Explore the often-ignored connections between oral health and chronic disease.
Conventional doctors are starting to come around to what integrative practitioners have known for a long time, and that is the crucial importance of the gut microbiome to overall health. But what conventional doctors and dentists continue to miss is that gut health starts in the mouth. Indeed, the mouth can provide a window into one’s overall health. Research has linked problems with oral health like periodontal disease with many health conditions like cardiovascular disease, type II diabetes, cognitive decline and Alzheimer’s, and respiratory disease, to name a few. This makes oral health a foundational but often overlooked component of your health.
Conventional dentistry focuses mostly on “drilling and filling,” that is, correcting structural and functional issues with teeth, as well as performing cosmetic work to make teeth visually appealing. This approach misses key aspects of oral health. Integrative and holistic health practitioners have known this for some time. Weston A. Price detailed the destructive effects of root canals in the early 20th century; he also noted the important link between nutrition, dental health, and overall health in his studies of indigenous people from across the world, particularly the importance of fat soluble vitamins like A and D.
It is now established that the gut microbiota—the trillions of microorganisms that reside in the digestive tract—plays a crucial role in many important bodily functions, including immunity. You can think of the digestive tract as one large tube going through the body, starting in the mouth, down the throat, into the stomach, the intestines, down to the colon and the rectum. The mouth is where it all begins—you have huge numbers of microbes in your mouth. Like your gut, the makeup of this microbial community is conditioned by your diet, lifestyle, environmental exposures, etc., and has profound and far-ranging effects on overall health.
To promote dental health, it is crucial to cultivate the correct balance of “good” and “bad” microbes in the oral cavity. This can be done with prebiotics and probiotics. Prebiotics are nutrients that promote the growth of preexisting good bacteria. Probiotics are foods that contain microorganisms (such as yogurt). There are a number of prebiotic toothpastes and mouth rinses on the market.
You might think that you have your bases covered with a typical mass-market mouthwash but be advised: many of the mouthwashes on the market carry the same drawback as antibiotics—they kill the good bacteria along with the bad, disrupting the balance of the oral microbiota.
Some of the microbial inhabitants of the mouth have the ability to inhibit inflammation. The oral microbiome also helps regulate the acidity of the mouth. People without cavities have species that are able to convert arginine or urea in the diet to ammonia, which helps balance the pH in the mouth. The oral microbiome also transforms nitrate from fruits and vegetables into nitrite, then nitric oxide, which helps regulate blood pressure. Many antiseptic mouthwashes will wipe out these beneficial bacteria: a 2020 study found that healthy people who used mouthwash containing chlorhexidine had higher blood pressure.
Oral dysbiosis occurs when the balance between the beneficial microbes and the pathogenic microbes is disrupted. Oral dysbiosis is caused mainly by poor dental hygiene; other factors include dietary habits (diets high in sugar and refined carbohydrates), smoking, genetic differences, and dysfunction of the salivary glands. Oral dysbiosis leads to the formation of biofilms in the oral cavity that create communities of “bad” or pathogenic bacteria to grow, leading to periodontal disease.
Periodontal disease is the result of infections and inflammation of the gums and bone that surround and support the teeth. Tooth decay and periodontal disease begin with plaque buildup. You may notice a slimy film on your teeth when you wake up in the morning; this biofilm is a breeding ground for bacteria. The acidic byproducts of this bacterial activity cause tooth decay and the eventual formation of cavities.
As mentioned above, periodontal disease is linked to a lot of serious health conditions. People with periodontal disease tend to have systemic inflammation; it’s possible that this inflammation in the gums sets off a cascade that causes inflammation in the cardiovascular system. Or the “bad” bacteria that proliferate during a state of dysbiosis could migrate to other areas of the body like the brain or the heart and cause damage that way.
The health of the oral cavity can also provide clues to underlying health issues. One doctor reported a case of a patient who complained of multiple chronic health issues, including fatigue and brain fog. Upon examination, the doctor found weak enamel—something that had been ignored by other doctors. This led him to the hypothesis that the patient had undiagnosed celiac disease, as this condition can lead to oral health issues. Upon testing, the patient did in fact have a marked response to gluten. Eliminating gluten cleared up the malaise and fatigue.
So what can be done to optimize oral health?
Diet is crucial. A diet high in sugar and processed starches increases the risk of tooth decay and cavities; microbes digest these sugars and produce acids that erode tooth enamel. Eating lots of fresh fruits and vegetables increases saliva flow and helps wash away food particles from teeth. Studies have found that a lack of physical activity is linked with periodontal disease and higher levels of physical activity are protective against it. Integrative health experts recommend xylitol gum and using an electronic toothbrush to promote the health of the oral cavity.
There are supplements that can support oral health like probiotics, CoQ10, vitamin C, vitamin D, and fish oil, to name a few. CoQ10 helps control inflammation in the gums, and patients with periodontal disease have exhibited a CoQ10 deficiency. Fish oil also helps address inflammation. Vitamin D deficiency has been associated with higher prevalence of periodontitis and gingival inflammation, and vitamin C has shown to help prevent periodontal disease. Oral probiotics can help fight the bad bacteria in your mouth and restore a healthy microbial balance.
It turns out, your parents were right! Ignore your teeth at your own peril.
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