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The Oral Microbiome and Its Impact on Dental Health
- By Reem Ibrahim
- Childrens Health, Digestive Health, General Health, Gut Health Blog
(edited by Sharon Erdrich)
The mouth harbours a diverse community of microbial species, in varying abundances in the different areas, such as on the teeth, gums, tongue, cheeks, and palate. The most represented genus of bacteria is Streptococcus. Studies have revealed that in a healthy oral cavity, 96% of bacteria belong to the six major phyla Firmicutes, Actinobacteria, Proteobacteria, Fusobacteria, Bacteroidetes, and Spirochaetes11. These microbes interact symbiotically with the host to maintain healthy gums and teeth and help preventing ill health and disease. This harmonious interaction supports maintenance of a healthy oral lining, strengthens the immune system, and inhibits harmful bacteria from thriving and causing problems2.
Saliva also plays an important role in maintaining oral health. It is a source of nutrients for the proliferation of beneficial bacteria. These nutrients include; glycoproteins, lipids, peptides, amino acids, minerals, vitamins, and gases10. Saliva coats the teeth and gums to prevent bacterial adherence and plaque formation, and cleanses away food residue. Additionally, saliva contains proteins that eradicate harmful bacteria, while helping maintain an optimal pH level in the mouth2. A consequence of interference with these functions is increased risk of periodontal disease, an infection that affects the tissues that surround and support the teeth2. According to the World Health Organisation, severe periodontal disease approximately affects 19% of the global adult population, representing more than 1 billion cases worldwide3. Understanding the connection between the oral microbiome and its impact on dental health can help individuals take steps to manage, prevent and treat this condition.
In periodontal disease, the immune system activates an inflammatory response, triggered by the presence and accumulation of dental plaque2. Dental plaque is composed of different types of gram-negative anaerobic microbes, which can include Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythias, Fusobacterium nucleatum, Campylobacter rectus, Streptococcus intermedius, and Treponema species4. These potentially harmful bacteria become entrenched within a biofilm, a polysaccharide matrix that sticks to the surface of the teeth. This biofilm, produced by microorganisms, acts as a glue-like protective substance that aids them to attach to teeth, prevents their removal by saliva, food and drinks, and can also inactivate antibiotics2.
Eliminating dental plaque is key to hampering bacterial adherence, thus preventing the immune system from activating an inflammatory response and restoring microbial balance2. However, if periodontal disease is left untreated, bone loss can occur. Bone loss can ensue, while an enzyme that is normally absent in individuals with healthy gums but is highly prevalent in those with gum disease, leads to the deterioration of collagen in the gums and ligaments2. The concentration of nitric oxide in the saliva of individuals with periodontal disease increases, which helps regulate the spread of harmful bacteria that can lead to infection, but can also have detrimental effects, resulting in oxidative stress and damaging periodontal tissues2,5.
The early stage of periodontal disease is gingivitis, which causes bleeding and red swollen gums and bad breath. If left unmanaged, the gums can begin to recede from the teeth, pus may form between the teeth and gums, becoming periodontal disease. Unless treated early, periodontal disease can affect various organs, and has been linked to neurological, gastrointestinal, chronic respiratory, rheumatoid arthritis, and heart disease, as well as diabetes, insulin resistance, lupus erythematosus, pregnancy complications, cancer and anaemia6. In more severe cases, the gum can detach from the tooth and supporting bone, changes in teeth alignment can occur, and teeth can become loose and eventually fall out3,7.
Preventative strategies to help prevent periodontal disease include brushing, flossing and the judicious use of mouthwash. Having regular check-ups and professional cleaning from a dental hygienist is important to remove plaque that hardens into tartar, as this can be difficult to remove with brushing and flossing alone. Additionally, smoking cessation, adequate hydration, and maintaining a healthy diet is recommended7,8.
However, if periodontal disease is present, strategies to mitigate it are crucial. Research suggests that using oral probiotics, prebiotics, and synbiotics has the potential to address the microbial imbalance associated with periodontal disease2,9. Oral probiotics are live microorganisms that serve many beneficial functions to keep the oral cavity in optimal health9. The most prevalent strains are Lactobacillus and Bifidobacterium genera. Although Lactobacilli constitute less than 1% of the bacteria, they play a role in eliminating harmful bacteria, such as Streptococcus mutans, which is strongly associated with dental cavities9. Lactobacillus paracasei, found in yoghurt also lowers the count of harmful bacteria in saliva9. Bad breath may be addressed by the probiotic strain Streptococcus salivarius K12; gargling with this strain may decrease hydrogen sulphide production, which contributes to bad breath9. Oral health-specific probiotics are a good preventative measure to manage inflammation and ensure homeostasis9.
The use of medicinal herbs is another avenue worth exploring to help manage periodontal disease. They possess anti-inflammatory, antioxidant, antibacterial and astringent properties4. Research suggests that medicinal plants help maintain the acid-alkaline balance in saliva, which prevents plaque formation4. Herbs such as Plantago major and Glycyrrhiza glabra have gained recognition for their ability to fight against plaque-forming bacteria4. Trifolium pratense, Aloe barbadensis and Medicago sativa, have also shown good results in treating periodontal disease4.
The role of the oral microbiome is crucial in helping maintain dental health through its naturally complex and diverse community. This balance is aided by saliva and is vital for preventing problems such as periodontal disease2. Therefore, gaining an understanding of the relationship between the oral microbiome and dental health provides insights into preventative and therapeutic strategies. Regular oral hygiene practices, lifestyle adjustments, and treatments such as probiotics and medicinal herbs can assist in the management and prevention of periodontal disease 2,7,8. Managing this condition is essential not only for oral health but also for reducing the risk of systemic implications 6.
NOTE: We offer an oral microbiome test, which uses PCR technology. Our recommendation at this stage is to use what is currently best science (shotgun metagenomics) of the stool, with or without the oral microbiome test. Oral species that are present in the stool are most certainly likely to be problematic in the mouth.
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References
- Siddiqui R, Badran Z, Boghossian A, Alharbi AM, Alfahemi H, Khan NA. The increasing importance of the oral microbiome in periodontal health and disease. Future Sci OA. 2023.
- Di Stefano M, et al. Impact of oral microbiome in periodontal health and periodontitis: a critical review on prevention and treatment. Int J Mol Sci. 2022;23(11):5142
- World Health Organization. Oral health. Geneva: World Health Organization; 2023 [cited 2023 Mar 14]. Available from: https://www.who.int/health-topics/oral-health#tab=tab_1https://www.who.int/news-room/fact-sheets/detail/oral-health
- Pasupuleti MK, et al. Role of medicinal herbs in periodontal therapy: a systematic review. J Int Soc Prev Community Dent. 2023;13(1):9-16
- Shang J, et al. Role of oxidative stress in the relationship between periodontitis and systemic diseases. Front Physiol. 2023;14:1210449
- Lohiya DV, et al. Effects of periodontitis on major organ systems. Cureus. 2023;15(9)
- Signs, W. Preventing periodontal disease. J Am Dent Assoc. 2001;132(9):1339
- Janakiram C, and Dye BA. A public health approach for prevention of periodontal disease. Periodontol 2000. 2020;84(1):202-214.
- Shirbhate U, et al. Clinical implications of probiotics in oral and periodontal health: a comprehensive review. Cureus. 2023;15(12)
- Santacroce L, et al. Oral microbiota in human health and disease: a perspective. Exp Biol Med (Maywood). 2023;248:1288-1301.
- Akimbekov NS, et al. Nutritional factors influencing microbiota-mediated colonization resistance of the oral cavity: a literature review. Front Nutr. 2022.
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