental caries and severe periodontal disease. Br J Oral Maxillofac Surg (1988 Jun) 26(3):244-7 Marty-Ane CH, Alauzen M, Alric P, Serres-Cousine O, Mary H. Descending necrotizing mediastinitis. Advantage of mediastinal drainage with thoracotomy. J Thorac Cardiovasc Surg (1994 Jan) 107(1):55-61 Mattila KJ. Dental infections as a risk factor for acute myocardial infarction. Eur Heart J (1993 Dec) 14 Suppl K:51-3 Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis (1993 Nov) 103(2):205-11 McCurdy JA Jr, MacInnis EL, Hays LL. Fatal mediastinitis after a dental infection. J Oral Surg (1977 Sep) 35(9):726-9 Meurman JH. Dental infections and general health. Quintessence Int (1997 Dec) 28(12):807-11 Mojseowicz K, Czerwinski F, Linnik-Kabat A. Intracranial complications as a consequence of purulent acute inflammatory processes on the face and in the oral cavity. Czas Stomatol (1971 Jun) 24(6):623-7 Molchanova KA, Stepanova TV. Clinical picture and therapy of odontogenic mediastinitis. Khirurgiia (Mosk) (1971 Jan) 47(1):79-83

References - 169

Moncada R, Warpeha R, Pickleman J, Spak M, Cardoso M, Berkow A, White H. Mediastinitis from odontogenic and deep cervical infection. Anatomic pathways of propagation. Chest (1978 Apr) 73(4):497-500 Montejo M, Aguirrebengoe K. Streptococcus oralis meningitis after dental manipulation [letter] Oral Surg Oral Med Oral Pathol Oral Radiol Endod (1998 Feb) 85(2):126-7 Morer G. Letter: Arthritis of the knee healed after dental avulsion. Arthrites du genou gueries apres vulsion dentaire Nouv Presse Med (1975 Oct 4) 4(32):2338 Morey-Mas M, Caubet-Biayna J, Iriarte-Ortabe JI. Mediastinitis as a rare complication of an odontogenic infection. Report of a case. Acta Stomatol Belg (1996 Sep) 93(3):125-8 Musgrove BT, Malden NJ. Mediastinitis and pericarditis caused infection. Br J Oral Maxillofac Surg (1989 Oct) 27(5):423-8

by

dental

N. Tani et al J. Endo 18:2 1992 Newman HN. Focal infection revisited--the dentist as physician [editorial] J Dent Res (1992 Nov) 71(11):1854 Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, McKaig R, Beck J. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996 Oct;67(10 Suppl):1103-1113 Orlenko MA, Tsymbaliuk VP, Katsnel'son BM. Odontogenic staphylococcus sepsis. Stomatologiia (Mosk) (1975 Nov-Dec) 54(6):81-2 Paunio K, Impivaara O, Tiekso J, Maki J. Missing teeth and ischaemic heart disease in men aged 45-64 years. Eur Heart J (1993 Dec) 14 Suppl K:54-6 Pernice L, Ribault JY, Fourestier J, Gacon J, Quilichini R, Aubert L, Chaffanjon P, Roubaudi G. Persistent fever of dental origin. Rev Stomatol Chir Maxillofac (1990) 91 Suppl 1:137-8 Persson et al. The formation of hydrogen sulfide and methyl mercaptan by oral bacteria. Oral Microbiol. Immunol. 5:195-201.(2082242) Petrone JA. Mediastinal abscess and pneumonia of dental origin. J N J Dent Assoc (1992 Autumn) 63(4):19-23 Piperno D, Gaussorgues P, Leger P, Gerard M, Boyer F, Tigaud S, Pignat JC, Robert D. Mediastinitis caused by anaerobic bacteria. 4 cases. Presse Med (1987 Nov 14) 16(38):1889-90

