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Oral Health- Beyond Brushing your Teeth

Oral Health and Overall Health

The oral cavity is the starting point of our digestive tract, masticating and breaking down our food so we can begin to get nutrients. Beyond that, it is the first point of exposure to many pathogens; this vulnerability means we have developed the physiology and structure to keep us protected. We are going to review why oral health contributes to overall health and what you can do to fortify your first line of defense.

Risky Business

Our mouths and throat are designed to optimise function, meaning improve digestion and prevent infection. Most people associate our mouths with the mechanical digestion that occurs when we chew. Our teeth are imperative for breaking down food into smaller pieces so that acid in the stomach, enzymes probiotics and assist in digestion to forms and materials that can be absorbed in out gut. So, when our teeth begin to decay due to plaque and cavities, we risk developing some malabsorption and possible nutrient deficiencies.

For good reason it has been drilled into us that we need to maintain healthy teeth and gums with regular brushing and flossing. This is because we are the junction between teeth and the deeper connective tissue with the blood supply below is particularly vulnerable to “leaky barriers”. An infection here can travel through our blood stream very quickly, transmitting infections to the heart tissue, kidneys, brain and more. We know this because poor oral health has been implicated as a risk factor for premature cognitive decline and other health issues. Bad bacteria can colonize the hard, non-shedding surfaces of the teeth, but also the continuously shedding mucosa. Luckily, so can good bacteria, which we will get to further down. Bacteria can colonize more easily as this environment is warm and moist, perfect conditions for growing. Even tongues are susceptible to overgrowth by anaerobic bacteria such as Streptococcus pyogenes which are a primary cause of sore throat. More serious pathogens such as Streptococcus viridans have been linked to heart conditions such as endocarditis and valvular dysfunction.

Signs and Symptoms that indicate your oral health needs some support:

It is important to pay attention to your oral health because it can be the result of an underlying issue or it may be the issue.

For example, a number of factors can cause halitosis, or bad breath. It may indicate a local exposure to odorous foods, an infection, or a deeper concern. The odour itself relates to volatile compounds that have a high sulfur content and are produced by bacteria on the tongue, or between and around teeth. Halitosis can be short term (from sulfuric foods, tobacco products, or dry mouth) or it can persist. A smaller percent of persistent halitosis cases (about 10%) indicate a systemic or local infection.

Dental health can be monitored at home with the following:

  • assessing for temperature sensitivities
  • discomfort when chewing
  • bleeding gums
  • blood in your sputum (spit) especially first thing in the morning
  • rust colored sputum may be a deeper lung infection while green or yellow may indicate local infection
  • frequent sore throat
  • hoarse voice or change in voice
  • post nasal drip

How the oral cavity is designed for protection

Thankfully, we have developed a number of mechanisms to protect ourselves, starting with the fact that the mucosal lining in our mouths is constantly being sloughed off and replaced. We also have a number of immune complexes such as dendritic cells to help recognise harmful antigens (or invaders) which are embedded within that connective tissue just below your gums. More importantly, we have lymphoid tissue, lingual and pharyngeal tonsils essentially meaning you have a defense force right on hand. Unfortunately, for a long time the necessity of tonsils was not known thus their hasty removal was a common occurrence.

We also produce saliva which provides enzymes to initiate digestion, IgA for immune support, regulation of pH, ducts store vitamin K2, and moves keeps bacteria moving.

The Oral Microbiome

The final protective mechanism in the oral cavity is so important it deserves its own section! Over 700 different species of aerobic and anaerobic bacteria in mouth and comprise what is known as your oral microbiome. While much of the research over the last decade on the benefits of probiotics has been related to the bacteria residing in the gut- the mouth is the second most diverse microbial community. Bacteria in the mouth and throat initiate digestion and drug metabolism, act as barriers against infection, begins the reduction of nitrates in food to produce nitric oxide, and communicates with the immune system. These bacteria are also integral to dental structure and health.

This microbial community is populated at birth, usually from vaginal transference. However, the increased incidence of c-section births, use of antibiotics, harsh mouthwashes, more sugar and processed foods means that its harder to establish a health mix of good probiotics in the mouth. When we threaten the diversity of microbes present in the mouth and throat, we can develop a dysbiosis, or an unbalance that can create an unhealthy inflammatory response or increased risk of infections.

