Biocidin Academy
December 19, 2023

Working Smarter: Using New Tools to Treat Dental Dysbiosis

By Barbara Tritz, BRDH

Treating patients with oral health concerns can be frustrating. Over 50% of adults in the US have some level of gum disease, and 90% have untreated tooth decay.1 Children fare little better: 50% of six- to eight-year-olds have decay in a primary tooth, and 50% of 12- to 19-year-olds have decay in a permanent tooth.2 Despite regular dental office visits, sealants and fluoride, and instructions on brushing and flossing, we are making little headway in treating patients’ oral dysbiosis. More of the same is not working.

We know the oral microbiome affects our systemic health. The increase in chronic diseases3 and their direct links to oral microbial pathogens4 mandates that we work smarter to support excellent oral health and reduce those statistics. Because so many chronic diseases start in the mouth – from cardiovascular disease5 to cancer6 and COPD7 to dementia8 – doing everything we can to support oral health is essential.

Oral Microbes

Poor oral health – dental caries, bad breath, tonsillitis, respiratory ailments, canker sores, and periodontal concerns – can all result from an imbalance of the oral microbiome.

It’s time to expand our practitioner’s toolbox. Knowing that dysbiosis is a crucial aspect of poor dental health, oral probiotics may be just the tool we need to help conquer dental problems.

Our mouths host about 1,000 different bacteria, as well as viruses, yeast, and archaea. We swallow over one trillion microbes each day, and these microbes affect health downstream in the digestive tract – which, in turn, affects our overall health. Thus, a healthy oral microbiome is the foundation for a healthy body.

Traditionally, dental therapies have focused on removing or killing the pathogens associated with dental dysbiosis. Antibacterial mouthwashes, antibiotics, anti-tartar toothpastes, and excessive essential oils, alcohols, surfactants, dyes, and sodium fluoride, comprise many of the “go-to” dental recommendations today. Unfortunately, these ingredients kill not only the “bad” microbes but also the “good” ones as well.

The good bugs make up 99% of the oral microbiome. Most are completely harmless, and some are downright beneficial. We need these bugs – they are critical to our survival. To name a few of their many benefits,10 they exist in our mouths to help:

  • Regulate and control the bad bacteria
  • Boost the oral immune system
  • Strengthen the epithelial barrier
  • Make vitamins
  • Produce anti-inflammatory substances
  • Reduce infections

Rather than eliminating all the microbes, we should focus on nourishing a healthy ecology that encourages the good microbes to grow and flourish.

Test, Don’t Guess

Given the rise of “superbugs” and antibiotic-resistant bacteria, the outdated philosophy of “kill everything with the hope the microbiome repopulates with just the healthy microbes” is no longer a responsible approach. “Hope" is not a tool we can count on. But diagnostic testing and oral probiotics can be. We live in a “smart” era – let’s use smart tools.

Salivary diagnostic testing (Bristle11 is one such salivary diagnostic company) can tell us about the mix of commensal and pathogenic bugs in an individual’s oral microbiome, allowing us to customize our recommendations for that individual accordingly. Salivary diagnostic tests can help identify possible risks of oral health concerns in their earliest stages, before any outward signs or symptoms appear. With testing, we can understand exactly which good bacteria the patient needs to achieve homeostasis and balance in their oral microbiome.

My motto: Test, don’t guess. Then, treat and retest.

Oral Probiotics

Oral probiotics are living bacteria that, according to the World Health Organization, “confer health benefits to the health of the host” when administered in adequate amounts.12

The goal of using oral probiotics is to reintroduce beneficial bacteria. By doing so, we work to alter the pathogenic environment and create one where the newly established good microbes can flourish. This field is still in its infancy, so as we learn more about harnessing the good microbes to help us prevent oral health issues and heal from them, we can expect an explosion of new and better knowledge and research.

The Food and Drug Administration13 has not yet approved oral probiotics for medical use. Because oral probiotics are classified as supplements, they are monitored with different guidelines than those to which a drug treating a medical condition is subjected. The research, however, is currently very favorable and shows us how microbes can benefit us with little to no side effects.14

Certain oral probiotic strains, in fact, have been shown to address dental concerns in specific ways:

  • Lactobacillus paracasei15 reduces the bacteria Streptococcus mutans that cause tooth decay.
  • Lactobacillus salivarius16 reduces tooth decay by inhibiting the formation of biofilms of both S. mutans and Candida albicans.
  • Lactobacillus reuteri17 inhibits plaque formation, modulates inflammation, helps to “crowd out” unwanted organisms, and supports gingival health. This strain also has an effect on improving bad breath.18
  • BLIS M18® Streptococcus salivarius19 inhibits decay-causing bacteria, increases pH, and reduces plaque formation.

Self-Care & Nutrition

To achieve and maintain dental health, it's essential for patients to brush, irrigate, tongue clean, and clean between teeth daily. Plaque re-forms and organizes very quickly. The goal is to reduce and remove the plaque biofilm every 12 hours. Brushing with botanical toothpaste and using a botanical mouth rinse can help reduce harmful bacteria in the mouth and set the stage to repopulate the oral cavity with good bacteria using oral probiotics.

Reseeding the mouth with good bacteria also requires feeding these beneficial microbes with prebiotic foods that contain the fiber these good bacteria need to survive. Bad bugs flourish with sugars, while good bugs depend on fiber-rich foods like onions, garlic, artichokes, unripe bananas, asparagus, apples, nuts, and seeds.

21st-Century Tools

Oral probiotics and salivary diagnostics represent a new generation in precision medicine – tools customized to fit your patient’s needs and help them achieve true oral health and systemic wellness. By using salivary diagnostics to dive deeper into the root causes of dental dysbiosis, we can prevent and treat rather than hope and guess. By using oral probiotics to repopulate the oral cavity with good bacteria, we can shift the oral microbiome in a gentle, non-invasive way. This is 21st-century medicine at its smartest.