170 – The Toothbrush Germ Theory

Plohberger HM. Cancer and focal infection. Osterr Z Stomatol (1974 Apr) 71(4):138-41(Published in German) Ogundiya DA, Keith DA, Mirowski J. Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. J Oral Maxillofac Surg (1989 Dec) 47(12):1317-21 Reil Bm Koblin I. Catamnestic surveys in 371 cases of abscess of the maxillofacial region in childhood. Dtsch Zahnarztl Z (1976 Feb) 31(2):182-4 Renton TF, Danks J, Rosenfeld JV. Cerebral abscess complicating dental treatment. Case report and review of the literature. Aust Dent J (1996 Feb) 41(1):12-5 Robustova TG, Gubin MA, Kharitonov IuM, Girko EI. The diagnosis and treatment of contact odontogenic mediastinitis. Stomatologiia (Mosk) (1996) 75(6):28-32 Root TE, Silva EA, Edwards LD, Topp JH. Hemophilus aphrophilus endocarditis with a probable primary dental focus of infection. Chest (1981 Jul) 80(1):109-10 Rouchon. Distant manifestations of bucco-dental origin in children. Med Infant (Paris) (1965 May) 72(5):341-9 Rousselie F. Eye infections of dental origin. Ligament (1978) 16(129):15-7 Rubin MM, Cozzi GM. Fatal necrotizing mediastinitis as a complication of an odontogenic infection. J Oral Maxillofac Surg (1987 Jun) 45(6):529-33 Ruzin GP, Zakharov IuS, Bolgov DF. A case of odontogenic osteomyelitis of the maxilla complicated by meningitis. Stomatologiia (Mosk) (1974 SepOct) 53(5):87-8 Sadowsky C. The tooth and periodontium as a site of focal infection. Diastema (1968) 2(3):43-7 Sallum AW, do Nascimento A, de Souza CA. Periodontal infection and disease as potential factors affecting the patients health. Bol Fac Odontol Piracicaba (1974) 75:1-12 Sara G, et al. Response to Periodontal Therapy in Diabetics and Smokers. J Periodontol Oct 1996 Sazonov AM, Muromskii IuA, Plotnikov NA, Zubkova LF, Troianskii Odontogenic mediastinitis. Grudn Khir (1977 Jul-Aug)(4):82-6

IV.

References - 171

Scannapieco FA, Mylotte JM. Relationships between periodontal disease and bacterial pneumonia. J Periodontol 1996 Oct;67(10 Suppl):1114-1122 Scheffer P, Ouazzani A, Esteban J, Lerondeau JC. Serious cervicofacial infections of dental origin. (Infections graves cervico-faciales d'origine dentaire.) Rev Stomatol Chir Maxillofac (1989) 90(2):115-8 Schotland C, Stula D, Levy A, Spiessl B. Brain abscess after odontogenic infection. SSO Schweiz Monatsschr Zahnheilkd (1979 Apr) 89(4):325-9 Seymour RA, Steele JG. Is there a link between periodontal disease and coronary heart disease. Br Dent J (1998 Jan 10) 184(1):33-8 Evidence suggests that dental health, in particular periodontal disease, may be a significant risk factor for coronary heart disease and further coronary events. Shimizu K, Toyota Y, Koh T, Ishikawa M, Hirose Y. A case of rheumatoid arthritis caused by focal infection from periodontal tissue (author's transl). Josai Shika Daigaku Kiyo (1977)(6):421-4 Shinoda T, Mizutani H, Kaneda T, Suzuki M. Fever of unknown origin caused by dental infection. Report of a case. Oral Surg Oral Med Oral Pathol (1987 Aug) 64(2):175-8 Siegel EB, Friedlander AH, Mongiardo JJ, Klebsiella.. Pneumonia facial fistula secondary to non-vital tooth. A case report. N Y State Dent J (1976 May) 42(5):291-2 Smith RW, Taylor RG, O'Connor JF. Dental infection: a source of pulmonary emboli. Oral Surg Oral Med Oral Pathol (1967 Aug) 24(2):158-63 Sobolewska E, Skokowski J, Jadczuk E. Pleural empyema as a complication of descending necrotizing mediastinitis. Pneumonol Alergol Pol (1997) 65(56):364-9 Steiner M, Grau MJ, Wilson DL, Snow NJ. Odontogenic infection leading to cervical emphysema and fatal mediastinitis. J Oral Maxillofac Surg (1982 Sep) 40(9):600-4 Stevenson GW, Gossman HH. Dental and intracranial actinomycosis. Br J Surg (1968 Nov) 55(11):830-4 Stortebecker P. Dental significance of pathways for dissemination from infectious foci. J Can Dent Assoc 33:6 1967 pp301-311 Stortebecker TP. Spreading hazards from infection foci. Sprindningsvagar fr~an infektiosa foci. Sven Tandlak Tidskr (1966 Feb 15) 59(2):99-107

172 – The Toothbrush Germ Theory

Strauss SI, Stern NS, Mendelow H, Spatz SS. Septic superior sagittal sinus thrombosis after oral surgery. J Oral Surg (1973 Jul) 31(7):560-5 Stypulkowski C, Lagan W, Stypulkowska J. Chronic focal oral infection as a factor causing the appearance of hemorrhagic hyperglobulinemic purpura of Waldenstrom. Pol Tyg Lek (1965 May 17) 20(20):734-5 Sugata T, Fujita Y, Myoken Y, Fujioka Y. Cervical cellulitis with mediastinitis from an odontogenic infection complicated by diabetes mellitus: report of a case. J Oral Maxillofac Surg (1997 Aug) 55(8):864- 9 Sukin L. Periodontal disease, focal infection and systemic health. J N J Dent Assoc (1975 Winter) 46(2):26-9, 47 Tamura M, Minemura T, Kurashina K, Kotani A. Mediastinitis caused by odontogenic infection associated with adult respiratory distress syndrome. Oral Surg Oral Med Oral Pathol (1992 Jul) 74(1):15-8 Terezhalmy GT, Bottomley WK. Pulmonary nocardiosis associated with primary nocardial infection of the oral cavity. Oral Surg Oral Med Oral Pathol (1978 Feb) 45(2):200-6 Thoden van Velzen SK, Abraham-Inpijn L, Moorer WR. Plaque and systemic disease: a reappraisal of the focal infection concept. J Clin Periodontol (1984 Apr) 11(4):209-20 Timosca G, Gogalniceanu D, Barna M, Streba P, Vicol C, Popescu E. Suppurative cervico-mediastinitis of odontogenic origin. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Stomatol (1989 Oct-Dec) 36(4):291-301 Taicher S, Garfunkel A, Feinsod M. Reversible cavernous sinus involvement due to minor dental infection. Report of a case. Oral Surg Oral Med Oral Pathol (1978 Jul) 46(1):7-9 Unteanu G, Solacolu VI. Problems concerning the etiopathogenesis of bronchopulmonary suppurations. Pneumoftiziol (1976 Jan-Mar) 25(1-2):23-6 Valachovic R, Hargreaves JA. Dental implications of brain abscess in children with congenital heart disease. Case report and review of the literature. Oral Surg Oral Med Oral Pathol (1979 Dec) 48(6):495-500 Wahl MJ. Clinical issues in the prevention of dental-induced endocarditis and prosthetic joint infection. Pract Periodontics Aesthet Dent (1995 Aug) 7(6):29-36 Webster AC, Parnell AG. The management of respiratory obstruction secondary to odontogenic infection--case report. Can Anaesth Soc J (1972 May) 19(3):299-304

References - 173

Whyman RA et al. Oral Surg Oral Med Oral Pathol 1994 Jul;78(1):47-50 Younessi OJ, Walker DM, Ellis P, Dwyer DE. Fatal Staphylococcus aureus infective endocarditis: the dental implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod (1998 Feb) 85(2):168-72 Zachariades N, Mezitis M, Stavrinidis P, Konsolaki- Agouridaki E. Mediastinitis, thoracic empyema, and pericarditis as complications of a dental abscess: report of a case. J Oral Maxillofac Surg (1988 Jun) 46(6):493-5

