a double face in health and disease

The educational content in this article was elaborated in partnership with Bromatech and independently developed and approved by the GMFH publishing team and editorial board.

Why is the oral microbiome important?

When we think about the vast community of bacteria living in our mouths, we're pleased to realize that, at least 1,000 different species divided into nine groups, has been identified. These bacteria are mostly harmless and do not usually cause illness in healthy individuals, but they can cause problems in situations such as illness, medical treatments such as chemotherapy, and a compromised body's immune system (we call them pathogens)1.

Under healthy conditions, strict pathogen species are least represented in the oral cavity and are generally dominated by the entire bacterial community. Actually, Under normal health conditions, oral microbes and host cells communicate in different ways and are in perfect dynamic balance, creating an environment that supports overall health.

Multiple studies have shown that a balanced oral microbiome helps prevent inflammation not only in the mouth, but also in other parts of the body, such as the lungs and intestines. For example, changes in the oral microbiota, such as those that occur during gum disease, have recently been linked to inflammatory diseases such as inflammatory bowel disease and intestinal cancer.

What happens in your oral microbiome doesn’t stay in your oral microbiome

The teeth, saliva, buccal mucosa, soft palate, hard palate, gingival sulcus, tonsils, throat and lips are all microbial habitats in the oral cavity. However, most of these bacteria live on the tongue, especially the back. This is an important site with regard to oral health because it may also contain periodontal pathogenic bacteria that cause gum disease.

This anatomical site has unique physicochemical conditions that modulate bacterial composition; for example, this region has the lowest oxygen levels, similar to the colorectum. Saliva carries food nutrients to nourish these bacteria and helps maintain the stability of health-related bacterial levels. Many studies show Oral dysbiosis may arise primarily from the accumulation of associated microbial cells (biofilm) on the back of the tongue, the number of potential pathogens often exceeds physiological limits due to poor dietary habits of the host. Clinical observational studies have also shown that tongue coating is related to bacterial dysbiosis. In fact, changes in coatings are directly related to changes in the structure and composition of bacterial biofilms. This coating can vary in appearance and thickness and can serve as a good indicator of oral and overall health2.

How to detect oral ecological imbalance in practice? Breath testing for bacterial products such as volatile sulfur compounds (VSCs), especially hydrogen sulfide and methyl sulfide, is commonly used in the laboratory to diagnose halitosis and oral dysbiosis3. This test complements studies that examine the tongue coating.

When dysbiosis is present, the oral microbiome produces more compounds, such as proteases and molecules such as endotoxins and leukotoxins, that can alter the immune system and inflammatory response4. At the same time, saliva on the tongue releases different bacteria that can spread to other parts of the mouth, such as the periodontal area or other organs. therefore, Maintaining a balance between the beneficial and harmful effects of these bacteria is essential for oral and overall health.

Oral bacteria spread to other parts of the body in these ways

Oral pathogens and commensal bacteria can move to other parts of the body in a variety of ways, with the oral-gut axis being the most common5. Oral microbiome and gut microbiome are interconnected, this connection is critical to understanding how oral health affects overall health. The gut may also facilitate the spread of oral pathogens throughout the body. Another pathway is the temporary presence of bacteria in the blood (bacteremia)6, a silent process by which oral bacteria temporarily enter the bloodstream. This condition may occur after certain dental hygiene activities or medical procedures disrupt the oral mucosa, allowing bacteria or their toxins to enter the bloodstream.

The oral cavity is the origin of bacteria associated with many systemic diseases. Among these pathogens are Porphyromonas gingivalis, Fusobacterium nucleatumand other oral periodontal pathogens. These Bacteria can migrate from the tongue to saliva and blood through inflamed oral tissues, exacerbating the development of various degenerative diseases Examples include chronic periodontitis, atherosclerosis, heart disease, rheumatoid arthritis, Alzheimer's disease, and colorectal cancer7,8.

How to balance the oral microbiome?

Scientific approaches to preventing and managing oral dysbiosis include9,10:

  • Maintain good oral hygiene habits: Regular brushing, flossing, tongue monitoring, and dental checkups are essential. Professional teeth cleaning and periodontal disease treatment are also vital to managing oral and general health.
  • lifestyle changes: Quitting smoking, managing stress, and following a healthy diet can help maintain a balanced oral microbiome.
  • Probiotics: In situations where signs of dysbiosis are present, such as bad breath, specific oral probiotics may provide some benefits along with tongue brushing. For example, some probiotics may help prevent bad breath, maintain a healthy balance of oral microbiota, and block dangerous bacteria associated with gum disease.

Overall, the association between oral bacteria and systemic disease emphasizes the importance of comprehensive oral care as part of overall health management. By addressing oral disease and maintaining good oral hygiene habits, individuals can reduce the risk of various systemic degenerative diseases11.

refer to

1) Li X, Liu Y, Yang X, Li C, Song Z. Oral microbiota: community composition, influencing factors, pathogenesis and interventions. Frontier microorganisms. 2022;13:895537.

2) Xiao Peng, Hua Z, Kang X, Lu B, Li Ming, Wu J, Dong W, Zhang J, Cheng C. Effect of oral intake habits on tongue coating microbiota in patients with esophageal precancerous lesions. Cancer Journal. 2022;13(4):1168-1180. doi:10.7150/jca.67068.

3) Li Z, Li J, Fu R, Liu J, Wen X, Zhang L. clinical oral research. 2023;27(11):6383-6393. DOI: 10.1007/s00784-023-05292-9.

4) Chimenos-Kustner E, Giovannoni ML, Schemel-Suarez M. Clinical Medicine(Barc). 2017;149(7):305-309. doi:10.1016/j.medcli.2017.05.036.

5) Abdelbary MMH, Hatting M, Bott A, Dahlhausen A, Keller D, Trautwein C, Conrads G. Pre-cell infection microorganisms. 2022;12:1010853.

6) Dubey R, Jalili VP, Jain S, Dubey A. Avant-garde orthodoxy. 2012;13(3):237-245. doi:10.1016/j.pio.2012.02.004.

7) Asili P, Mirahmad M, Rezaei P, Mahdavi M, Larijani B, Tavangar SM. Association between oral microbiota dysbiosis and gastrointestinal cancer and its diagnostic efficacy. Journal of Gastrointestinal Cancer. 2023;54(4):1082-1101. DOI: 10.1007/s12029-022-00901-4.

8) Thomas C, Minty M, Vinel A, Canceill T, Loubieres P, Burcelin R, Kaddech M, Blasco-Baque V, Laurencin-Dalicieux S. The oral microbiota: a major player in the diagnosis of systemic diseases. Diagnostics (Basel). 2021;11(8):1376. DOI: 10.3390/diagnosis11081376.

9) Cugini C, Ramasubbu N, Tsiagbe VK, Fine DH. Dysbiosis relevant to oral health and disease from a microbial and host perspective. Frontier microorganisms. 2021;12:617485.

10) National Institute of Dental and Craniofacial Research. Oral hygiene. October 2023.

11) Inchingolo F, Inchingolo AM, Malcangi G, et al. Benefits of probiotics on oral health: a systematic review of the literature. drug. 2023;16(9):1313. doi:10.10.3390/ph16091313.

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