Dental / Oral Health
The oral microbiome is part of the gateway of our health for the entire body. The state of health of your gums reflects the health of the tissue of the heart. The mouth houses the second most diverse microbial community in the body, harbouring over 700 species of bacteria that colonise the hard surfaces of teeth and the soft tissues of the oral mucosa.
Different body sites support completely distinct microbial communities due to differences in biological and physical properties of each area. The most diverse bacterial populations are found in the gastrointestinal tract and the mouth. A detailed study of 9 oral sites in 26 subjects using DNA sequencing revealed a mean of 296 species-level taxa in each individual, while 557 taxa were found among the 26 subjects.
The environment of the mouth suits the growth of many microorganisms and offers host-derived nutrients, such as saliva proteins, glycoproteins and gingival crevicular fluid (GCF). The teeth are the only natural non-shedding surfaces in the human body and thus allow opportunities for pervasive biofilm formation and ongoing microbial development, not unlike barnacles developing on the hull of a boat. Dental restorations, crown and bridgework, removable prostheses and implants all add non-shedding surfaces in the mouth that can increase biofilm formation and composition.
Salivary components are the primary nutritional source for microorganisms, and thus are required for the growth of a balanced microbiome. Saliva also allows for flourishing biofilms, and allows growth of the layers of plaque. This biofilm is a range of microbes that live together. Some bacteria are initial colonisers, others only move in when conditions are exactly right. Plaque biofilm is dislodged during speech and mastication and by the flow of saliva. Disruption of the microbiome due to illness, medication or change in saliva, allows disease-promoting bacteria to grow, causing issues such as caries, gingivitis and periodontitis. Biological changes in a person’s life can affect the balance of the oral microbiome, including age, or hormonal changes during puberty and pregnancy.
Initially, it was believed that dental infections develop from the nonspecific over-growth of all bacteria in dental plaque. Then in the 1980s, an ecological plaque hypothesis developed, enveloping the relationship between the host environment, the resident oral microbiota, and oral diseases. This hypothesis awakens the concept that disease can be prevented, by inhibiting pathogens, but also by changing the environmental factors which favour the bacteria. For example, an increased frequency of sugar intake, or a reduction in saliva flow, can lead to plaque biofilms that are exposed for longer periods to lower pH levels, resulting in caries.
The ecological plaque hypothesis was further developed by the concept that specific low-abundance microbial pathogens can lead to inflammatory disease by interfering with the host immune system, which affects the microbiota, opening the pathway to gingivitis and periodontitis.
The June 2020 British Dental Journal published a study suggesting the link between the oral microbiome and COVID-19 complications. There was increased risk of complications and death also associated with altered oral biofilm, and periodontal disease. Periodontopathic bacteria are implicated in inflammation, bacteraemia, pneumonia and even death. Bacterial superinfections are common in patients with a severe case of COVID-19, noted in more than 50% of deaths.
Lifestyle issues which are detrimental to oral health:
- Smoking
- Vaping: e-cigarette use demonstrates more oral health issues and poor gum health than non-smokers
- Mouthwash: long term and/or multiple daily use of mouthwash is associated with increased risk of oral cancer
Habits to improve dental health:
- Brushing every day, at least twice daily
- Flossing is as important as brushing
- Avoiding highly processed foods which stick to the teeth, creating more opportunities for bacteria to flourish
- Consider avoid toothpaste which contains sodium laurel sulphate, which is disruptive to the oral muscosa
- It is essential to work on breathing through your nose as mouth breathing is highly detrimental to oral microbiome
- If you clench or grind your teeth, this can lead to issues with teeth and jaw, and is a symptom of stress, which needs to be addressed and resolved. (See my handout on this)
Supplements to help with oral health:
- vitamin A
- Vitamin C
- Vitamin D
- Vitamin E
- Folate
- Calcium
- CoQ10: improved gum health
- Omega-3 fatty acids: long term fish oil intake improves markers of gum disease
- Probiotics:
Probiotics can be used to prevent the demineralisation of enamel, improve periodontal health, eliminate halitosis and reduce the prevalence of C. albicans in adults.
Scientific research has demonstrated that probiotics has helped with the following:
- daily probiotic consumption in children showing the significant lowering in S. Mutans levels in their saliva
- Patient with periodontitis benefited from specific probiotics reducing need for surgical outcome, with other studies demonstrating significant reduction in pocket depth of periodontal issues, reduced bleeding and inflammation
- Daily probiotics reduced halitosis and improved quality of life
- Regular intake of probiotics in children can reduce development of dental caries in children
Podcasts:
https://theatpproject.libsyn.com/dental-care-and-oral-health
https://peterattiamd.com/patriciacorby/
Articles:
https://peterattiamd.com/importance-of-oral-health/
https://www.sciencedirect.com/science/article/pii/S1756464620302097
https://pmc.ncbi.nlm.nih.gov/articles/PMC10534711/
https://pmc.ncbi.nlm.nih.gov/articles/PMC4232036/
Testing:
