Oral Health – Gateway To Systemic Health

Beginning in the 1950s, forward-thinking doctors started to recognize the association between oral and systemic health. The relationship is not new – but only recently have we begun to understand how inextricably linked the two really are. 

The discovery of oral bacteria in arterial plaque (e.g., coronary, carotid) and cerebral plaque (amyloid) in the brain makes it clear that oral microbes do not stay confined to the mouth. 

What happens when the bacteria in the mouth are pathogens? They lead to inflammation in our mouth – whether bleeding gums or caries – and ultimately chronic inflammation in the body. In order to achieve total body health, we must include oral health as a key component.

Oral Microbiome Stats

• 20 of the 100 billion microbial cells live here
• 700+ species
• Various niches – (teeth, gums, tongue, tonsils, palate, and mucosa)
• Multiple microbes – bacteria (commensals, symbionts, and pathogens), fungi, and viruses
• Biofilms are involved 

Biofilms – A Particular Problem in the Mouth!

The non-shedding structure of teeth, dental implants, dental restorations, prostheses, and orthodontic appliances enables large masses of microorganisms to form as biofilms. When not routinely disrupted with proper oral hygiene, biofilms create incipient dysbiosis. In the mouth, this biofilm is commonly referred to as “dental plaque” and protects bacteria from environmental fluctuations and host defenses.

The lipopolysaccharide (LPS) that is found on the outer shell of gram-negative bacteria is a component of biofilms and a chief cause of chronic inflammation. Because periodontal biofilm is so close to the gingival bloodstream, these inflammatory mediators and immune complexes can disseminate throughout the body.¹

Upgrade Your Physical Exam Skills

As a clinician, you may not be accustomed to including oral health in your physical exam. But adding this to your assessment is a powerful tool for the prevention and identification of a possible root cause for many systemic diseases. 

If you find signs that indicate poor oral health or beginning stages of oral illness, qPCR analysis of saliva or gingival crevicular fluid now allows for detection of subclinical disease. Keystone periodontal pathogens can be identified even in the absence of clinical signs.

Clinical signs of a healthy mouth	Clinical signs of dysbiosis
Pink, firm, stippled gums	Red, puffy, smooth gums
No visible plaque or calculus	Visible plaque or calculus
No caries or restorations due to caries	Visible caries or decay restorations
Well-lubricated oral tissues	Dry mouth
Clean tongue	Coated tongue
Pleasant breath	Halitosis
No bleeding during home care or cleaning	Bleeding with homecare or cleanings

 

Origins of the Oral Microbiome

There remains some debate as to the origins of the oral microbiome, but research shows that the mode of birth delivery affects the oral microbiome of an infant. Babies who are delivered vaginally have a more diverse oral microbiome than those delivered via cesarean, and it is very similar to their mother’s microbiota.² Breastfeeding also influences the composition of the oral microbiome, with breastfed infants demonstrating higher levels of lactobacilli than formula-fed infants.³

Factors that Influence Oral Health 

Diet is one of the biggest influences on the oral microbiome. Diets high in refined carbohydrates and sugars and low in fiber encourage both gut and oral dysbiosis. Hard foods and foods high in fat-soluble vitamins A, D, E, and K encourage better alveolar bone growth and enamel mineralization. 

Proper oral hygiene is essential to mechanically disrupt the periodontal biofilm, however many common over-the-counter hygiene products can have a deleterious effect on the oral microbiome by upsetting the delicate balance with harsh chemicals. 

Low salivary flow or medications that cause dry mouth will also contribute to oral dysbiosis. Saliva contains protective immunoglobulins (IgA, IgG, IgM), lactoperoxidase, and lactoferrin. It controls the pH balance in the mouth, feeds oral microbes, and generally prevents cavities and periodontal disease. 

Lastly, the oral microbiome is influenced by those with whom oral bacteria is shared via kissing, food, and drink.

Oral Health and Systemic Health: Making the Connection

Cardiovascular Health

Understanding cardiovascular disease as a chronic inflammatory disease with many root causes places periodontal disease and endodontic disease alongside genetics, hypertension, insulin resistance, and lifestyle factors as some of the many contributors to arterial disease. According to the AHA, an estimated 50% of cardiac events can be linked to oral bacteria. The research is replete with evidence showing how the microbial shift that occurs with oral dysbiosis increases inflammation and induces platelet aggregation.⁴

Gut Health

In 1 milliliter of saliva, there are an estimated 108 microorganisms, and we swallow one liter or more of saliva each day.⁵ Dysbiotic microbiota make their way into the gut and can contribute to gut dysbiosis. Stool levels of Candida have been shown to decrease dramatically after brushing, suggesting that the mouth is actually the primary source of C. albicans in stool samples.⁶

Cognitive Health

The oral bacterium Porphyromonas gingivalis, which is a keystone pathogen of periodontal disease, has been associated with cardiovascular, metabolic, pulmonary, and rheumatological diseases, as well as cancer and poor birth outcomes. Notably, it has been implicated as a causative factor for Alzheimer’s disease.⁷ Toxic proteases called “gingipains” cleave proteins in the brain and contribute to the amyloid plaques that are a hallmark of the neurodegenerative disease.

