Written by: Bonnie Feldman, DDS, MBA, Hailey Motooka BS, Becca Malizia, BS, Ellen M. Martin
When you think about it, our mouths are pretty dirty places. We trash them on a daily basis by putting all sorts of foods inside, sometimes letting foul language slip out. We kiss, we talk, we laugh, we spit, we breathe; our mouths are at the forefront of our lives, where our organisms encounter the outside world. Yet, we dedicate such little time and thought throughout the day to cleaning up our oral cavities. This is because we either forget or are unaware that our oral cavity is an ecosystem in and of itself, home to some 700 different species of bacteria that live in different microbial sub-habitats: teeth, tongue, lips, cheek, hard palate, soft palate, and tonsils.
The mouth contains one of our most significant microbiomes; it is the gateway to the body. It is the first meeting place between the immune system, the gut, the outside environment, food, microbes and pathogens. Maintaining a balance between “good”, symbiotic bacteria and “bad”, pathogenic bacteria is a key component not only in maintaining good oral health, but also in achieving good systemic health as well.
New understanding of the oral microbiome is shaping how we think about caries, periodontal and oral diseases, as well as disease far removed from the mouth. While the traditional view held that mouth diseases were caused by a small number of specific pathogens, and that broad-spectrum antisepsis was the key to healthy mouths, we now think of the oral microbiome as a finely tuned community that determines oral health and disease, but perhaps more importantly, influences systemic diseases such as heart and lung disease, cancer, and some autoimmune diseases (1).
But how exactly do we maintain a balanced oral microbiome?
We have done some research and put together a few tips on how you can do so.
1. Avoiding Chemicals
This may seem obvious, but what most people don’t realize is that some chemicals are hiding in everyday products. These products include popular brands of toothpaste and mouthwash that may contain the following chemicals that you should try to avoid.
Triclosan is a broad spectrum antimicrobial agent. The chemical is added to many consumer products to reduce or prevent bacterial contamination. Recent studies have shown that TCS may have endocrine disrupting effects. TCS was recently banned by the FDA, but only from certain soap products. The chemical still remains in many other consumer products such as toothpaste (2)(3).
DEA is typically used as a foaming agent in toothpastes. The Environmental Working Group (EWG) rates DEA as a 10 on its hazardous scale (4).Not only is DEA a hormone disruptor, but it also reacts with other toothpaste ingredients to form nitrosamines — a compound that is a widely-accepted carcinogen.
The debate on whether or not fluoride is beneficial or harmful to oral health has been ongoing in the dental community for years now. Fluoride has been championed as the key ingredient for ‘fighting cavities’ even before the 1940’s when the United States began to fluoridate water supplies. However, recent research has raised concern over fluoride as a potential risk for cancer and impaired brain development ( 5, 6, 7). While these studies have not found any definitive links between fluoride, cancer, and impaired brain development, they do all conclude that fluoride is safe and effective in appropriate amounts.
Our individual susceptibilities to dental caries differ; the more cavity-prone or those with weak enamel may consider the risk tradeoffs of fluoridated toothpaste worthwhile, whereas those with little susceptibility to caries and especially those with chronic inflammatory conditions or high cancer risk may choose to eschew fluoride.
Then why is fluoride on our list of chemicals to avoid?
In the United States fluoride levels in the water supply differs greatly from state to state, or even from municipality to municipality, depending on the occurrence of natural minerals in the water supply and supplemental fluoride added (along with chlorine and chloramines) as part of sanitary water treatment. This means that, in some locales, you may be drinking fluoride every day, and fluoridated water is used for showering, watering crops, or added to multivitamins. While safety regulations ensure that there are no health risks for water fluoridation, these regulations do not take into account fluoride accumulation from the food we eat, the toothpaste we use, and the vitamins we take. We are already getting enough fluoride as it is from other sources besides oral care products. So it is best to play it safe and try out some natural, fluoride-free toothpastes altogether. This suggestion, though based on lack of substantial research, takes into account the additive intake of fluoride.
A toothpaste brand we recommend…
Hyperbiotics’ Activated Charcoal Probiotics Toothpaste. Hyperbiotics’ toothpaste emphasizes the use of natural ingredients that work cohesively with the innate defenses of the oral microbiome. The toothpaste’s formula contains activated charcoal and coconut oil to polish and whiten teeth, and diatomaceous earth as a source of calcium to strengthen teeth. The formula uses xylitol– a natural sweetener originally discovered in birch tree bark. Unlike sugar, xylitol can’t be fermented by pathogenic bacteria and starves them out of the oral microbiome (8).
2. Using Probiotics / Prebiotics
Previously, broad-spectrum antibiotics were used to eliminate harmful microflora. The problem is that many symbiotic and commensal bacteria that actually promote health are also killed by these treatments, creating dysbiosis–an imbalanced microbiome that triggers many symptoms. This is where probiotics are different. Probiotic products from companies such as Hyperbiotics and BLIS Technologies incorporate bacterial strains Streptococcus salivarius K12 and S. salivarius M18 in their formulas. These species minimize disruption within the oral microbiome, while targeting particular bacterial species associated with oral disease. Research has shown that oral probiotics can address common oral problems such as halitosis (bad breath), dental caries, periodontal disease, and even ear, nose, and throat issues.