What can you do to help your mouth?

Oral hygiene is quite simple, ensure you are keeping things moving (i.e. support shedding and regeneration), populate your microbiome with good bacteria, and avoid things that increase decay.  Beyond brushing and flossing regularly, make sure you are cleaning your tongue, as this can remove some of the offensive compounds (food remnants, dead cells etc.) that the bacteria feed on that cause bad breath and decay. You should also consider avoiding sugars, starchy foods, carbonated pop, highly acidic food and drink and overuse of antibiotics. When considering oral probiotics supplementation make sure you choose the right strain AND the right delivery form. For example, Streptococcus salvaris found in Blis K12 repopulates the microbiome of the mouth by preventing the growth of harmful bacteria and their toxic by-products. However, for optimal colonization you need to keep the probiotics in your mouth for a sufficient amount of time, for example do not chew or swallow too fast. Forms such as mints, lozenges, granules or powders may help keep the probiotic at the site of colonization. 

Finally, an underappreciated vitamin for oral health is Vitamin K2. This important vitamin is normally associated with bone health as it ensures calcium is taken out of the blood stream and into tissue such as bone and teeth. Vitamin K2 has a much more diverse mechanism of action in that it is important for carboxylation reactions which basically means it can “cleave” bulky preventing plaque formation and supplementation has been shown to reduce dental caries in children.  Further it is stored in salivary glands emphasising its benefit in oral health.

Select references:

Burton, J.P., et al., A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters. J Appl Microbiol, 2006. 100(4): p. 754-64.

Dierksen, K. P., C. J. Moore, et al. (2007). “The effect of ingestion of milk supplemented with

salivaricin A-producing Streptococcus salivarius on the bacteriocin-like inhibitory activity of

streptococcal populations on the tongue.” FEMS Microbiol Ecol 59(3): 584-591.

Di Pierro F, Colombo M, Zanvit A, Risso P, Rottoli AS. Use of Streptococcus salivarius K12 in the prevention of streptococcal and viral pharyngotonsillitis in children. Drug Healthc Patient Saf. 2014 Feb 13;6:15-20. doi: 10.2147/DHPS.S59665. eCollection 2014.

Fantinato V, Jeorge AOA, Shimizu MT. 1999. Production of bacteriocin-like inhibitory substances (BLIS) by Streptococcus salivarius strains isolated from the tongue and throat of children with and without sore throat. Rev. Microbiol. 30:332-34.

Lif Holgerson P, Harnevik L, Hernell O, Tanner AC, Johansson I. Mode of birth delivery affects oral microbiota in infants. Journal of dental research. Oct 2011;90(10):1183-1188

Marchetti E, Tecco S, Santonico M, Vernile C, Ciciarelli D, Tarantino E, Marzo G, Pennazza G. Multi-Sensor Approach for the Monitoring of Halitosis Treatment via Lactobacillus brevis (CD2)-Containing Lozenges–A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Sensors (Basel). 2015 Aug 10;15(8):19583-96. doi: 10.3390/s150819583.

Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Almas K. The Role of Nutrition in Periodontal Health: An Update. Nutrients. 2016;8(9):530. Published 2016 Aug 30. doi:10.3390/nu8090530

Power DA, Burton JP, Chilcott CN, PJ Dawes and Tagg JR (2008) Preliminary Investigations of the Colonisation of Upper Respiratory Tract Tissues of Infants Using a Paediatric Formulation of the Oral Probiotic Streptococcus salivarius K12. European Journal of Clinical Microbiology & Infectious Diseases 27: 1261 -3.

Southward K. A hypothetical role for vitamin K2 in the endocrine and exocrine aspects of dental caries. Med Hypotheses. 2015;84(3):276–280. doi:10.1016/j.mehy.2015.01.011

Wescombe PA, Hale JD, Heng NC, Tagg JR. Developing oral probiotics from Streptococcus salivarius. Future Microbiol. 2012 Dec;7(12):1355-71. doi: 10.2217/fmb.12.113.

Dr. Navnirat Nibber

About The Author

ND, BSc, AOR Medical Advisor

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