The oral microbiome and patient empowerment

The oral microbiome and patient empowerment

Aaron Kinsey and Juliette Reeves discuss the research around the oral microbiome that is directing patient interactions and oral hygiene education towards a more holistic approach to healthcare.

Thanks to new tools that explore the diverse microbes in our bodies, our understanding of oral microbes is growing fast. However, many questions remain about how these microbes interact with us. Unlocking these secrets could lead to revolutionary treatments in dentistry and medicine. New technologies are uncovering complex, dynamic relationships between oral bacteria and their human hosts, showing effects that reach well beyond the mouth.

Novel therapeutic strategies based on diet (eg limiting simple sugar consumption) and probiotic supplementation could exert beneficial effects by restricting the growth of pathogen microorganisms implicated in some oral and systemic pathological conditions.’ (Santacroce et al, 2023)

Oral microbiome: a ‘hot topic’

Aaron Kinsey is a dental hygienist at Dulwich Dental Office in south-east London. He graduated from Portsmouth’s esteemed dental hygiene programme in 2021, impressively scooping the British Society of Dental Hygiene and Therapy’s Student of the Year Award.

Since then, his career has taken off remarkably. His published research in oral biomarkers and microbiome – ‘a hot topic that’s very much being discussed within the research community’ – supports his clinical delivery. He empowers his patients by sharing his knowledge and expertise to help them maintain their best oral health. ‘It’s my avid intention to develop my knowledge within my scope of practice,’ he says.

‘My previous research in oral microbiome has undoubtedly widened my understanding of the dynamic interplays between the mouth and cohabiting bacteria. With a growing body of evidence linking changes in oral microbiome with local and systemic changes, communicating these findings to patients is essential.

‘Advice offered regarding microbiome is typically centred on the effects of mouthwashes, probiotics and diet, with emphasis on acidic foods and beverages.

‘The response from patients is generally of interest and curiosity. Many know that certain behaviours and lifestyle choices can have wider-reaching implications on general health but do not necessarily appreciate the effects on their oral health.’

Lifestyle factors affecting the microbiome

Juliette Reeves is a multi-award-winning dental hygienist and trained nutritionist with over 40 years of clinical experience. She has written and lectured internationally over the last 20 years on the systemic associations between nutrition and oral health.

She says the human and oral microbiome is dynamic and changes with developmental and environmental factors (diet, medications, smoking and lifestyle), especially in response to disease. In practice, manipulating microbiomes offers the potential to prevent and cure diseases (Scott et al, 2015).

She adds that a healthy microbiome develops in response to many factors, including lifestyle, genetics and environmental factors such as smoking, alcohol, drugs and medicines. This may explain why disease manifests and progresses differently in some individuals, prompting the need for a more individualised approach when treating disease (Zarco et al, 2012).

Why are dental professionals well positioned to educate patients?

As dental care professionals, holistic, patient-centred care is at the core of their practice, and Aaron’s research shapes his approach: ‘I start by discussing the impact of micronutrients on general health and how these can be obtained through certain foods. Probiotic-rich foods like yoghurt, kefir, and certain vegetables such as nitrate-rich beetroot are well known to support a healthy oral microbiome.

‘I will generally advise patients to limit their sugar consumption where possible whilst raising awareness of the increased risk of caries and gum disease. We know that the frequency and timing of sugar intake can impact the propensity for harm, especially regarding tooth surface loss (acid erosion, exogenous). With that in mind, I advise patients to consume anything sugary or acidic closer to meal times to reduce the compound effects on teeth and gums.’

Aaron adds: ‘With the privilege of seeing patients at least twice a year – sometimes more – we’re uniquely positioned to educate and raise awareness about the vital connections between oral health and overall systemic health.

‘The correlative links between oral diseases and diabetes, obesity and cardiovascular disease are well documented within dentistry, with emerging evidence forming associative links to rheumatoid arthritis and even dementia. This presents an opportunity for educational and inter-collaborative efforts with allied healthcare professionals for diagnosis and treatment planning.

‘I’ve collaborated closely with specialists, GPs, dietitians, nutritionists, physiotherapists, radiographers and other healthcare professionals to deliver seamless healthcare. Working together, I’ve seen how integrated care leads to better outcomes. These experiences continually empower me as a hygienist, highlighting my vital role in supporting each patient’s health and wellbeing.’

Education first

For him, education comes first and starts in the surgery, the success of which very much depends on an ability to communicate effectively.

