Oral Microbiome Solutions
“The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
—Thomas Edison
You have the power to keep your oral microbiome healthy. You can also do things to heal your oral microbiome if it is sick. One of the great things about the mouth is that it is easy for you to access. You can promote health from the inside and from the outside. For instance, your diet influences your oral microbiome (and every other cell in your body, for that matter). When you change your diet, you are improving your microbiome from the inside. You can also directly affect the bugs in your mouth with probiotic toothpastes, by avoiding mouthwash, and more.
The major ways you can impact your oral microbiome are through:
• Diet
• Nutrition
• Dental hygiene
• Balancing your microbes with supplements or medications
• Lowering inflammation
• Healing mouth tissue
• Boosting your immune system
In this chapter, I will also tell you about the cutting-edge tests available to find out what bugs are living in your mouth. I will list resources to help you find an integrative and functional medicine doctor to work with in your area. In Chapters 7 and 8, you learned that the mouth is intimately interconnected with the rest of the body, so it could be that your oral microbiome is not the root cause of your health problems. On the contrary, you may have a disease process going on elsewhere in your body that is just producing symptoms in the mouth. Therefore, you may need to work with a clinician to address other problem areas first, in order to restore health to your mouth. Continue reading about the many treatments and resources available to help you optimize your oral microbiome.
“Every time you eat or drink you are either feeding disease or fighting it.”
—Heather Morgan, MS
Your diet is one of the most powerful ways to influence your microbiome. Have you heard the adage “You are what you eat”? It might be more appropriate to say instead, “You are what your bugs eat.” All of our bugs have evolved alongside us for millennia. They eat what we eat. Bacteria eat the break-down products of protein, fiber, sugar, fats, and plants, just like we do. Your microbiome likes plant-based foods. One of the most powerful ways to shift your microbiome is to eat more plant-based foods and fiber. Prebiotics, found in these foods, are literally bacteria food. The more prebiotics you eat, the more you feed your good bugs, and the happier you and your bugs are. Take a look back at Chapter 5, page 37, to learn more about prebiotics. Examples of prebiotic foods are chicory root, Jerusalem artichoke, banana, and whole grain breakfast cereal.
If you have trouble eating lots of vegetables and fruits, you can also take prebiotics in a powder form. Nutritional supplements contain these common prebiotics: galacto-oligosaccharides, inulin, and larch arabinogalactan. Klaire Labs has BiotaGen and Designs for Health has PaleoGreens and PaleoReds (available through a practitioner). Another popular prebiotic supplement is SunFiber, which contains guar gum and is tasteless, colorless, and odorless.
For a comprehensive guide about the diet that promotes oral health, see The Dental Diet, by Dr. Steven Lin. It includes a step-by-step meal plan with recipes. Books that tell you how to feed your gut microbiome will apply equally well to feeding your oral microbiome, too.
Breastfeeding
In our first days and months of life, we are given milk, even before we eat a whole foods diet. Breastmilk is by far the best milk for an infant’s microbiome, as we discussed earlier. It is chock-full of mother’s good bacteria, the prebiotics that feed those bacteria, and immune boosters, among many other nutritional and health benefits. Breastfeeding provides all of the nutrients needed to build strong teeth and nourish the mouth. It also helps develop the jaw, the nasal cavity, and alignment of the teeth.142
Breastmilk gives a child a foundation of healthy bacteria that will colonize the gut, the mouth, the skin, and the rest of the body. Nature has designed a magnificent system whereby a mother passes on her microbiome to her child through vaginal childbirth and breastfeeding (see Chapter 5). Antibiotics, C-section births, and infant formula interfere with the process of transferring mother’s microbiome to her child. These things should be avoided, when at all possible.
Despite our best efforts, however, children are born by C-section and/or can’t breastfeed at alarmingly high rates. There are some things you can do to simulate the microbiome transfer that normally happens during vaginal birth and breastfeeding.
One technique to restore a baby’s microbiome after C-section delivery is called vaginal seeding, whereby gauze is placed into the mother’s vagina where it absorbs the mother’s vaginal fluid (and good bacteria). When the baby is delivered, the gauze is removed and then brushed over the newborn’s mouth, nose, and skin. A very small study showed that vaginal seeding “rescued” the C-section infant’s microbiome143 and restored it so that it more closely resembles that of babies born vaginally. Pretty incredible! I did it with my daughter. Some doctors discourage this practice, saying that there is not enough evidence to support it. They believe pathogenic microbes in the mother’s vaginal fluids could present harm to the newborn. Instead, they encourage at least six months of breastfeeding to overcome the depletion of microbes caused by the C-section birth.
Mothers who can’t breastfeed should consider using donor human milk. Human breast milk is actually recommended by the American Academy of Pediatricians for all premature infants because it reduces the risks of blindness, blood infections, gut infections, and death in these vulnerable babies. When breast milk isn’t available, they recommend pasteurized human donor milk over formula. Dairy and soy infant formula can’t even touch the sublime benefits to health and the microbiome of human milk for our babies.
