Wow. It’s high time a solid, clinician and consumer-friendly book is delivered on the oral microbiome, is it not? Cass Nelson- Dooley began researching the topic years ago, and is now arguably one of the foremost leading experts on integrative interventions for oral health. I interviewed her on New Frontiers years ago, and she’s blogged previously on oral endotoxemia. Check out the below, based on her new book Heal Your Oral Microbiome. – DrKF
When was the last time you aced a test without studying? When it comes to optimizing the oral microbiome, you may already know the tricks of the trade- most of them, anyway. That’s because the oral mucosa is remarkably similar to the gut mucosa. The architecture is similar. The microbial inhabitants are similar. The immune tissue is similar, although it goes by slightly different names: in the gut it is “GALT” and in the mouth, simply “MALT.” And in integrative and functional medicine, we spend a lot of time studying, understanding, and manipulating gut ecology. That means that you already have many of the tools you need to address the oral microbiome. Sweet!
There’s no question that the oral cavity is a major player in overall health and wellness. Heart disease, diabetes, rheumatoid arthritis, cancers, and preterm births, just to name a few. If you want a refresher on the oral-systemic connection and why it is the future of comprehensive wellness, check out Endodontic Endotoxemia: The Oral-Systemic Connection.
But what do you do on Monday morning at the clinic when your patient tells you she has had extensive dental work? Or a patient mentions he has bleeding gums and a chronically elevated CRP? Or a routine dental procedure that triggered joint pain? What if you’re treating a patient with none of those complaints, but who has cardiovascular disease?
Treat the oral microbiome and optimize oral health
You can treat the mouth from the inside and the outside. Just like the gut, the mouth and the oral microbiome thrive on a healthy diet with plenty of plant-based whole foods. You have to remove sugar, allergenic foods, and dysbiosis in the mouth. And also similar to a gut protocol, you then need to repopulate the oral microbiota and heal and nourish the oral lining. One of the great things about the mouth is that it is easy to access. You can directly interfere with bacterial biofilms in the mouth with brushing, flossing, tongue scraping, oral rinses, oral probiotics, and probiotic toothpastes. There are many ways to manipulate the oral microbiome. For the purposes of this blog, however, we will review the nutrients that help to boost oral health and oral probiotic products that can balance microbes in the mouth.
The most important ways to impact your patient’s oral health are:
- Dental hygiene
- Balancing microbes in the mouth
- Lowering inflammation
- Healing the oral mucosa
- Boosting immunity
Nutrients for Oral Health
The patient with oral dysbiosis (like all of us) needs a foundational nutrition plan that includes a diet of healthy proteins, complex carbohydrates, essential fatty acids (including linolenic and alpha-linoleic acids), plenty of vegetables, and supplements, including a multivitamin-mineral and a probiotic. In addition, certain nutrients have been shown to specifically benefit the mouth. And providing optimum nutrition to the tissue in the mouth and the teeth promotes a healthy oral microbiome. The following nutrients are recommended for oral health.
|Nutrients for Oral Health||Dosing Considerations|
|B vitamins||Vitamins B1 50 mg/d, B2 50 mg/d, B3 50 mg/d, B5 500 mg/d, B12 1,000 mcg/d|
|Folate||1,000 – 2,000 mcg/d|
|CoQ10||200 – 400 mg/d|
|Phosphorous||Supplementation unnecessary; plentiful in the diet|
|Vitamin A||5,000-10,000 IU/d|
|Vitamin C||1,000-5,000 mg/d|
|Vitamin D3||1,000-5,000 IU/d|
|Vitamin E||200 – 1,500 IU/d|
|Vitamin K2||500- 1,000 mcg/d|
|Zinc||30- 50 mg/d|
Table Notes: These nutrient doses serve as a guideline only. They are higher than the reference daily intakes (RDI) and are intended to replenish body stores over the course of 3-6 months in patients who have inadequate levels.
Vitamins D and A are necessary for healthy enamel on teeth. Calcium and other minerals help build teeth and keep teeth strong, while vitamins D and K help direct tooth formation. Low protein, iron, or zinc can slow down saliva production, worsening nutrition in the mouth and leaving the mouth defenseless against infection. Patients with low folate are more likely to develop periodontal disease. Deficiencies of B vitamins can cause inflammation of the lining of the mouth and tongue, a burning sensation of the tongue, and more.
Antioxidants like CoQ10 and vitamins A, D, E, and C help protect the mouth from the dangers of smoking, tobacco products, and alcohol consumption. Some studies have shown that people with gum disease and bleeding gums have low levels of CoQ10 in their gums. CoQ10 treatment can reduce gingivitis and bleeding gums, as can Vitamin C. You can deliver these nutrients directly to teeth and gums by using a toothpaste such as Revitin Prebiotic Toothpaste, which contains CoQ10, vitamins C, D, K, calcium carbonate, and prebiotics.
Balancing the Oral Microbiome with Probiotics
We know probiotics do great things for the gut, but what about the mouth? Perhaps it is no surprise: They do great things for the mouth, too! Probiotic supplements for the gums and teeth decrease the numbers of bacteria that cause cavities and they help to get rid of periodontal pathogens. When people with periodontal disease took oral probiotics, they had less bleeding and their gums were healthier and more supple. Probiotics calm down inflammation (the immune system’s biological warfare against dysbiosis). They make chemicals that kill off unwanted bacteria. They help to kick Candida species out of the mouth, too.
