The Mouth As The Gateway To The Body

6 Paths Towards A Healthy Oral Microbiome

In a previous piece on microbiomes – the bacterial communities within our body – I briefly mentioned gum disease to be an example of when our mouth’s community becomes imbalanced. However, the significance of this community – the oral microbiome – on our health goes much further than this. A dysbiotic oral microbiome is not only implicated in diseases of the mouth, such as tooth decay and gum disease, but can also impact on diseases elsewhere in the body. This begins to make sense when we realise the mouth is a gateway to the rest of the body.

So what can be done to ensure we have the right bacterial community in the mouth? Let’s explore six means by which we can achieve this, in a way that addresses the root cause of a dysbiotic microbiome and the resulting symptoms they are associated with.

1 - Having A Good Oral Hygiene Routine

No piece talking about the health of our mouths would be complete without giving mention to how we clean our teeth. While getting rid of all the plaque and food that builds up in-between our teeth mechanically (e.g. brushing and flossing) is often an important part of the equation, we should be mindful of what products we are using when we clean our teeth.

While commercial toothpastes may look and "feel" good, it's always important to ask "what is actually in my toothpaste? And do I need it?"

Many commercial toothpastes contain ingredients that, while good at getting rid of staining, can have a detrimental effect on the healthy bacteria within the mouth, such as fluoride-based products. This piece from Dr Mercola, although acting as an advert for his company’s own toothpaste, and this piece by Mark Burhenne DDS contain good overviews of many toothpaste ingredients which might not be compatible with a truly holistic view of how our bodies work. Even toothpastes marketed as “natural” and “organic” can still contain some of these ingredients. If you’re struggling to find products that are accessible to you that have ingredients you are satisfied with, why not try making your own toothpaste?

Other areas of oral hygiene deserve attention too for their role in affecting the oral microbiome. Instead of triclosan and chlorhexidine-based mouthwashes, which target all bacteria indiscriminately, a good oil-pulling technique done before brushing can help leave healthy bacteria in-tact while clearing out less beneficial bacteria and toxins contributing to bad breath, decay and gum disease.

Miswak has a notable place in traditional Middle-Eastern medicine. It is said in religious texts that even the Islamic prophet Mohammad recommended and used Miswak.

For the brushing itself, it seems there are a few different microbiome-friendly modalities. Proponents of native medical approaches may point to things like miswak which, although I can see being an improvement over commercial toothpastes, can still have a relatively high fluoride content that it accumulates from water during the plant’s growth. There are also more cutting-edge technologies available like red light therapy electric brushes. In this respect, it’s about finding a technique and modality that gets to every part of the tooth properly that works for the individual.

2 - Staying Properly Hydrated

Being well hydrated is important for a wide range of bodily functions, but one that is particularly relevant to the bacteria of the mouth is saliva production. Saliva has many means of influencing the oral microbiome and encouraging the proliferation of beneficial bacteria over ones that contribute to conditions like tooth decay. This is achieved partly through mitigating the non-desirable impacts that certain bacteria in the mouth can have, such as in neutralising acids that erode teeth, which can be produced as a by-product of certain bacteria breaking down sugars that build in plaque.

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A summary of different functions of saliva. Source: https://journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1008058

Certain medications and excess caffeine also decrease salivary flow, which make it even more important for those taking those substances, as well as those with abnormally low saliva production, to be well hydrated.

Contrary to popular belief, simply drinking lots of water is not the most optimal way to stay hydrated. This is because being hydrated has multiple variables that need considering, including taking in the right amount of both water and electrolytes. As this video by Eric Berg goes in to, drinking too much pure water will simply dilute the existing electrolytes in the body and actually cause dehydration in certain parts of the body. Adding cucumber, lemon and a tiny bit of Himalayan salt to water is one straightforward way of getting both the required water and electrolytes into the body. Making the water slightly alkaline by adding a small amount of sodium bicarbonate can also be beneficial for neutralising dietary acids and aiding hydration.

Another consideration to make is the quality of the water being drunk. Tap water can vary in quality from place-to-place. Water directly from mountain springs, deep springs and glaciers melting has long been regarded as being better quality, not just due to the relative lack of contaminants like heavy metals from pipes and fluoride, but is also high in exclusion zone, or “fourth phase” water. In short, fourth phase water plays a crucial role in providing energy to our bodies tissues and, while our bodies can produce fourth phase water naturally, it takes a lot of energy to do so. Drinking sources of fourth phase water is thus better at rehydrating all the body’s tissues, not least in the mouth, than normal water as the body doesn’t need to convert the normal water to fourth phase water first.

Glacial meltwater is high in fourth phase water. This is partly because normal liquid water must go through a "fourth phase" state before freezing. The reverse is also true for ice that is just melting.

3 - Ditching The Cigarettes

Many of you reading this are probably familiar with the connection between cancer and smoking that is endlessly pushed through public health messaging. However, far less attention is paid to all the impacts it can have on the mouth, including the make-up of the bacterial populations. The influence on the oral microbiome can be indirect, such as through reducing saliva flow, which we have already discussed, or direct. This likely contributes to the rates of gum disease being higher in smokers compared to non-smokers.

It’s interesting to see that one of the products being advertised as a means of “quitting” smoking are e-cigarettes and vapes. E-cigarettes, which are created by the very same companies that concealed harmful safety data about their cigarettes for many years, are still packed with nicotine – the addictive substance in tobacco – thus struggling to address the underlying addiction. Additionally, the fluids used in e-cigarettes have relatively little regulation, making it easy for companies to add in compounds and chemicals which have little to no long-term safety data. There are already indications that e-cigarette fluid may have damaging effects on the DNA within the tissues of the mouth.