And even before birth, you can optimize your microbiome so that it’s in tip-top shape for your baby. Take probiotics during pregnancy to help boost your good bacteria and gut function. A healthy diet low in sugar and refined carbs, and rich in vegetables and fruits will help grow your healthy bacteria. You can offer the same kinds of healthy foods to your baby when he or she starts eating solid foods. Don’t give them sugar or cereals, but instead veggies and fruit to help them cultivate a garden of beneficial bacteria. Avoid antibiotics before, during, and after pregnancy, when possible. Chronic ear infections in babies can be a sign of food sensitivities, so exercise caution when introducing allergenic foods into your baby’s diet (such as wheat, dairy, corn, and soy). Limiting allergenic foods can help to reduce infections and unwanted antibiotics.
Get Rid of Your Sweet Tooth
A diet high in sugar and refined carbohydrates (which turn to sugar quickly) is like feeding your microbiome junk food. Examples of foods high in sugar and refined carbs are crackers, bread, pasta, cereal, baked goods, cakes, cookies, chips, sweets, and white rice. They’re not good for you and they’re not good for your microbes, either. Sugar and refined carbohydrates can cause harmful bacteria to flourish and take over. Instead, you should eat complex carbohydrates. Complex carbs are found in beans, sweet potatoes, oatmeal, whole wheat, brown rice, and more. Because they take longer for the body to break down, they don’t act like a sugar jolt to your system.
Cutting sugar and packaged foods out of your diet will help to balance Candida or other fungi in your mouth. Fungi and yeasts (a type of fungus) like sugar. If high Candida is a problem in the mouth (or in the gut), you can lower it by cutting foods out of your diet that are high in fungus, such as bread, cheese, beer, corn, and nuts. When you eat these foods, you are increasing fungal levels in your mouth and gut. Some people have trouble keeping their fungal microbiome in balance. They may have vaginal yeast infections, jock itch, athlete’s foot, a white coating on their tongue (thrush), or other symptoms of fungal overgrowth. These people often benefit from an “anti-Candida diet” that is low in sugar, starch, and the foods listed above, as well as mushrooms and vinegar.
See if you can give up sugar, soda, and processed foods. Sugar does nothing good for your mouth or your body. Instead, use natural sweeteners like stevia leaf and xylitol from the birch tree. You can also try monk fruit. These are sweeteners that will not cause dysbiosis. In fact, xylitol, which tastes a lot like sugar, actually fights cavities. Stevia and xylitol have the added bonus that they are healthy sweeteners for people with diabetes or who are trying to lose weight.
If you have extreme sugar cravings, you may have a serious dysbiosis. Bacteria and yeast can take over, causing you to crave sugar. Intense sugar cravings can also be a sign of hormonal imbalance or problems with your metabolism. Consider finding an integrative and functional medicine practitioner to help figure out the root cause of sugar cravings so you can start making healthier food choices.
Instead of eating sugars and refined carbohydrates, choose vegetables, fish, meats, eggs, fruit, and whole grains. Try to cook at home more frequently. Green tea and other herbal teas also are good food for our bacteria because they contain polyphenols, a natural product in plants that bacteria like to eat. Green tea also fights cancer. Whole foods are what our microbiomes have been accustomed to eating for millennia, and they are better for us, too!
Fruits should be eaten sparingly. Use whole fruit to satisfy your sweet tooth instead of fruit juices, foods with added sugar, or packaged foods that are high in refined carbohydrates. While certainly some fruits are acidic, acidic fruits are not the major cause of high acid in the mouth. Instead, make sure to eliminate other causes of high acid in the mouth, like sugar, fruit juice, and soda.
When you eat fermented foods such as sauerkraut, kimchi, and kombucha, you are eating good bacteria that will impact your mouth and gut. Keep in mind that pasteurization kills good bacteria. So look for these products that have not been treated. Making your own fermented foods is another option. However, exercise caution because we don’t know all of the microorganisms that grow in these fermented concoctions. Things like sauerkraut and kimchi have been eaten for millennia, so fermenting foods is not dangerous, but it would be better to buy it (or starter cultures) from a trusted source.
Many people think yogurt is a good dietary probiotic. I don’t agree. The first problem is any flavored yogurt has a lot of refined sugar in it. That’s not good for your bacteria and yeast. Secondly, yogurt doesn’t deliver high doses of probiotics, just lower doses. To fully benefit from the perks of probiotics, you will likely need higher doses that are typically found in supplements. Unsweetened yogurt is certainly a healthy food, but I wouldn’t rely totally on it to provide your body with all of the beneficial bacteria that you need (take a look at Balancing Your Microbes on page 72).
Your body requires a long list of vitamins, minerals, amino acids, fatty acids, and carbohydrates in order to stay healthy. Every cell of the body, including those of the mouth, needs these nutrients to function at its best. Your diet should include all of these life-sustaining nutrients. A healthy diet discourages cavities, helps build enamel, prevents tooth break-down, and fortifies the immune system. It nourishes the oral mucosa so that it can defend itself and heal rapidly. Certain nutrients can promote saliva production, which is critical for oral health. Unfortunately, even an organic, whole foods, healthy diet may not deliver all these nutrients to meet your body’s demands. Nutritional supplementation may be needed.