So far, the main probiotics that improve oral health are Lactobacillus species, Bifidobacteria species, and Streptococcus species. Lactobacillus have been estimated to make up approximately 1 percent of the oral commensal flora. The Lactobacillus strains found in saliva are L. fermentum, L. rhamnosus, L. salivarius, L. casei, L. acidophilus, and L. plantarum.
Take a look at the table, which summarizes the evidence behind certain strains of oral probiotics and their effects on cavities and gum disease. It also shows what oral probiotics can reduce oral pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida species, and more.
Oral Probiotic Effects on Cavities, Gum Disease, and Organisms Involved in Cavities or Periodontal Disease
|Oral probiotic species||Health benefits in the mouth|
|Bifidobacteria species||Decreases S. mutans|
|Bifidobacteria lactis||Decreases S. mutans|
Reduces periodontal pathogens: P. gingivalis, Prevotella intermedia, and A. actinomycetemcomitans
|Lactobacillus brevis||Improves gingivitis; improves periodontal disease|
|Lactobacillus paracasei||Prevents cavities; reduces S. mutans; reduces P. gingivalis|
|Lactobacillus plantarum||Reduces S. mutans|
|Lactobacillus rhamnosus GG||
Reduces S. mutans; reduces oral pathogens; prevents cavities; improves periodontal disease similarly to surgical treatment
Reduces S. mutans; reduces Candida; reduces dental plaque in gingivitis
|Lactobacillus salivarius||Reduces S. mutans; maintains oral health|
|Streptococcus salivarous K12||Prevents gum disease; may prevent bad breath|
|Streptococcus salivarious M18||Prevents gum disease; may prevent bad breath|
|Weisella cibaria (previously a Lactobacillus species)||Reduces bad breath|
Saccharomyces boulardii is a friendly yeast. It is also a probiotic. Since it is a fungus, it’s ideally suited to crowd out other, less friendly fungi. Since dysbiosis in the mouth may be fungal as well as bacterial, a combination of probiotics and S. boulardii may be needed.
Probiotic toothpaste or chewable probiotics deliver probiotics directly to the gums, tongue, and teeth. Designs for Health carries PerioBiotic Toothpaste. A study on PerioBiotic Toothpaste showed that it reduced levels of plaque. It also lowered the cavity-causing bacteria, S. mutans, after brushing. However, when participants had a high-sugar drink, it blunted the effects of the toothpaste, once again showing that the oral microbiome is an interaction of diet, microbes, and other factors. Other oral probiotics include Prodegin TM from Klaire Labs, which is a chewable probiotic for oral health (they also carry a children’s chewable probiotic); TheraBreath carries oral probiotics and probiotic lozenges. GUM PerioBalance is a lozenge designed to prevent gum disease; it contains probiotic strains of Lactobacillus reuteri.
Remind your patients to protect their microbiomes from dental procedures. They can take probiotics and the friendly yeast, S. boulardii, before and after dental procedures. If they take antibiotics, they still can take their probiotics, just recommend that they take them a few hours apart from each other. The good bacteria can then recover more quickly after getting wiped out by antibiotics.
Address the Oral Microbiome for Comprehensive Wellness
The oral microbiome is the new frontier in the human microbiome. It is highly biodiverse. It has far-reaching effects not only in the mouth but also in extraintestinal sites and in systemic disease. With only 57% of its inhabitants characterized, we will continue hearing about new oral microbes and their roles in health and disease. In this blog we reviewed the nutrients that are needed for healthy gums, teeth, and oral mucosa. We discussed oral probiotics, delivery modes, and what strains counteract cavities, gum disease, and oral pathogens. The similarity between the gut and oral cavity mean that the integrative and functional medicine practitioner already has a range of tools and interventions to apply to oral health. It’s just a matter of incorporating the oral mucosa and oral microbes into your patient’s comprehensive wellness plan.
Want to learn more about the gut’s kissing cousin? Listen to the Oral Microbiome podcast with Dr. Kara Fitzgerald and Cass Nelson-Dooley (transcript can be found there, too). Build out your clinical toolbox with even more treatments in Heal Your Oral Microbiome, the first book exclusively on the oral microbiome, now available on Amazon.
About the Author:
Cass Nelson-Dooley, MS, studied medicinal plants in the rain forests of Panama, in 2003 as a Fulbright Scholar, and then launched a career in science and natural medicine. She researched the pharmacology of medicinal plants at the University of Georgia and AptoTec, Inc, and then joined the innovators at Metametrix Clinical Laboratory and Genova Diagnostics. She enjoys teaching, presenting, writing, and researching how to address the underlying causes of disease, not just the symptoms. She has over a decade of experience teaching doctors about integrative and functional laboratory results. In 2013, she started Health First Consulting, LLC, a medical communications company with the mission to improve human health using the written word. Ms. Nelson-Dooley is the author of Heal Your Oral Microbiome and has published case studies, book chapters, and journal articles about natural medicine, nutrition, and laboratory testing.
This is a great article and quite inspiring as I prepare to take time in the coming months for my own comprehensive project on natural oral health. If I may make one comment that is to emphasize the importance of adequate Vitamin A (Retinol) for the preventing and reversing minor tooth decay and ensuring proper facial development in children. Beta Carotene clearly has some remarkable qualities as an antioxidant but I would be careful not the confuse them which I find to the norm when discussing this topic. Especially given the challenges that many of us have to convert Beta Carotene to Vitamin A.