Another option is prebiotics. Prebiotics are nutritional non-digestible molecules (mostly fiber carbohydrates) that actively promote the growth of resident microbiota (9). They do this by acting as food for our beneficial bacteria, supporting their growth, while hindering the growth of pathogenic bacteria. If you are interested in trying out prebiotics, we recommend Daily Dental Care. Daily Dental Care’s product utilizes advanced Selective Microbial Metabolism Regulation Technology (SMMRT) developed by founder Dr. Emily Stein. Research conducted on their prebiotic formula has been been shown to address the microbes that cause issues such as inflammation, cavities, gum disease, and bad breath.
3. Drink Well & Eat Well
What you eat and drink heavily affects your oral microbiome. Certain foods and drinks can help promote a healthy balance or encourage mouth dysbiosis. So what to do…
Water, yes! Soda, no!
Water helps to normalize the pH of your mouth- if you can remember from middle school science, the pH scale runs from 0-14 with neutral hovering close to 7, acids falling on the lower end and bases hitting the upper end of the scale. Healthy human saliva has a pH of 7.4. When you eat acidic foods and beverages such as soda, fruit juices, and sugary processed foods, your oral pH is thrown out of balance. When the pH in our mouth falls below 5.5, demineralization can occur. This, in turn, can create dysbiosis in your mouth and makes you more susceptible to oral diseases such as dental caries and periodontal disease. Drinking plenty of water throughout your day can help maintain a healthy mouth pH. Drink water alongside all meals, snacks, and even when you are drinking other things such as tea or coffee, to keep your mouth happy!
Food- what to eat
In addition to avoiding sugary foods, there are alkaline foods (alkaline is another word for basic), which can help balance the mouth from getting too acidic. Based on The Mouth Body Connection, by Dr. Gerald P. Curatola, DDS, here are some highly alkaline foods to eat:
- Himalayan salt
- Kelp and sea vegetables
- Green drinks containing some or more of these foods
Food- how to eat it
Chewing your food thoroughly and slowly is the first and easiest step to mindful eating. It is recommended to chew each bite about 15-20 times before swallowing. Challenge yourself, count your bites when you eat and see how off this target you are, and then work on it! By chewing your food, you engage your jaw muscles and activate your robust oral microbiome. To find out some other foods that are not only great for oral health but for reducing inflammatory symptoms of chronic pain, check out our Guide to Food Therapy E-book .
Current pop culture and social media emphasizes the importance of oral care for aesthetic purposes. But oral care is much more than straight teeth and a pearly white smile. The connections between the mouth and systemic health and disease reveal the need to practice proper oral care that goes beyond cleaning out all the bacteria in the oral cavity and, instead, finding ways to nourish the beneficial bacteria that support microbial balance and overall well being.
Here at Your Autoimmunity Connection we are dedicated to educating, helping, and supporting you every step of the way in your journey to better health and well-being. If you have any questions about how to improve your oral hygiene routine, we encourage you to reach out to us!
#spoonies do you have any unique oral health tips for us?
- Zhang, Xuan, et al. “The Oral and Gut Microbiomes Are Perturbed in Rheumatoid Arthritis and Partly Normalized after Treatment.” Nature Medicine, vol. 21, no. 8, 2015, pp. 895–905., doi:10.1038/nm.3914.
- Feng, Yixing, et al. “Endocrine Disrupting Effects of Triclosan on the Placenta in Pregnant Rats.” PLOS ONE, vol. 11, no. 5, 5 May 2016, doi:10.1371/journal.pone.0154758.
- Weatherly, Lisa M, and Julie A Gosse. “Triclosan Exposure, Transformation, and Human Health Effects.” Journal Toxicology and Environmental Health, vol. 20, no. 8, 2017, doi:10.1080/10937404.2017.1399306.
- “NITROSAMINES.” EWG Tap Water Database, www.ewg.org/skindeep/ingredient/726336/NITROSAMINES/.
- Levy, Michael, and Bernard-Simon Leclerc. “Fluoride in Drinking Water and Osteosarcoma Incidence Rates in the Continental United States among Children and Adolescents.” Cancer Epidemiology, vol. 36, no. 2, 2012, doi:10.1016/j.canep.2011.11.008.
- Mahoney, M C, et al. “Bone Cancer Incidence Rates in New York State: Time Trends and Fluoridated Drinking Water.” American Journal of Public Health, vol. 81, no. 4, 1991, pp. 475–479., doi:10.2105/ajph.81.4.475.
- Choi, Anna L., et al. “Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis.” Environmental Health Perspectives, vol. 120, no. 10, 2012, pp. 1362–1368., doi:10.1289/ehp.1104912.
- Miyasawa-Hori, H., et al. “Difference in the Xylitol Sensitivity of Acid Production among Streptococcus Mutans Strains, and Its Biochemical Mechanism.” International Congress Series, vol. 21, no. 4, 2006, pp. 187–188., doi:10.1016/j.ics.2005.06.049.
- Marsh, Philip D. “Ecological Events in Oral Health and Disease: New Opportunities for Prevention and Disease Control?” CDA Journal, vol. 45, no. 10, Oct. 2017.