Index A AIDS (Auto Immune Deficiency Syndrome), 43, 69 Alzheimer's disease, 31 development of, 107 inflammation and, 94, 103, 105, 107 American Academy of Periodontology, 85, 89 American Cancer Society, 108 American Dental Association, 27, 59 American Dental Hygienists Association, 54, 71, 87, 89 American Diabetes Association, 91 American Heart Association, 70, 98 American Stroke Association, 85 antibiotics, 36, 37, 42, 50 antibiotic resistance, 43, 44, 130, 131 before oral surgery, 8 antiseptic solutions, 14 bleach, 127 hydrogen peroxide, 14 Listerine, 127, 128 mouthwash, 13, 128 rubbing alcohol, 14 atheroma, 70 atherosclerosis, 70, 74, 86 bacteria and, 68, 72, 74 development of, 70, 72, 74 inflammation and, 73, 86, 101 autoclave, 117 B bacteria cultivated in the lab, 47

directly into bloodstream, 11, 27, 30, 45, 50, 58, 61, 62, 75 focal infection, 54, 57, 58, 59, 64 removed while brushing, 8, 10, 20, 25 bathroom"bacterial mist", 123 bacteria contamination, 10, 25, 62, 122, 124, 125, 137 dirtiest room in the house, 10, 122 bleach, 127 blood clots, 72, 84 boiling water, 127, 129 breast cancer, 41 Bruce, Debra, 50 C Canadian Dental Association, 45, 124 cancer, 31, 39, 69, 98, 107, 108 infectious causation of, 31, 39, 41, 42 inflammation and, 94, 103, 105, 109 Candida, 15, 26, 135 cardiovascular disease. See heart disease or stroke cavities. See dental caries cervical cancer infectious causation of, 39, 40 Chlamydia pheumoniae, 74 cholesterol, 72, 98, 99, 102 atherosclerosis and, 70, 99, 100, 101, 102, 104 inflammation and, 101, 109 statin drugs, 53, 69, 98, 99 chronic infection, 55, 57, 58, 59, 66, 88, 105, 107, 113 infectious causation of, 45, 53, 56, 57, 61, 90 inflammation and, 56, 68, 73, 86, 110, 111

Index - 175

Clemmensen, 39 cold virus (Rhinovirus), 135 common cold. See Rhinovirus community cup, 10, 124 Coussens, Lisa, 109 C-reactive protein (CRP), 16, 73, 86, 102 cross-contamination, 15, 75, 137 cytomegalovirus, 74 D dental caries infectious causation of, 10, 15 diabetes, 31, 98, 105, 106, 107 infectious causation of, 9, 34, 41, 53, 87, 90 inflammation and, 94, 103, 105, 106, 112 periodontal disease and, 87, 88, 91, 107, 112 Discovery Channel. See Myth Busters dry heat, 133, 137 E

E. coli, 8, 48, 116, 135 on toothbrushes, 7, 25, 75 endotoxins, 71 Ewald, Paul W, 40, 41, 42, 43, 66 F FDA (Food and Drug Administration), 9, 10, 24, 133 Medical Device Application 510(k), 136 fecal coliforms, 25, 26, 30, 75 Fleming, Richard, 97 Flemings, Merton, 117 flu virus. See Influenza focal infection, 54, 57, 58, 59, 63, 64

G Gammal, Robert, 63 Garcia, Raul, 57 Genco, Caroline, 68, 74, 86 Gerba, Charles, 122, 123, 124 Germ Terminator, 16, 28, 30, 133, 134, 136, 138, 139 in the news, 138 infomercial, 7, 27 storage chamber, 137 germ theory of disease, 34 Ewald, Paul W, 40, 41, 42, 43 Germ Theory Part II, 41, 42, 43 new germ theory, 35, 40, 43 germs. See bacteria giardia, 9 gingivitis. See periodontal disease gum disease. See periodontal disease H hand washing. See Semmelweis general public, 18, 19 hospital staff, 17, 18, 19, 23 heart attack. See heart disease heart disease, 31, 92, 107 cholesterol and, 69, 71, 98, 99, 102 development of, 68, 70, 99 heart attack, 69, 72, 86, 99, 104 infectious causation of, 9, 31, 34, 41, 42, 43, 71, 72, 73, 74, 76, 85, 86, 90, 99 inflammation and, 73, 74, 94, 98, 100, 101, 102, 103, 104, 110, 112 periodontal disease and, 68, 71, 88, 91, 112

