Updated: May 8
Dental health, including the health of our teeth, gums, oral mucosa and the entire apparatus keeping the tooth attached to the gum, is often a neglected part of the health in mainstream non-dental medicine. We now have an abundance of research studies, both observational and interventional, that show how the disease of the gums and teeth may contribute to broader health problems, including but not limited to cardiovascular disease and infection.
The way most people think about dental health is that having nice straight white teeth makes their face prettier and that if something hurts, we need to see a dentist. But a mild bleeding or some mild pain is usually nothing to worry about as “a lot of people have that”.
In this article, we’ll try to challenge some of those perspectives and see why dental care if way more than just a cosmetic thing (nice teeth = nice smile = being more attractive) and why neglected dental health can do us way more harm than being shy with smiling.
These will be a 3-part Blog series that in the future I'm hoping to also turn into videos
Part 1 – Introduction to the dental microbiome and oral disease
Part 2 – Link between oral disease and the rest of the body
Part 3 – Holistic prevention and support of healthy mouth & teeth.
NOTE: If you suffer from ongoing dental health problems, pain, bleeding or suspect a deep cavity or inflammation, please speak with your dentist or hygienist and get it treated adequately by a licensed professional. This is not medical advice and is not meant to replace a proper dental treatment.
You have probably heard about the gut microbiome, the billions of bacteria, viruses and fungi living in our digestive system. But it is quite likely you have not heard about the oral microbiome. That’s right; our mouth is filled with so many bacteria that a millilitre of saliva contains about 109 microbial species of different groups, classes and types. So far, about 600 bacterial species have been identified in the mouth, and it is estimated that we have not yet identified at least 45% of them, possibly more. These microbes inhabit the saliva, tongue, gums, teeth surface, upper and lower palate, cheeks, tonsils, throat, larynx, pharynx and pretty much every single nanometre of the inside of the human mouth all the way down to the stomach.
Besides bacteria, a variety of fungal species (oral mycobiome) as well as viral species (oral virome) coexist as a part of the oral microbiome. A study from Spain found over 430 different viral species in the mouth of people. That’s right; we have thousands of viruses living inside of our bodies all the way from the mouth to the anus. Not all of them are harmful or deadly. Protozoa and archaea are also components of the oral microbiome, though little has been researched on either group.
Beneficial roles of the oral microbiome
localised immunity and protection from periodontal diseases such as gingivitis and periodontitis
protection from oral cancers
assistance with food digestion
protection of oral mucosa against penetration by pathogenic bacteria into the bloodstream towards the rest of the body
communication with the rest of the digestive system and possibly even with the brain about the state and health of the oral cavity
protection from a variety of diseases such as cardiovascular disease, dementia, pneumonia, infection, arthritis and autoimmunity through constant competition and battle with the pathogenic (negative) bacteria
The good thing is that unless something radical happens, the balance of microbes inside the month remains relatively stable. Some of the most apparent disruptors of a healthy oral microbiome are alcohol, smoking, processed junk, excessive salt use of oral antibiotics. Personally, I believe the overuse of antibacterial mouthwashes aimed at killing 99% of bacteria is an utter disaster for our oral microbiome, but at this point, this remains only my speculation as studies on this topic are very limited. We will further explore this in part 3.
ORAL MICROBIOME IN ORAL DISEASE
An imbalance in different species of the oral microbiome, same as the imbalance of the gut microbiome, may lead to a gradual development of dental disease such as gingivitis or periodontitis as well as a variety of other health problems.
The most common inflammatory conditions of the gums are gingivitis and periodontitis.
Gingivitis refers to swollen, red and bleeding gums. The gums bleed when brushed; however, at this stage, there is no gum recession, no tooth or bone loss or development of inflammatory pockets. Gingivitis is the first stage of advanced periodontitis.
Periodontitis is a progressed gingivitis. Inflammation has now set deeper. Pockets between the teeth become deeper and more inflamed. Bacteria start growing inside these pockets and can no longer be cleared by brushing. A layer of plaque starts building up, and the early receding of gums may start to occur.
Advanced periodontitis is a more severe level of periodontal disease. The alveolar bone may now be affected. Teeth may start becoming wobbly and unstable due to the gradual destruction of the cementum and the tissue holding them together. Where there was pain previously, there may not be any as the nerve could have been destroyed. Large bacterial biofilms are forming, and if unmanaged, the inflammation, as well as the bacteria, may start to migrate through the blood into other tissues of the body including the heart and the lungs.
Many studies are now indicating that the development of these conditions is often preceded by an imbalance in the oral microbiome. For example, in periodontitis, an overgrowth of Porphyromonas gengivalis and Streptococcus mutans were risk factors for the development of periodontitis, while Aggregatibacter actinomycetemcomitans was protective against the disease. Of course, this is infinitely more complex, many other species can be problematic once they grow over other types, and the balance is lots. Same as when cities become too overcrowded, and criminality rises.
Once the balance is lost and pathogenic bacteria start to proliferate (overpopulate) they may get clustered in biofilms, small areas with a massive concentration of different species, which is extremely difficult to eradicate even by oral antibiotics. These can usually be found in areas between teeth and the periodontal pockets under infected teeth.
How is the oral cavity protected from harmful bacteria?
It is common for people to have a layer of plaque on their teeth, even some mild cavities, yet most do not develop periodontal disease. This is because our oral environment and the oral microbiome cooperate to create a strong localised immune system and a protective layer
There are several layers of the localised immune system:
the physical barrier of mucosal cells tightly cemented to each other prevent physical penetration
immunoglobulins in our saliva can trigger an immune response such as producing antibodies and calling upon the immune cell army
Inside the mucosa exists a micro-electrical barrier that detects a difference of electrical potential between the cells of the hosts and the microbial layer on the other side. Think of this as a billions of mini CCTVs inside your mouth
special molecules called defensins acts as natural antibiotics regulating certain pathogenic populations of oral bacteria
there are also mechanisms that detect and balance PH inside the mouth as some bacteria may alter the PH towards too acidic and that is not favourable.
Under normal circumstances, these barrier systems work together to inhibit and eliminate penetrating bacteria. However, when this defensive layer is disturbed through a variety of factors, problems including any of the above oral disease starts to develop. Not only that but once these defences are disrupted, the bacteria from these huge biofilms may actually start to enter the bloodstream and migrate towards other parts of the body such as the lungs, heart, joints and brain. And this is how neglected dental health may systematically start creating health problems. We will talk more about this in part 2
SUMMARY & KEY POINTS
Dental health is an inevitable part of systemic, holistic health. It must not be neglected as it can impact the rest of the body in many ways.
Our oral cavity (the mouth) contains around 600-700 different species of bacteria, viruses, fungi and protozoa, all commonly referred to as the oral microbiome. These colonise all parts of our mouth and mucosa in billions.
Similar to the well-known gut microbiome, the oral microbiome plays an important role in the homeostasis of the healthy environment inside of our mouth. When this balances is disrupted, and the natural defence mechanisms of the mouth are exhausted or breeched, oral diseases such as gingivitis, periodontitis or advanced periodontitis may develop. Commonly these diseases are referred to as periodontal diseases.
Over the long-term, if these diseases are unchecked and untreated, systemic diseases such as cancer of the oral mucosa or a variety of cancers down the digestive tract may start to develop.
In part 2 we will talk about the relationship between dental health and the systemic disease of the rest of the body, such as heart disease, pneumonia, Alzheimer's disease and autoimmunity
In part 3 we'll list strategies to keep your dental health top notch including nutrition & diet as well as avoidance of things that hurt our dental health and oral microbiome.