Pretty much everyone 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 (see specific recommendations on page 72). If you have oral dysbiosis, then these nutritional recommendations are all the more important for you. In addition, certain nutrients have been shown to specifically benefit the mouth. And keeping the tissue in the mouth and the teeth healthy helps keep your oral microbiome healthy. The following nutrients are recommended for oral health:
• B vitamins
• Calcium
• Coenzyme Q10 (CoQ10)
• Folate
• Magnesium
• Phosphorous
• Potassium
• Vitamin A
• Vitamin C
• Vitamin D
• Vitamin E
• Vitamin K2
• Zinc
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. If you don’t have good levels of folate (the synthetic version is called “folic acid”), you 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.144
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.145, 146, 147
If you eat a diet of junk food, fast food, or lots of packaged foods, you may not have good nutrition. If you don’t eat the rainbow of vegetables, you may be malnourished. If you have a chronic illness, your body may be drained of vital nutrients. If you weren’t breastfed, you might have had a poor nutritional start. If you suspect that you have a weak nutritional foundation, you should see a clinician who can test your levels and replenish these fundamental nutrients with diet and supplements (see Finding an Integrative and Functional Healthcare Practitioner on page 78). Your oral health—and perhaps your bodily health—depends on it.
I am a big fan of the oral microbiome. But our oral bacteria can overgrow and become imbalanced, or dysbiotic. If we never brushed our teeth, we would have tons of bacteria living in our mouths. And as much as I like good bacteria, in high numbers they will probably cause gum disease and cavities. The trick isn’t to kill off all bacteria or to let them grow wildly out of control, but to keep them in balance. Since the advent of dental hygiene, we have tools at our disposal to keep our bacteria from growing out of control. For someone with oral infections or dysbiosis, antimicrobial treatments and even antibiotics may still be necessary, but we should exercise caution not to kill oral bacteria needlessly.
Dental hygiene physically removes the microorganisms in the mouth. Dental hygiene keeps plaque lower and helps prevent cavities and oral dysbiosis. Studies show that well-off teenagers who brushed their teeth daily with a fluoride-containing toothpaste, had dietary and oral hygiene counseling, fluoride treatments, and regular dental visits since early childhood had a low rate of oral dysbiosis, specifically in the form of cavities.148
Brushing teeth affects the oral microbiome and the gut microbiome. When people brushed after every meal, it significantly decreased Candida levels in the saliva and stool, much more than brushing one time per day.149 Brushing and flossing lowers inflammatory markers in your blood and reduces your risk of heart attacks in real-time.150 As you saw in the case story from Chapter 8, Dr. Ellie Campbell changed her patient’s oral microbiome by recommending a stainless steel tongue scraper before brushing, GUM soft picks, and frankincense oil in the patient’s Waterpik.
However, oral hygiene doesn’t affect the major players in the oral microbiome. It affects the relative proportions of each bug in the community. Even two human populations with totally different brushing and flossing habits both had the same “core microbiome,” as we discussed in Chapter 5. The same 24 bacterial species were found in all participants, and the same 78 species were found in 90 percent of the participants. That’s a lot of overlap for people with different dental hygiene habits.
When people stopped all forms of oral hygiene, the bacteria in their mouths skyrocketed after only four days. By day 10 without oral hygiene, everyone in the study had developed moderate to severe gingivitis. When they resumed their normal dental care, they were able to lower the overall amounts of bacteria on their teeth. But the composition of the microbiome on their teeth did not bounce back to baseline, even after two weeks of renewed oral hygiene. The changes to the tooth microbiome stuck, despite getting back on the dental hygiene wagon.151 What we do can dramatically affect our microbial populations; even 10 days without brushing can change your microbiome semi-permanently.
Brushing and flossing not only keep the bacteria levels down, they also act as a physical therapy to keep the oral mucosa and gums healthy. My dental hygienist highly recommends a Waterpik water flosser, or water irrigation of gums and teeth. She has seen excellent results, often better than flossing, to keep gums plump, healthy, and strong. These therapies stimulate and strengthen your gum tissue and help the gums stay tight around the teeth, like a suction cup. Healthy, strong gums reinforce the oral mucosa and form a strong defensive barrier, which keeps bad bugs out of the bloodstream where they don’t belong. If you want to revisit this, we discussed the barrier and the problems caused by leaky mouth in Chapter 4. The key to oral hygiene is finding the tools that work best for you, both in terms of your daily habits and what therapies make your teeth and gums happy.
In one of my biology classes in college, we were told matter-of-factly that adding fluoride to our water system was one of the greatest public health victories of all time and had dramatically reduced the incidence of cavities. Indeed, dentists use fluoride treatments to strengthen and rebuild teeth. Calcium, found in the tooth’s hard hydroxyapatite material, can be swapped out for fluorine, which makes teeth more durable and less susceptible to cavities.
It was only when I started working at an integrative and functional medicine laboratory that I learned that not everyone agreed with my biology professor. Groups of dentists and physicians oppose water fluoridation because of its health risks. In population studies and animal studies, fluoride exposure seems to harm brain development. At the time of writing this, a study came out suggesting that fluoride could be neurotoxic to unborn babies. The more fluoride that pregnant women were exposed to, the more likely their future children were to have ADHD, even years later.152 Between fluoride in water, toothpaste, food, pharmaceuticals, and other sources, we may be getting much more fluoride than we need. In fact, too much fluoride causes fluorosis, a harmless discoloration or surface pitting on teeth, which has been reported in 41 percent of US teenagers.153 To fluoridate or not is a hotly debated topic so you will want to do further reading to come to your own conclusion about fluoride, oral health, and overall health. At the minimum, be careful about fluoride exposure during pregnancy and in children.
Smoking
Smoking increases your risk of gum disease, diabetes, heart disease, cancer, obesity, and more. Stop smoking to improve your oral microbiome, decrease oral dysbiosis, and fight disease elsewhere in the body. This is one of the all-time best things you can do for your overall health. Quitting can be extremely difficult. Check with government smoking cessation programs and even your health insurance company for resources and moral support to help you quit.
Healthy Salivary Flow
Perhaps you take saliva for granted, or you just see it as a nuisance. A generous flow of healthy saliva is absolutely essential for a healthy mouth! It is packed with nutrients that feed your teeth and gums. It washes away bacteria so that they don’t overgrow. It carries molecules that protect your teeth and gums, raise your immune defenses, and fight infections. Eating a healthy diet and making sure you have good levels of vitamins and minerals will ensure that your saliva can do its job. Drink plenty of water—half of your body weight in ounces each day. Chewing up whole foods can help salivary flow; chewing certain foods such as peanuts, gum, and hard cheeses seems to stimulate saliva production. If you have an autoimmune disease or other illness that causes dry mouth, please see page 78 to find a practitioner that can help you address that condition as well as support your oral health.
If you are a “mouth-breather,” it means that you breathe in most of your air through your mouth, instead of your nose. Breathing through your nose is actually a healthier way to breathe. Mouth-breathing can dry up saliva and increase bad breath, cavities, and gum disease. What does that mean? Mouth-breathing contributes to dysbiosis of your oral microbiome. If you notice that you breathe through your mouth by day and have dry mouth when you wake up in the morning, check out resources by Dr. Mark Burhenne, on how to turn around mouth-breathing at askthedentist.com.
Boost Your Good Bugs
The most obvious way to alter your oral microbiome is to encourage good bugs to grow or get rid of bad bugs. You can boost your good bacteria levels by taking probiotics and prebiotics. You feed your good bacteria when you eat a diet rich in plant-based foods and fiber. We will talk about how to remove bad bacteria in the next section.
Probiotics are beneficial bacteria that cause no harm. They can be taken as a pill, powder, or paste. Probiotics can crowd out bad bacteria and help fight infections. They can change the environment of the mouth so that other friendly bacteria can have an easier time growing. They help you shift your microbiome to a healthier balance of bacteria. Fermented foods, such as sauerkraut, kimchi, and kombucha, also contain beneficial bacteria (see Diet on page 66).
There are many great probiotics out on the market now. Most of them are for improving gastrointestinal function. Probiotics taken in a capsule can alleviate symptoms like diarrhea, constipation, bloating, stomach ache, gas, and more. I like Custom Probiotics (available online) and Masters Supplements (available through a practitioner). Take 50 to 300 billion colony forming units per day (CFU/day) to provide your body with a good dose of healthy microbiota. A dose of 50 billion CFU/day is appropriate for maintaining health. A dose of 300 billion CFU/day is appropriate for someone with serious illness related to bacterial imbalance, such as ulcerative colitis. At high doses like 300 billion CFU/day, you should be under the care of a healthcare professional knowledgeable about probiotic therapies.
Some common probiotics, backed up by scientific evidence, to help promote gut health are:154
• BioGaia by Everidis Health Sciences
• Culturelle by Valio, Helsinki, Finland/Amerifit Brands, Inc.
• DanActive by Dannon
• VSL #3 by Sigma-Tau Pharmaceuticals, Inc.
Probiotics usually contain Lactobacillus and Bifidobacteria species. Look for brands with a variety of species. These have many great health benefits for the intestines and rest of the body!
We know probiotics do great things for the gut, but what about the mouth? It should be no surprise to you after reading this book: 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 (bugs that are thought to cause gum disease). When people with periodontal disease took oral probiotics, they had less bleeding and their gums were healthier and more supple.155 Probiotics calm down inflammation (the immune system’s biological warfare against dysbiosis). They make chemicals that kill off unwanted bacteria. Oral probiotics can stick to teeth and make a place for themselves at the “dinner table,” effectively kicking bad bugs out of the picture. They help to kick Candida species out of the mouth, too. If you want to refresh your memory about oral dysbiosis that causes cavities or gum disease, take a look at Chapter 6.