176 - The Toothbrush Germ Theory

Helicobacter pylori, 35, 36, 37, 38, 72 hepatitis, 15 hepatitis C, 43, 135 Herpes Simplex Type - 1, 15, 26, 135 HIV (human immunodeficiency virus), 15, 135 hospitals deaths from infection, 17, 18, 19 infection control, 17, 18, 19 HPV (human papillomavirus), 39 hydrogen peroxide, 14 hydrogen sulphide, 59 I immune system, 45, 61, 89, 90, 93, 95, 96, 98, 100, 101, 103, 105, 106, 107 infection control, 14, 46, 47, 51, 76 hand washing, 23 procedures, 46 infectious disease, 31, 41, 43, 46 inflammation, 16, 73, 89, 92, 93, 98, 100, 101, 104, 106, 113 chronic response, 110, 111, 112, 114 development of, 92, 93, 94, 97, 102, 103, 109 infectious causation of, 44, 68, 72, 73, 86, 105, 111 periodontal disease and, 55, 73 Influenza A Virus, 15, 26, 135 Interleukin-6, 16, 100 Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC), 19, 67

K Klokkevold, Perry, 87 Koch, Robert, 34, 42 Koop, C. Everett, 112 L lab testing

Candida albicans, 135 E. coli, 135 FDA registered laboratories, 134 Germ Terminator, 134, 136 hepatitis C, 135 Herpes simplex virus type 1, 135 HIV, 135 independent laboratories, 134, 137 Influenza A Virus (Flu Virus), 135 Listeria monocytogenes, 135 Neisseria meningitidis, 135 Porphyromonas gingivalis, 135 Rhinovirus (cold virus), 135 Salmonella choleraesuis, 135 Staphylococcus aureus, 135 Lister, Joseph, 23 Listeria monocytogenes, 135 Listerine, 128 low birth weight infectious causation of, 53, 89 periodontal disease and, 89, 91 lung diseaseinfetious causation of, 53 periodontal disease and, 91 M macrophage, 96, 103, 108 Mann, Madeline, 88 Marler, John, 84 Marshall, Barry, 35, 36, 37, 38, 72, 118 medical device

Index - 177

Germ Terminator, 133, 136 toothbrush, 9, 10, 24, 61 Meggs, William Joel, 109, 110, 111, 112, 119 mental illness, 42 methyl mercaptans, 59 MIT Lemelson Invention Index, 116, 117 mouthportal of infection, 10 mouthwash, 13, 128 Listerine, 128 Myth Busters, 30 N

Neisseria meningitidis, 135 O oral health, 10, 21, 54, 115, 117, 143, 146 Surgeon General's Report, 52, 53, 54, 87, 89 oral infections, 52, 55, 56, 57, 66, 68, 71, 73, 86, 87, 88, 89, 90, 105, 110, 111, Also see periodontal disease P Parkinson’s disease inflammation and, 31 Pasteur, Louis, 23, 34 peptic ulcers. See stomach ulcers periodontal disease, 52, 55, 68, 73, 90, 111 gingivitis, 55 heart disease, 68 increased risk of death, 57 infectious causation of, 10, 15, 26, 55, 56, 57 periodontitis, 55 Porphyromonas gingivalis, 68

periodontitis. See periodontal disease, See periodontal disease Petri dish, 9, 30, 60 Plank, Max, 118 Pneumococcus, 50 pneumonia, 9, 53, 65 Porphyromonas gingivalis, 26, 71, 135 gum disease, 68 heart disease study, 68 premature birth, 88 infectious causation of, 53, 89, 90 periodontal disease and, 89, 91 R Rammelsberg, Anne, 130 Relman, David, 47 rheumatoid arthritis, 31, 107 inflammation and, 94, 103, 105 Rhinovirus, 15 Ridker, Paul, 92, 101, 102, 119 Rift Valley fever, 43 rubbing alcohol, 14 S