CDC_electronic_cigarettes_October_2015_(cropped)
E-cigarettes are becoming an increasingly attractive product for the "big tobacco" companies, whose traditional tobacco products are increasingly taxed and have negative stigma attached to them.

If conventional smoking cessation routes are proving ineffective, I had a health practitioner tell me recently that she has seen success in using liquorice root. Liquorice root is non-toxic, doesn’t contain addictive nicotine, and  still allows patients to still hold something between their lips if they feel the need to have something there. Furthermore, there are compounds in liquorice root that aid in things like ulcer healing, regulating stress responses from the adrenal glands and as an anti-inflammatory agent.

4 - Producing Nitric Oxide

Beetroot has a following among some athletes who consume them for their ability to encourage nitric oxide production.

There are some foods we can be adding in to our diets that specifically promote a healthy oral microbiome. Foods like beetroot deliver a form of dietary nitrate to the oral cavity in a combination of other vitamins and nutrients, like Vitamin C, that allow the production of nitric oxide.

There are also artificial products that claim to increase nitric oxide production, including supplements and chewing gums.

Nitric oxide is an important signalling molecule in our bodies that helps with controlling blood pressure, nerve impulses and keeping harmful bacteria and cancers at bay, among other things. While our bodies can produce some nitric oxide naturally, we have to outsource to bacteria in the mouth to make up the shortfall. Thus, by avoiding products that damage nitric oxide-producing bacteria, such as antimicrobial mouthwashes and fluoride-based toothpaste ingredients, and instead introducing compounds that promote the activity of these bacteria, we then provide a health benefit for the whole body, and not just the mouth.

5 - Keeping Sugars (And Carbs) Out

It perhaps shouldn’t come as a surprise that what we eat has a significant impact on the bacteria in our mouths. Refined sugars, present in so many foods available on supermarket shelves, are rapidly converted by the bacteria in the mouth into acids that erode teeth. As such, more sugar drives the proliferation of the bacteria that can metabolise sugar into acid, thus increasing the amount of decay, inflammation in the gums and so forth.

However, there is reason to suggest that reducing all carbohydrates – not just short-chain sugars – and instead having a diet rich in fibre and fats can be a good approach to take, both in general health terms and for the oral microbiome. These diets have consistently been shown to have a positive effect on controlling a range of inflammatory illnesses, including diabetes and cardiovascular diseases. Interestingly, many of these illnesses are thought to have a synergistic relationship with gum disease – a disease characterised by a dysbiosis in the oral microbiome. Thus a low-carb diet, in theory, may help remove some of the factors influencing periodontal disease and indirectly promote recovery of the oral tissues and microbiome.

An illustration of the kinds of foods that should be prioritised in a ketogenic or low-carb diet.

High-fat, low-carb diets have also been correlated with direct changes in the oral microbiome, leading to a reduction in the number of Gram-negative bacterial species, which are commonly implicated in gum disease. Interestingly, the same study also showed a slight reduction in the number of nitric oxide producing oral bacteria, which could be indicative of the body’s tissues being able to better produce its own nitric oxide and not relying on oral bacteria to supplement the supply.

6 - Breathing Through The Nose, Not The Mouth

Noses are for breathing and smelling, mouths are for eating and speaking. Breathing through the nose ensures the air coming in to the body is adequately moist and filtered from debris before it enters into the lungs. Yet many of us – including children – are bypassing this important organ through chronic mouth-breathing. This has detrimental health impacts systemically – such as for IQ and asthma – but also local effects in the mouth, which can be reflected in the oral microbiome.

Mouth breathers often show detrimental changes in the oral microbiome that can predispose individuals to bad breath, decay and gum disease. This may happen indirectly through impacting on saliva evaporation. If mouth breathing continues, the bacteria and compounds we don’t want in the mouth get dragged further and further into the airway, potentially contributing to airway infections. Furthermore, mouth breathing means certain body tissues, such as the paranasal sinuses, are not stimulated adequately to produce nitric oxide. As a result the body must rely on the bacteria in the mouth to work overtime, which they can fail to do.

Thankfully, there are some easily-accessible solutions to switching to nose-breathing that can include deliberate breathwork practises, the use of mouth tape and/or nasal dilators.

The nose is highly complex to allow for appropriate filtering and passage of air into the body.

Conclusion

There is perhaps one more question that needs to be asked; is it the bacteria and a dysbiotic oral microbiome that are directly responsibe for the illnesses we see? There is a very valid argument to be made that the “disease-causing” bacteria of the mouth are only exploiting vacant ecological niches – such as using sugar in food trapped in teeth and gums as their own food source – and in doing so contribute to the symptoms we see. Many of the bacteria implicated in the progression of oral illnesses can be found naturally in the mouths of healthy individuals without causing illness. This demonstrates that the oral microbiome is not necessarily the root cause of diseases, and instead that poor diet, habits and lifestyles are where problems begin. The health of the oral microbiome is, therefore, a reflection of the health of the individual. If the mouth – the gateway to the body – is kept healthy and clean, then that opens up the rest of the body to be the same.

To the best of my knowledge, I believe I have demonstrated some of the best means of achieving a healthy oral microbiome. If nothing else, I hope this piece gives you some appreciation on just how interlinked the different aspects of health and the body are, and where the mouth fits in to all of this. For those looking to explore the topics mentioned in this piece further, I can recommend the following books:

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