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.156
Oral Probiotic Effect on Cavities, Gum Disease, coccus Mutans) or Periodontal Disease, and Organisms Involved in Cavities (Strepto-Streptococcus Mutans) or Periodontal Disease,157,158
ORAL PROBIOTIC SPECIES |
HEALTH BENEFITS IN THE MOUTH |
Bifidobacteria species |
Decreases S. mutans |
Bifidobacteria lactis |
Decreases S. mutans |
Lactobacillus species |
Reduces periodontal pathogens: P. gingivalis, Prevotella |
intermedia, and A. actinomycetemcomitans |
|
Lactobacillus brevis |
Improves gingivitis; improves periodontal disease |
Lactobacillus paracasei gingivalis |
Prevents cavities; reduces S. mutans; reduces P. |
Lactobacillus plantarum |
Reduces S. mutans |
Lactobacillus rhamnosus GG |
Reduces S. mutans; reduces oral pathogens; prevents cavities; improves periodontal disease |
Lactobacillus reuteri |
Reduces S. mutans; reduces Candida; reduces dental plaque in gingivitis |
Lactobacillus salivarius |
Reduces S. mutans; maintains oral health |
Streptococcus salivarius K12 |
Prevents gum disease; may prevent bad breath |
Streptococcus salivarius M18 |
Prevents gum disease; may prevent bad breath |
Weissella 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. A common brand of S. boulardii is Florastor by Biocodex, Inc.
If you have dysbiosis in the mouth, consider using a probiotic toothpaste or chewable probiotics. This delivers probiotics directly to your 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.159 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.
Protect your microbiome from antibiotics and dental procedures. Remember to take probiotics during and after any treatment with antibiotics. Also, make sure to take probiotics and the friendly yeast, S. boulardii, before and after dental procedures. If you are taking antibiotics, you can still take your probiotics, just take them a few hours apart from each other. This helps your good bacteria recover more quickly after getting wiped out by antibiotics.
Get Rid of Bad Bugs
Sometimes bad bugs grow up and take over, causing an infection. Or a group of bad bugs might be “at the top of the heap” in a bacterial community, creating imbalance. We call this dysbiosis. There are many treatments—both pharmaceutical and herbal—that lower bad bugs with the hope of re-establishing a better microbial balance.
Antibiotics can kill off bad bacteria. They are appropriate to use in serious or dangerous infections or in infections that don’t respond to more gentle treatments. Above all, use antibiotics with extreme caution. There is a time and a place for antibiotics, but our society is coming off of a few-decade bender of overdosing antibiotics (see Chapter 2). If your doctor recommends antibiotics, ask this question: What infection do I have? Be wary of a doctor who wants to treat a virus or an ear infection with antibiotics if there is no evidence of a true bacterial infection.
Antibiotics wipe out all bacteria, not just the bad guys. And research tells us that they never go back to normal. Bacteria do grow back rapidly, however; it’s just not back to their prior pattern. The longer you can go without antibiotics, the better. But when they are necessary, it helps a lot if you have already been taking probiotics. You should also take probiotics while taking antibiotics, and after for a few months, to help restore your microbiome.
Antimicrobial herbs (or herbal antibiotics) are not as powerful as pharmaceutical antibiotics. Since each herb has thousands of plant chemicals, they are more similar to natural whole foods. They have the added bonus of being effective against some bacteria that are antibiotic resistant. There is some research that suggests they may not obliterate the good bacteria in the same way that pharmaceutical antibiotics can. For example, garlic is an antimicrobial herb that can kill pathogenic bacteria but promote the growth of beneficial bacteria. Some antimicrobial herbs are berberine, uva ursi, caprylic acid, garlic, oregano oil, and olive leaf; the latter four also work against bacteria as well as fungi. You can eat more of these herbs in your diet (like oregano, thyme, garlic) if you are trying to lower dysbiosis, but for an infection or widespread dysbiosis, higher doses are typically needed than what you can get from your food. Brands of antimicrobial herbal formulas, or mixtures of different medicinal herbs, include GI Microb-X, ParaBiotic Plus, Berbemycin, Candicidal, Candicid Forte, GI-Synergy, Candibactin-AR, and Candibactin-BR. You may have heard of treatments to break or bust biofilms as a way to root out and destroy unfriendly gut bacteria. While the idea makes sense, these products are in their infancy and should be used only with a skilled integrative and functional medicine practitioner.
You can treat dysbiosis or infection in the mouth directly using antimicrobial mouthwashes, rinses, or even toothpaste. Again, use caution with mouthwash. It can kill the bacteria in your mouth! If you have a microbial imbalance in your mouth, and haven’t been able to correct it with other measures, you can try an antimicrobial toothpaste like Dentalcidin by Bio-Botanical Research or an antimicrobial mouth swish such as Dentalcidin LS, also by Bio-Botanical Research, which also contains nutrients for oral care. Both of these products are based on the company’s flagship product, Biocidin, which is an herbal antibiotic for gut dysbiosis. Some clinicians simply prescribe a tea tree oral rinse (from tea tree oil) to cut down bacterial and fungal overgrowth in the mouth (as in Grayson’s story in Chapter 6).