Prenatal Health

The presence of periodontal disease in an expectant mother makes her 7.5 times more likely to experience premature labor, a risk factor higher than alcohol consumption or smoking!⁸ A number of keystone periodontal pathogens are associated with low birth weight and chorioamnionitis – a serious condition in pregnant women in which the membranes that surround the fetus and the amniotic fluid are infected by bacteria.⁹

Healing Oral Dysbiosis

Effective treatment requires restoration of a healthy microbiome. That must include antimicrobial activity against pathogenic species, support for probiotic abundance, and management of biofilms. Botanicals provide activity in all of these areas.

While biofilms are resistant to host immune responses and difficult to eradicate with antibiotics, botanical and essential oils have proven the most effective in treatment.¹⁰ Garlic, oregano, bilberry, bladderwrack, goldenseal, thyme, lavender, tea tree, grapeseed, bilberry, black walnut, echinacea, gentian, shiitake mushroom, olive leaf, and raspberry are all helpful in controlling biofilms. In vitro pilot research shows that not only is this combination of botanicals effective against organisms in their free-floating form, but also against biofilm communities.

These botanicals can inhibit all phases of the biofilm life cycle – quorum sensing, attachment, swarming motility, and the “drug resistant” efflux pumps that are characteristic of biofilms.

Cutting to the Chase - What Works?

Disrupting oral biofilms is the first step in healing oral dysbiosis. Other considerations include seeding with oral probiotics to shift the host terrain, ruling out mouth breathing as a contributing factor, and dialing in diet, as discussed above. 

Achieving this delicate balance in the oral microbiome is essential to achieving optimal systemic health. You can make a difference for your patients by including a basic oral examination and providing these simple recommendations.

• See the Dentalcidin® Oral Care System
• See the Oral Health Protocol

 

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[1] Colombo APV, Magalhaes CB, Hartenbach FARR, do Souto RM, da Siva-Boghossian. Periodontal-disease-associated biofilm: A reservoir for pathogens of medical importance. Microbial Pathogenesis. 94 (2016); 27-34.

[2] P. Lif Holgerson, L. Harnevik, O. Hernell, et al., “Mode of Birth Delivery Affects Oral Microbiota in Infants,” Journal of Dental Research 90, no. 10 (2011): 1183-1188, doi: 10.1177/0022034511418973

[3] https://doi.org/10.1038/sj.bdj.2016.865

[4] Bale BF, Doneen AL, Vigerust DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J. 2017 Apr;93(1098):215-220. doi: 10.1136/postgradmedj-2016-134279. Epub 2016 Nov 29. PMID: 27899684; PMCID: PMC5520251.

[5] https://www.nature.com/articles/sj.bdj.2016.865
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5274568/

[6] Auchtung TA, Fofanova TY, Stewart CJ, Nash AK, Wong MC, Gesell JR, Auchtung JM, Ajami NJ, Petrosino JF. Investigating Colonization of the Healthy Adult Gastrointestinal Tract by Fungi. mSphere. 2018 Mar 28;3(2):e00092-18. doi: 10.1128/mSphere.00092-18. PMID: 29600282; PMCID: PMC5874442.

[7] Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, Nguyen M, Haditsch U, Raha D, Griffin C, Holsinger LJ, Arastu-Kapur S, Kaba S, Lee A, Ryder MI, Potempa B, Mydel P, Hellvard A, Adamowicz K, Hasturk H, Walker GD, Reynolds EC, Faull RLM, Curtis MA, Dragunow M, Potempa J. Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019 Jan 23;5(1):eaau3333. doi: 10.1126/sciadv.aau3333. PMID: 30746447; PMCID: PMC6357742.

[8] Journal of Pregnancy
Volume 2010, Article ID 293439, 4 pages doi:10.1155/2010/293439

[9] HAWAI‘I JOURNAL OF MEDICINE & PUBLIC HEALTH, OCTOBER 2012, VOL 71, NO 10 281

[10] Givskov M.  Future Microbiol. Sep 2012;7(9):1025-1028

[11]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498498/