‘I adapt my style according to the individual, using various forms ranging from simple one-to-one discussions to jargon-free pamphlets – digital or paper – to be read at home. I’ll often signpost patients to our practice website, where they can access short videos ranging from advice on brushing techniques to keeping your biome in check,’ he says.

Changes to the oral microbiota, such as those occurring during gum disease, have been recently linked to inflammatory bowel disease and bowel cancer. When sharing this evidence with patients, Aaron uses analogies when discussing gum disease and other models of inflammation.

‘My go-to is the garden analogy. The soil (gums) requires careful attention and care, maybe even landscaping in some instances (work with the dentist), without which weeds/pests (plaque/calculus) take over, and the garden’s ability to sustain the life of plants/flowers/crops becomes compromised.’

Flow charts

Aaron has also recently started using flowcharts in surgery.

He explains: ‘They help illustrate the development of gum disease and act as a communicative tool when proposing treatment. They relay information in a condensed format that can be followed quickly without confusion. In all this, I would be lost without my Oral-B Test Drive. Typically, it’s the first and sometimes last thing I reach out for during an appointment.

‘Before having my Test Drive in surgery, I found describing how to brush effectively to be time-consuming and sometimes confusing for patients to understand. The phrase “How can you learn what’s never shown?” is a truism that’s helped shape my oral education delivery.

‘I use the Oral-B Test Drive at every opportunity to demonstrate the best techniques, assess current brushing habits or compare the technology’s differences against older models or alternative brands. In-person demos are always welcomed, and patients appreciate that investment in time to show them the correct technique.’

Immunity and the oral microbiome

Juliette observes: ‘We know that an immune system disorder can cause an ecological shift in the microbiome, and the immune system regulates interactions between the microbiome and the host. A compromised immune system disrupts symbiotic relationships (Badger et al, 2011).

‘Embracing the concept of a balanced oral microbiome is essential for oral and systemic health. As a first approach, active health maintenance rather than disease management provides a stepping stone to a healthy microbiome. This includes OHI and lifestyle choices such as nutrition and smoking. Once dysbiosis occurs, the treatment goal should be to re-establish symbiosis and avoid the indiscriminate use of antimicrobials, CHX and CPC antibiotics, local and/or systemic, to safeguard the beneficial oral microbiota and avoid resistance states.

‘A recent report has indicated how using stannous fluoride in toothpaste compared to zinc-containing sodium fluoride could help maintain a healthy oral microbiome by preferentially targeting certain pathogenic bacteria to reverse dysbiosis (Wang, 2024).’

She adds: ‘Clinical practice needs to shift from eliminating the microbiota to a new focus on proactive oral health management through an ecological approach to the whole microbiome. In other words, put the mouth back into the body (Kilian, 2016).’

Aaron’s use of multimedia brings the complex world of the oral microbiome into clear focus, making it easy for patients to understand its impact on their health. By equipping them with practical, at-home oral care skills, he empowers patients to take charge of their wellness, fostering a lasting partnership for healthier smiles – and overall wellbeing.

Juliette is lecturing on protecting the oral microbiome for Oral-B. Watch live on 12 February at 7pm or on demand at www.oralbprofessional.co.uk.

References

  1. Santacroce L, Passarelli PC, Azzolino D, Bottalico L, Charitos IA, Cazzolla AP, Colella M, Topi S, Garcia Godoy F, D’Addona A. Oral microbiota in human health and disease: A perspective. Rev Exp Biol Med (Maywood). 2023 Aug;248(15):1288-1301.
  2.  Scott et al: Manipulating the gut microbiota to maintain health and treat disease. Microbial ecology in health and disease.2015;  26. 25877. 10.3402/mehd.v26.25877.
  3. Zarco MF, Vess TJ, Ginsburg GS. The oral microbiome in health and disease and the potential impact on personalised dental medicine. Oral Dis. 2012 Mar;18(2):109-20.
  4. Badger JH et al: The human genome, microbiomes, and disease. In: Nelson KE, ed. Metagenomics of the human body. Springer Science+Business Media: New York, vol 17, pp. 1–14.
  5. Wang L, He T, Strand R, Zhang X, Lim L, Xu J,Shi Y and Dong W (2024) Interactions and effects of a stannous-containing sodium fluoride dentifrice on oral pathogens and the oral microbiome. Front. Microbiol. (2024) 15:1327913.
  6. Kilian M, Chapple ILC et al: The oral microbiome – an update for oral healthcare professionals. BDJ 2016; 22(10) 657-666

This article is sponsored by Oral-B.

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