  1. Oral Health in America - April 2022 Bulletin. (n.d.). Retrieved from https://www.nidcr.nih.gov/research/oralhealthinamerica/section-3a-summary
  2.  Oral Health Surveillance Report, 2019 (cdc.gov)
  3. Hajat, Cother, and Emma Stein. “The Global Burden of Multiple Chronic Conditions: A Narrative Review.” Preventive Medicine Reports, U.S. National Library of Medicine, 19 Oct. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6214883/. Accessed 13 Nov. 2023.
  4.  Oral Systemic Link (dentalantioxidants.com)
  5.  Li, Yiwen, et al. “The Oral Microbiota and Cardiometabolic Health: A Comprehensive Review and Emerging Insights.” Frontiers in Immunology, U.S. National Library of Medicine, 18 Nov. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9716288/. Accessed 11 Nov. 2023.
  6.  Hou, Kaijian, et al. “Microbiota in Health and Diseases.” Signal Transduction and Targeted Therapy, U.S. National Library of Medicine, 23 Apr. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9034083/. Accessed 11 Nov. 2023.
  7. Tamiya H, Mitani A, Abe M, Nagase T. Putative Bidirectionality of Chronic Obstructive Pulmonary Disease and Periodontal Disease: A Review of the Literature. J Clin Med. 2023 Sep 13;12(18):5935. doi: 10.3390/jcm12185935. PMID: 37762876; PMCID: PMC10531527.
  8.  Demmer RT, Norby FL, Lakshminarayan K, Walker KA, Pankow JS, Folsom AR, Mosley T, Beck J, Lutsey PL. Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC). Neurology. 2020 Sep 22;95(12):e1660-e1671. doi: 10.1212/WNL.0000000000010312. Epub 2020 Jul 29. PMID: 32727837; PMCID: PMC7713724.
  9.  Frontiers | The Oral Microbiota: Community Composition, Influencing Factors, Pathogenesis, and Interventions (frontiersin.org)
  10.  Dr Steven Lin. “Good Bacteria in the Mouth and Gut Flora.” Dr Steven Lin, 27 Apr. 2017, www.drstevenlin.com/good-bacteria-mouth-gut-flora/. Accessed 11 Nov. 2023.
  11.  Bristle Health
  12.  Kobayashi, R, et al. “Oral Administration of Lactobacillus Gasseri SBT2055 Is Effective in Preventing Porphyromonas Gingivalis-Accelerated Periodontal Disease.” Scientific Reports, U.S. National Library of Medicine, 3 Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5428773/. Accessed 11 Nov. 2023.
  13.  Mosley, Brenda L. “Are Probiotics FDA Approved? What You Need to Know - Gut Health Improvement: Improve Your Gut Health Naturally.” GutHealthImprovement, 7 May 2023, guthealthimprovement.com/are-probiotics-fda-approved/
  14.  Stowik, Turner A. “Contribution of Probiotics Streptococcus Salivarius Strains K12 and M18 to Oral Health in Humans: A Review.” Digital Commons @ UConn. https://digitalcommons.lib.uconn.edu/srhonors_theses/488/. Accessed 13 Nov. 2023.
  15.  Nocerino R;Paparo L;Terrin G;Pezzella V;Amoroso A;Cosenza L;Cecere G;De Marco G;Micillo M;Albano F;Nugnes R;Ferri P;Ciccarelli G;Giaccio G;Spadaro R;Maddalena Y;Berni Canani F;Berni Canani R; (n.d.). Cow’s milk and rice fermented with Lactobacillus paracasei CBA L74 prevent infectious diseases in children: A randomized controlled trial. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26732025/
  16. Krzyściak W, Kościelniak D, Papież M, Vyhouskaya P, Zagórska-Świeży K, Kołodziej I, Bystrowska B, Jurczak A. Effect of a Lactobacillus Salivarius Probiotic on a Double-Species Streptococcus Mutans and Candida Albicans Caries Biofilm. Nutrients. 2017 Nov 14;9(11):1242. doi: 10.3390/nu9111242. PMID: 29135948; PMCID: PMC5707714.
  17.  Vivekananda, M. R., Vandana, K. L., & Bhat, K. G. (2010). Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084569/
  18.  Keller MK, Bardow A, Jensdottir T, Lykkeaa J, Twetman S. Effect of chewing gums containing the probiotic bacterium Lactobacillus reuteri on oral malodour. Acta Odontol Scand. 2012 May;70(3):246-50. doi: 10.3109/00016357.2011.640281. Epub 2011 Dec 20. PMID: 22182258.
  19.  Vivekananda, M. R., Vandana, K. L., & Bhat, K. G. (2010). Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084569/
Written by Barbara K. Tritz, RDH

Barbara K. Tritz, RDH, BS, MSB, HIAOMT, is a practicing biological dental hygienist at Green City Dental in Edmonds, WA. Barbara also practices orofacial myofunctional therapy at her clinic, Washington Oral Wellness, in Kirkland, WA. She completed her accreditation in Biological Dental Hygiene through the International Academy of Oral Medicine and Toxicology and is laser-certified through the Academy of Laser Dentistry. 

Known online as the Queen of Dental Hygiene, Barbara loves to share her knowledge and help others achieve total body health. She lectures everywhere, from local schools to professional education classes. In 2019, Barbara received the HuFriedy-American Dental Hygienist Association Master Clinician Award at the annual ADHA Conference in Louisville, KY. Contact her at barbaratritz@gmail.com or visit her website at http://queenofdentalhygiene.net/.