Use caution with conventional mouthwash that contains antimicrobial agents like chlorhexidine or cetylpyridinium chloride. Conventional antiseptic mouthwashes contain chlorhexidine, an antimicrobial which lowers the bacteria, spores, and fungi in your mouth. Mouthwashes can also contain essential oils, fluoride, alcohol, or peroxide. They are intended to help control or reduce bacteria involved in bad breath, gingivitis, plaque, and cavities. Perhaps that sounds like a good idea, but we now know that blindly killing our oral microbiome could harm our oral and overall health. Bacteria in our mouths help protect us from infection and lower our blood pressure. If you use mouthwash to help with gum disease, cavities, or bad breath, consider instead changing your diet, using oral probiotics, and even using herbal antimicrobials instead. When patients used chlorhexidine-containing mouthwash, their blood pressure increased.160 Use antiseptic mouthwash when your dentist orders it, before or after surgery or to manage oral infections, especially when you can’t brush daily. Listerine Original is a good option because it does not contain chlorhexidine, but instead essential oils from eucalyptus, mint, and thyme.
Gingivitis and other diseases often involve inflammation. Inflammation is like having a chemical and biological weapon spill in the body. It can be a response to an infection or to harmful foods or to high sugar in the blood. Our immune systems and healing mechanisms create inflammation when there is something that needs to be killed, like an infection, or healed, like a wound. Inflammation in small doses is a good thing but too much of it can cause serious illness, pain, and suffering.
Microbial dysbiosis can cause inflammation in the mouth. Balance and repair oral dysbiosis by cutting out sugar, soft drinks, and packaged foods, eating more veggies, taking probiotics, rebuilding your nutrition with vitamins, and work on your dental hygiene. If this doesn’t shift your oral inflammation, then you may have a baseline of inflammation in the mouth, unrelated to your microbes.
If you have chronic inflammation in your mouth, you will not be able to foster a healthy oral microbiome. You will have trouble healing and will likely have sores, burning, heat, redness, and/or bleeding in the mouth. There is usually a root cause of inflammation that needs to be uncovered and treated. This can clear the way for a healthier immune system that doesn’t overreact. However, until you can get help to find out and treat the root cause of inflammation (see page 29), there are things you can do to try to calm down the chemical and biological warfare.
Aloe vera juice is a cooling, soothing plant product that can calm down inflammation in the mouth. Curcumin, from turmeric, is anti-inflammatory, as is resveratrol, which comes from grapes. Eating a diet low in sugar and high in plant-based foods fights inflammation. Limiting meat intake and choosing grass-fed or free-range meat products can calm inflammation. Omega-3 fatty acids, or fish oil, is a natural anti-inflammatory. One gram per day is appropriate for a healthy person, while 3 grams (or more) per day is appropriate for someone fighting inflammation. Make sure to use a high-quality fish oil, one that has been tested for harmful levels of mercury. The Healthy Dentist brand has a Healthy Gums Antigingivitis Rinse that contains 20 percent aloe vera juice. It also contains herbs that fight bacterial overgrowth and those that promote healing.
Even after you’ve located the root cause of dysbiosis, changed your diet, started supplements, and started working with a healthcare provider, sometimes your body may need a little help to recover from months or years of illness. My recommendations to heal the oral mucosa come from what we know about healing the gut mucosa. When your oral mucosa is healthy and free of disease and inflammation, your beneficial microbes will also flourish.
A number of nutrients and plant components can help heal tissue. These are often dried and ground up into powders and sold as nutritional supplements. L-glutamine is an amino acid that is consumed heavily by the cells lining the GI tract. It helps with tissue healing by giving the cells fuel. Consider swishing powdered glutamine dissolved in water or aloe juice. Zinc carnosine helps to heal mucosal tissue. And slippery, slimy herbs can coat and protect the lining of the mouth so it can heal. Examples are deglycyrrhizinated licorice (DGL), okra, or slippery elm. Healthy Gums Antigingivitis Rinse from The Healthy Dentist, which includes aloe vera juice, can also help to heal the lining of your mouth.
These powders that are made to help soothe and heal the gastrointestinal tract can be dissolved in water, used as a mouth swish, and then swallowed for mouth and gut benefits. These healing ingredients could be added to a tooth bleaching tray or a mouth guard if you want to soak your gums for a short time. Examples of healing powders include GI Revive by Designs for Health and GlutAloeMine by Xymogen. You will need a medical professional to buy these products. If you can’t find one, compare the ingredients in these products to over-the-counter products at your local health food store to find a close match.
Another way to enhance the healing of your mouth lining is by giving up all wheat-containing products for a few months. The main allergenic protein in wheat is gliadin. Gliadin damages the connections between cells in the gut mucosa, breaching the intestinal barrier. Given the way gliadin can harm the gut mucosa, it may do the same thing in the mouth, contributing to leaky mouth (discussed in Chapter 4).161 Staying away from wheat products may help jumpstart the healing of your oral mucosa.
Mercury
Sometimes toxins in the mouth can spell trouble for oral health. Mercury amalgams, or dental fillings that contain mercury, are commonly used in dentistry and have been for centuries. While a very controversial topic, biological dentists and clinicians practicing integrative and functional medicine are very concerned about mercury causing illness in the mouth and elsewhere in the body. In the mouth, mercury can cause soreness, inflammation, and/or gingivitis. Mercury toxicity symptoms elsewhere primarily affect the brain, including the infamous “mad hatter syndrome,” insomnia, fatigue, and poor short-term memory, as well as tremors, gut and kidney disturbances, and a suppressed immune system.162 If you think mercury or another metal implant is affecting your oral health, find a healthcare practitioner (page 78) to consult further. Urine, blood, and hair mercury tests are available to identify daily exposures to this metal.
