The Oral Microbiome in Health and Disease

November 13, 2024

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In our very first Let’s Talk Oral Health podcast episode, we welcomed Prof Egija Zaura, professor of Oral Microbial Ecology, to discover how managing the oral microbiome can be an effective tactic in a 360° strategy to prevent periodontal and peri-implant diseases. Listen to her insights in our podcast or continue reading here.

New understanding in oral biofilms

Oral ecosystem model

There has been recently an increased understanding in biofilms and microbial ecosystem, causing a paradigm shift in how health and disease are approached.

Oral diseases are not looked at as infectious diseases anymore but more as ecological catastrophes with a disbalance or dysbiosis of the oral microbiome that makes the host respond in a certain way. Diseases are not initiated by just one bacteria but by a whole community of bacteria with special talents, that shift out of balance due to poor hygiene, sugar intake or dry mouth.

Caries microbiome and periodontitis microbiome

This new oral ecosystem model can be applied to the two most common oral diseases:

Our mouth, our first defense line

Our oral microbiome evolves as we grow and it needs to get exposed to the right microbes. Our immune system thus trained to a healthy microbiome can respond in a correct way and protect us from non-oral and potentially harmful microbes. A stable oral microbiome is our first line of defense against intruders.

Oral Microbiome and systemic health

Oral microbes are also crucial for our general health. For instance, one of the most evidenced relationship between the oral microbiome and the systemic health is the nitrate-nitrite-nitric oxide pathway in blood pressure regulation.

Some oral bacteria reduce nitrate from food (such as red beans or spinach) into nitrite. This nitrite is later further reduced in our body in nitric oxide which contributes to blood vessel dilatation, hence to a lower blood pressure and a healthier cardiovascular system. It comes back to the oral-systemic link and to the fact that the mouth is indeed part of a whole body.

How to maintain a healthy microbiome

There are good bacteria and bad bacteria. In healthy individuals we should promote and protect the existing healthy oral microbiota.

Hygiene first and foremost

Keeping up a good oral hygiene regimen will prevent plaque maturation and the outgrowth of anaerobic proteolytic microbiota which would otherwise trigger inflammation. Good oral hygiene habits, by avoiding plaque accumulation, will keep this biofilm in a less mature state, with less facultative anaerobes, pioneering, pathogenic species. Learn more in our podcast episode on mechanical plaque control with Prof. Filippo Graziani.

Avoid the use of antimicrobial agents

Antimicrobial agents could indiscriminately and unnecessarily attack all bacteria including the health-associated microbiota, potentially increasing the risk for disease-associated dysbiotic communities. Those are usually more resistant to frequently used antimicrobials and will outgrow the healthy microbiota.

For healthy patients, it is preferable to simply stick to mechanical plaque control as much as possible, to keep a healthy microbiome.

For patients with periodontal disease and in post-surgery for example, antimicrobial agents should be kept to a minimum time.

Promote growth of health-associated oral bacteria

Aside from the appropriate mechanical cleaning, supporting health-associated bacteria seems like a proactive solution to balance an unbalanced microbiome.

Probiotics are live microorganisms which, when administered in adequate amounts, confer a health benefit on the host. Probiotics are the actual good bacteria. These adjuncts represent a nice ecological approach, with accumulating studies showing promises.

Commercially available probiotic strains currently often originate from non-oral strains. They mostly derive from gut or food strains. This prevents probiotics from establishing in the oral cavity and colonizing it. Although they could still have a systematic effect, probiotics should preferably come from oral strains.

Novel approaches include prebiotics, which are food for probiotics (like a substance, a fiber, a sugar substitute) or synbiotics, which are a combination of pre- and pro- biotics for example, to help support and promote the healthy microbes.

In patients affected with periodontitis, after making sure that the biofilm is removed by mechanical cleaning first, probiotics can be applied for both local and systemic effects depending on the strains used. These strains can present different properties: antimicrobial activities, lowering pH as anaerobic and proteolytic bacteria prefer basic environment, or anti-inflammatory signaling.

Healthy diet

Besides the above, another important but often forgotten aspect is watching out what we eat. A healthy diet is paramount for a healthy mouth and a healthy oral ecosystem.

Indeed, our diet is often pro-inflammatory, it contains a lot of sugars, which promotes inflammation everywhere including in the mouth. As evoked before, food with specific probiotic strains might have systemic anti-inflammatory effects for example. Learn more on nutrition and oral health in our episode on the oral-systemic link.

Key insights on the oral microbiome

Expand your knowledge on a 360º approach to periodontal and peri-implant disease prevention by listening to the other episodes in the Let’s Talk Oral Health podcast for experts. Don’t miss our discussions on behavioral change in patients, the oral -systemic link, and mechanical plaque control.

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