Advancing an understanding of the oral microbiome

oral microbiomeSurina Sehgal discusses the importance of the oral microbiome and explains why the dental team should talk to patients about their food choices.

The digestive health market is showing steady recent growth. With people increasingly taking the initiative when it comes to gut health and recognising the importance of the microbiome in areas such as supporting immune health.

Interestingly, research shows that 60% of people acknowledge the link between digestive health and overall health. However, the mouth and the oral microbiome is somewhat left out of the conversation.

To start with, not all bacteria are bad. We tend to focus on bacteria being the culprit. But we actually need bacteria to help maintain health and fight off disease in the mouth and in the rest of the body.

The mouth contains around 500-1,000 different types of bacteria with various functions. Some pathogenic (harmful) and some beneficial.

What is the dental relevance?

Like the other microbiomes of the body (gut, skin, vaginal) the oral microbiome is a collection of bacteria, viruses, fungi and protozoa. The mouth has a variety of micro-environments that host different bacterial populations: the tongue, the hard palate, the teeth, and the area around the tooth surfaces, above and below the gums.

The oral microbiome is a major player in the mouth-body connection. There was a study in 2019 in the Journal of Oral Maxillofac Pathol that discovered bacterial populations from the mouth can make their way to other parts of the body, including the gut microbiota (Priya Nimish Deo, 2021). This can alter immune responses and potentially lead to systemic diseases.

However, many approaches to dental care still don’t consider the importance of supporting a balanced flora within the mouth. Instead they focus still on eradicating all bacteria.

There are ways to boost ‘good’ bacteria in the mouth through natural means. Intake of dietary fibre, prebiotics and probiotics are proven to improve bacterial diversity. While interesting, research has shown lifestyle changes like stress and sleep, can also change the microbial balance in the body (Karl et al, 2018).

Clinical benefits for our patients

As dental professionals it is our duty to give tailored preventative advice to our patients. It requires a blended approach including oral hygiene and dietary/lifestyle advice.

In the oral microbiome, organisms associated with health exist side-by-side with those associated with disease. Maintaining a state of harmony within this population is therefore crucial. It can prevent the overgrowth of disease-associated bacteria and also keep oral problems at bay.

When we give advice to try to improve the balance of the oral microbiome, we can expect to see improved oral health. Including improved gingival health and fewer carious lesions.

This lifestyle advice can have oral health benefits and general health benefits too! The training I received at university was limited for this. So I decided to do my own research and I was truly blown away at what I found and how really important a 360 approach is.

Who would benefit from an improved microbiome?

The short answer is absolutely everyone! The lifestyle advice I talk through with my patients has only beneficial effects and causes absolutely no harm.

I would always recommend patients to see a dietician or nutritionist to aid them in transitioning towards a healthier lifestyle and making better food choices. They are best qualified at doing this. However, there a few simple things that we can all benefit from.

How can patients and practitioners help nurture the microbiome?

Practitioners can begin the conversation by asking open ended questions about their patients’ lifestyle. Not just about their sugar intake, but also whether they are getting adequate nutrition in their diet.

As dental professionals we see our patients very regularly. That is a huge advantage because we can follow up and review the advice we give them.

The science on how to improve levels of good bacteria is developing all the time including around the role of diet in promoting good bacteria. Here are a few things that can help ensure the microbiome is healthy and balanced:

  1. Advise to eat a diverse range of foods, which leads to a diverse microbiome. In particular, legumes, beans and fruit contain lots of fibre and promote the growth of good bacteria
  2. Advise to eat fermented foods such as yogurt, sauerkraut and kefir. These all contain healthy bacteria and can reduce the prevalence of pathogenic bacteria
  3. Advise to eat prebiotic food. Prebiotics such as fibre stimulate the growth of healthy bacteria. These include artichokes, bananas, asparagus, oats and apples
  4. Reduce sugary intake. A high sugar diet can encourage the growth of acid-loving bacteria like streptococcus mutans, which contribute to caries and periodontal disease and inhibits good bacteria
  5. Avoid fizzy drinks and diet drinks. These can contribute towards dental erosion and caries and also alter the balance of microorganisms and upset the good bacteria
  6. Choose a microbiome boosting toothpaste. Good oral hygiene is the foundation of all mouth care. The advice we give is to brush twice daily, floss and use mouthwash. But the products we use are very important. Zendium is a daily fluoride toothpaste that contains natural enzymes and proteins which are clinically proven to boost good bacteria in the mouth and reduce bad bacteria.

Zendium results

In ground-breaking clinical research published in the Nature Journal Scientific Reports, Adams et al (2017) tested Zendium against a standard fluoride toothpaste without enzymes and proteins to evaluate its effect on bacterial species in the mouth.

The results were striking. After 14 weeks of use, Zendium shifted the balance of the oral microbiome towards a state of health. It also showed a significant increase in the proportion of gum health-associated bacterial species and a significant decrease in the proportion of gum disease-associated species (Adams et al, 2017).

I personally use Zendium twice a day and recommend it to my patients for everyday prevention while improving the oral microbiome.

In conclusion, the microbiome is not a new concept, but one dentist should actively consider to stay ahead of the curve. Lifestyle medicine is well taught and implemented by doctors all around the world. But dentistry seems to be behind.

Patients seem to over complicate their oral hygiene regimes. They therefore rely solely on over-the-counter products to help prevent dental problems and improve their oral hygiene.

In fact, it does not require much expense. It requires small simple steps daily to improve oral health and in turn general health.

References

Adams SE, Arnold D, Murphy B, Carroll P, Green AK, Smith AM, Marsh PD, Chen T, Marriott RE, Brading MG (2017) A randomised clinical study to determine the effect of a toothpaste containing enzymes and proteins on plaque oral microbiome ecology. Sci Rep 27(7): 43344

Karl J, Hatch A, Arcidiacono S, Pearce S, Pantoja-Feliciano I, Doherty L and Soares J (2018) Effects of Psychological, Environmental and Physical Stressors on the Gut Microbiota. Front Microbiol 9: 2013

Priya Nimish Deo, R (2021) Oral microbiome: Unveiling the fundamentals. J Oral Maxillofac Pathol v.23(1): PMC6503789

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