Your mouth’s immune system helps protect you from infection, identify and quarantine bad bugs, give entry to good bugs, and sift harmful molecules from harmless ones. When your immune system is overactive, it can cause inflammation. But when it is weak and worn down, it leaves your mouth defenseless. Suddenly your mouth is wide open to attack from harmful bugs and toxins from the outside world.
Use probiotics such as Bifidobacteria, Lactobacillus, and S. boulardii to fortify the immune system in your mouth (and along your GI tract). You can also take colostrum, which is a precursor to breastmilk that contains immunoglobulins, to raise your immune defenses. As discussed earlier in this book, immunoglobulins, such as sIgA, are defense molecules that can bind and remove toxins and bad bugs while promoting a healthy microbiome. Note that colostrum is usually derived from cow’s milk and may not be appropriate for dairy-sensitive individuals. Serum-derived immunoglobulins, like Ortho Molecular’s SBI Protect (in pill or powder), provide immune support without traces of dairy or egg.
A healthy diet and lifestyle also contribute to a healthy immune system. A good nutritional program including minerals, vitamins, fatty acids, and protein are important for good immune defenses. Other nutrients and herbs that help you fight infection are zinc, echinacea, vitamin A, vitamin C, and vitamin D. Finally, when you lower your stress levels, you give your immune system a chance to recharge. If you are chronically stressed out, it could be draining your immune defenses and leaving you open to imbalances in the mouth.
In our busy, hustle-bustle culture, it is very challenging to reduce stress. First, eating regularly and sleeping for eight hours a night reduces stress. Cut back at work and get exercise at least four times a week. Some people are so stressed they have to block out down time on their calendars. Take naps. Delegate things to others. You can also work with a practitioner to treat adrenal dysfunction, which can help you rein in your fight-or-flight response. They often give nutritional supplements to nourish the adrenal glands and balance stress hormones.
Other Things to Consider When Optimizing Your Oral Microbiome
We have talked about the main ways you can optimize your oral microbiome: diet and nutrition, dental hygiene, balancing your bugs, lowering inflammation, healing your mouth, and boosting your immune system. But if there is some other, bigger problem going on in your body, many of these efforts may be in vain! Here are some examples of imbalances that could be causing illness in your mouth.
• Food sensitivities or allergies. Food sensitivities can drain your immune system so that it can’t work properly in the mouth.
• Infection. If you have dysbiosis or an infection somewhere else in your body, it could be causing inflammation that stresses your mouth. One of the most likely places for a hidden infection is the gut.
• Hormone imbalances. If your hormones are imbalanced, it could be contributing to a sick mouth. Pregnancy, menopause, or just growing older can disrupt your hormone balance. Stress can throw your hormones out of whack, disturb your wake and sleep cycle, and suppress your immune system. Women may show hormonal imbalance as fatigue, irritability, low libido, hot flashes, insomnia, acne, or weight gain. If oral dysbiosis symptoms crop up with pregnancy, premenstrual syndrome, or menopause, it’s more likely to be a hormone imbalance. Men’s hormonal imbalance appears as fatigue, low muscle mass, weight gain, and low sex drive.
• Leaky gut. Discussed in Chapter 4, if you have intestinal permeability, your bloodstream is wide open to the harmful molecules of the outside world. Leaky gut means that you don’t have good protection from infections and toxins. Your immune system is often confused and overactive, creating a state of inflammation. If you have leaky gut, you may be more likely to have leaky mouth or damage to the oral mucosa.
Finding an Integrative and Functional Healthcare Practitioner
Any of the underlying root causes discussed earlier could be a hold-up when trying to get your oral health back on track. The best option is to find a healthcare practitioner in your area who can help you determine what is holding you back from achieving optimum wellness. I highly recommend finding an integrative and functional medicine practitioner to help you address overall health. The Institute for Functional Medicine has an online directory of clinicians. The Kresser Institute has a directory of clinicians that have completed advanced training in functional medicine and ancestral diet and lifestyle. You can also contact some of these specialty clinical laboratories, which will locate doctors in your area: Diagnostic Solutions Laboratory, Genova Diagnostics, Doctor’s Data, Great Plains, Meridian Valley Labs, and Dunwoody Labs. If you don’t have an integrative and functional medicine doctor in your area, consider consulting with one that does telemedicine, so you don’t have to leave home.
Integrative dentists and biological dentists are harder to find but could be a critical partner in getting your oral health on track. Biological dentists treat the whole person. They don’t use mercury or fluoride. They are very careful about metal implants, believing that metals in the mouth must be specifically tailored to, or biocompatible with, the patient. They believe the mouth is connected to the whole body. If you have chronic oral dysbiosis, go to the International Academy of Biological Dentistry and Medicine online to find a biological dentist in your area. The International Academy of Oral Medicine and Toxicology can also help point you to a biological dentist near you.