Salmonella choleraesuis, 135 SARS, 43 Satcher, David, 53 schizophrenia, 41 Semmelweis, Ignac, 22, 24, 28, 34, 42, 118 sepsis, 57, 58 Shoelson, Steve, 106 skeptics, 27 Staphylococcus, 15, 26, 50, 135 on toothbrushes, 49 steam, 126, 133, 134 Stern, Rigoni, 39 stomach ulcers, 33, 36, 37, 40 storage chamber, 127, 137 Streptococcus, 15, 26, 49 on toothbrushes, 49 strokedevelopment of, 84, 85,

178 - The Toothbrush Germ Theory

103 infectious causation of, 9, 34, 53, 72, 84, 85, 86, 90 inflammation, 101 inflammation and, 103, 104, 112 periodontal disease and, 84, 85, 88, 91, 112 T tap water, 8, 13, 14, 121 Thompson, Kimberly, 50 Thun, Michael, 108 toothbrush bacterial growth, 14, 26, 27, 120 bathroom contamination, 10, 25, 62, 122, 125 community cup, 10 contaminated with 100 million germs, 9, 24 contaminated with fecal bacteria, 25, 30 cross-contamination, 15, 75 FDA registered medical device, 9, 10, 24, 61 lacerates the gums, 61, 62, 75 most popular invention, 116 replacement, 13, 14, 120 sharp bristles, 10, 45, 50, 61, 75 transmit disease, 15, 16, 27, 45 toothpasteantimicrobial, 14 tuberculosis, 42, 43, 50 U U.S. Centers for Disease Control, 26, 76, 140 U.S. Surgeon General, 9, 52, 53, 54, 87, 89, 92, 112, 143, 145 David Satcher MD, PhD, 53 Oral Health Report, 52, 53, 54, 87, 89 Oral Health Report, 52

ulcers. See stomach ulcers ultraviolet (UV) light, 127, 129, 130, 131, 132 W Warren, Robin, 35, 36, 37, 38 Z Zolnowski-Casey, Mary, 129 Zur Hausen, Harald, 39

“If you care about your long-term health, this is a must read.” -- Stephen Langer, M.D., Author: Solved: The Riddle of Illness Know the serious long-term health risks caused by unsanitized toothbrushes and lingering low-level oral-germ infections that you never knew existed and why everyone is at risk.

THE TOOTHBRUSH GERM THEORY describes one man’s mission to inform the public about a serious health threat that most of us have never even thought about — chronic brushing with germ-contaminated toothbrushes. It is undisputed by dentists, physicians, dental hygienists, and micro-biologists that toothbrushes, once used, become dental biohazards. This book tells an alarming story of the silent, pathogenic germs that grow and breed inside the pointed bristles of our toothbrushes; prickly toothbrush bristles that cause daily microscopic cuts and abrasions to the soft, mucous-membrane tissues of the oral cavity, consequently, injecting germs (and their corresponding endotoxins) directly into our bloodstreams. By brushing with chronically dirty toothbrushes, we risk infecting our mouths with germs that can spread throughout the body — to the heart, kidneys, liver, brain, and anywhere else our bloodstreams will take them. Once they arrive at their destinations, they can nest, flourish, and take on lives of their own, causing silent havoc and constant stress to our immune systems. The counterattack launched by our immune systems produces a quiet inflammatory build-up throughout our bodies. Year after year, decade after decade, this chronic inflammation, the buzzword in medical research today, may promote devastating diseases and health problems including, but not limited to, heart and lung disease, stroke, diabetes, Alzheimer’s, bacterial pneumonia, adverse pregnancy outcomes, cancer, chronic fatigue, and many other chronic degenerative diseases. Brushing with contaminated toothbrushes turns the practice of oral hygiene on its head and may help explain why 90% of adults suffer from some form of periodontal (gum) disease. Furthermore, it may be destructive to long-term health, and is diametrically opposite to contemporary medical knowledge combined with common sense, which tells us that if something is dirty, it should be cleaned. The author of this eye-opening book not only states his theory, but he offers the solution.

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