Testing is a powerful tool for you and your healthcare practitioners to get to the underlying causes of illness or simply to optimize wellness. Laboratory tests can detect inflammation, dysbiosis, food sensitivities, infections, hormonal imbalances, or leaky gut using a blood, urine, saliva, or stool sample.
If you have problems with oral dysbiosis, gut dysbiosis, or inflammatory conditions like the ones listed in Chapter 8, the top areas to test are:
1. Microbes. There are tests that measure your oral, fecal, and small intestinal microbes. You can also work with your healthcare provider to order urinary organic acids, which can detect bacterial and fungal metabolism.
2. Immune system. Food sensitivity, celiac disease, and leaky gut testing can help you pinpoint why the immune system is malfunctioning.
3. Inflammation. Use hs-CRP to check your overall state of inflammation.
Microbes
You can run a test to measure your oral microbiome. OralDNA Labs measures bugs in the mouth using a saliva specimen. They are using a type of DNA technology called polymerase chain reaction, or PCR, which is far and above better than microbial culture methods. Your dentist or periodontist may also be able to do a culture test on a specimen from your mouth to see what bugs are in the mix.
Keep in mind that this is a new area of dentistry. Some of the testing profiles may be concerned only with “periodontal pathogens” and may not tell you much about your normal oral microbiota. As we discussed earlier, your oral microbiome is unique. There is no established “normal” microbial composition. That means that even when you have dysbiosis of the mouth, it is still more similar to your normal healthy pattern than it is to anyone else’s microbiome. And after you get a dental cleaning or a periodontal treatment, your oral microbiome is still closer to your pattern than anyone else’s. That means you have to use yourself as a healthy standard for your oral microbiome pattern. Run tests before and after treatment to monitor your improvements.
Figure 9.1: Commercial lab testing of oral microbiota using DNA analysis.
Since the mouth and the gut are connected, you may want to consider a stool test to look at your gut microbiome, inflammation, and immune function. Comprehensive stool tests are widely available from these commercial laboratories, through a qualified practitioner: Diagnostic Solutions Lab, Genova Diagnostics, and Doctor’s Data. uBiome and Viome also measure gut microbiota with cutting-edge DNA or RNA sequencing. If your doctor runs a test that involves bacterial culture or identifying microbes through a microscope (sometimes called an “Ova and Parasitology” stool test), then you still need a more sophisticated, accurate, and sensitive test that looks at microbial DNA or RNA. If you don’t have a clinician to work with, check out My Med Labs, where consumers can order a wide variety of tests on themselves.
Immune System
Tests for food allergies, food sensitivities, and leaky gut are available through many of the laboratories listed in this section. Food sensitivity tests can help you pinpoint which foods may be irritating or draining your immune system. Certain foods, like gluten, can put a person’s immune system on red alert. Leaky gut tests help to figure out if your gut mucosa is strong and able to keep large molecules out of the bloodstream. Leaky gut might be an underlying problem in autoimmune diseases and chronic inflammatory conditions.
Inflammation
You can find out your systemic inflammation with a simple, common blood test called hs-CRP (page 59). Ask your healthcare provider to run it along with your cholesterol and blood sugar levels. You can order it without a doctor’s prescription in some states.
High CRP says that you have inflammation or infection in the system. It can be a sign of heart disease, oral dysbiosis, or many other conditions. CRP is released in the blood in response to infection, inflammation, or trauma, and is widely used to monitor various inflammatory states. In the Appendix on page 87, you will find a letter by Dr. Mark Burhenne that will help your doctor and your dentist collaborate on your oral health and hs-CRP levels.
After checking that your microbial inhabitants, immune system, and inflammation are all in good shape, you and your healthcare provider may want to test your sex hormones, stress hormones, nutritional status, or even toxicity markers. These tests can help determine if there is another imbalance in your system making it hard for you to get your oral health back on track. Hormonal imbalance can make your mouth sick and unhappy. Poor nutrition can make your gums and teeth weak and prone to infection. Toxicity, from leaky mercury fillings for example, can create inflammation and damage in the mouth.
Oral Microbiome Solutions for Oral, Gut, and Whole-Body Health
There are many solutions to oral disease. Some of them are downright simple, like monitoring diet and nutrient intake (although they may be hard to implement). Certain solutions require going to see the dentist or periodontist. Some call for simply taking dietary supplements and natural mouthwashes to help balance the bugs in your mouth, lower inflammation, and heal the lining of your mouth. Other solutions may require partnering with a clinician and running some tests to figure out if something deeper is amiss. But all of these things are possible with the right help, so don’t give up!
• You can optimize your oral microbiome from the inside and the outside.
• Your diet is one of the most powerful ways to influence your microbiome.
• Dental hygiene keeps plaque lower and helps prevent cavities and oral dysbiosis.
• Probiotic toothpaste or chewable probiotics deliver probiotics directly to your gums, tongue, and teeth.
• Use antibiotics with extreme caution.
• Hs-CRP tells you how inflamed your body is and can be a clue to a hidden infection.
• The mouth is intimately interconnected with the rest of the body, so a health problem elsewhere could be a hold-up when trying to get your oral health back.