Dec
16
2017

Mouth Flora And Your Health

By | alcohol, Cancer, Infectious Disease

You may not be aware that there is a connection between mouth flora and your health. But a recent publication provided proof that certain bacteria can cause esophageal cancer.

Esophageal cancer from certain bacteria

In a 2017 publication a study of mouth flora from 122,000 people showed an association to two types of esophagus cancer. The finding was that the periodontal pathogen Tannerella forsythia had as association with esophageal adenocarcinoma. This cancer is originating from the glandular tissue of the esophagus. In contrast, the bacterium Porphyromonas gingivalis caused another histological type of esophagus cancer, namely esophageal squamous cell carcinoma. This cancer originates from the inner lining of the esophagus. In addition, two mouth bacteria showed a relationship with reduced risk of causing esophageal adenocarcinoma. These two common mouth bacteria were the Neisseria species and the species Streptococcus pneumoniae.

Clinical example of a patient with esophageal cancer

To illustrate this with a clinical case description, here is an example from another publication. This is regarding a man who suffered from esophagus cancer. Initially doctors were puzzled about his diagnosis. He was a 53-year old patient with chronic alcoholic liver disease. He had an increased white blood cell count. A blood culture isolated Parvimonas micra, which is a pathogen normally only living in the mouth flora. A gastroscopy as part of the work-up showed an invasive squamous cell carcinoma of the esophagus. It had almost completely blocked the passage to the stomach. The pathological bacterium had accessed the blood circulation via the tumor mass in the lower esophagus. In the past physicians did not know about these associations.

Brush your teeth and floss every day

Brushing your teeth and flossing everyday controls the bacteria in your mouth. It prevents leakage of bacteria into your blood affecting your heart valves. Studies have shown that this also prevents heart attacks.

The literature on this is clear: chronic gingivitis has a link with bacteria in the mouth. They grow on the gums and can spread into your blood. They can then colonize in your heart valves and even in the lining of the arteries. This is particularly so in cases where there is already hardening of the arteries (arterial plaque). This can lead to heart valve disease like mitral valve disease. If this process occurs in coronary arteries, it can lead to heart attacks.This reminds you that there is a connection between mouth flora and your health.

Mouth wash

Many people feel they have “bad breath” and they need a mouthwash product. This is good marketing for companies that produce mouthwash. However, the truth is you need to be diligent about appointments with a dental hygienist, brush your teeth regularly and floss your teeth. If you suffer of constipation, increase your fiber intake and consider colonics. If you still think you have bad breath, use a natural mint product (read the ingredients). Why do I not like mouthwashes? They kill your mouth bacteria that are naturally there; this can disbalance the rest of your gut bacteria as you swallow part of the mouth flora when you eat or drink fluids. If you still want to use a mouthwash, use one without alcohol and without any carcinogens such as parabens. Also read this 2009 news item. It is as valid as it was then.

Chronic gingivitis and heart disease

It was not until about the mid 1990’s when it became apparent that gum infections and severe tooth decay could cause inflammation in the blood measurable by using the CRP marker (C-reactive protein). Dr. Joseph Muhlestein at the University of Utah demonstrated in 1996 that chronic gum infection could cause a heart attack. He isolated the bacterium Chlamydia pneumoniae in 79% of patients undergoing coronary bypass surgery, while samples from heart transplant patients isolated this bacterium in only about 5%. The new thinking was that bugs that multiply in diseased gums could migrate into the blood and cause platelets from the blood to clump together and block coronary arteries causing heart attacks. Also, restenosis after percutaneous coronary intervention was more likely to occur, if the pathogen count of gum bacteria in the blood was higher.

Infectious causes of endocarditis and heart attacks

Harvard University researchers have confirmed this. In the past physicians did not know that a bad tonsillitis with an aggressive bacterium, Streptococcus viridans, could cause subacute endocarditis, a dangerous infectious disease of the heart valves, which can be responsible for sudden death in younger persons. Neglected cavities in teeth can also harbor this bacterium. Another study in 2009 showed that two particular strains of bacteria in infected gums, Tannerella forsynthesis and Preventella intermedia, showed a connection with an increased risk for heart attacks; but it was more the overall burden of bacteria in the infected gums than the specific bacteria strains that mattered most.

See your dental hygienist regarding your mouth flora and your health

Given this background it is easier to understand that we need to take good care of our teeth and gums, if we want to maintain good health. As a start most people should see their dental hygienist (who usually works in a dentist’s office) twice a year. The dental hygienist will probe the depth of gingival pockets with a periodontal probe. A normal depth measures up to and including 3 mm. Deeper pockets than that usually indicate that the patient did not floss the teeth regularly. One needs to floss at least once per day, better twice per day, and it should not bleed after flossing (initially when a person flosses for the first time the gums tend to bleed a bit).

What the dental hygienist does

The hygienist will do scaling of plaques on the tooth enamel. If the hygienist detects any cavity, he or she will bring it to the attention of the dentist. At the end of the scaling procedure the hygienist will apply fluoride, which puts a coating on the tooth surfaces to prevent tooth decay.

When deeper pockets (6 mm or more) are detected a trial of sub-gingival root brushings has shown to have a very beneficial result within only 14 days.

Periodontal pockets were improved and bacterial counts of periodontal infections also showed improvement.

Mouth flora in alcoholics

This 2016 study from Poland examined the mouth flora of 25 alcoholics. They were compared to the mouth flora of 25 patients from a periodontology clinic.

There were significant differences between the two groups. The alcoholic group had higher bacterial counts of these three strains: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Treponema denticola. There was no difference in bacterial counts between those who drank only little alcohol compared to those who drank lots. The bacterial concentration in the sub-gingival flora was the same. Patients with severe periodontal disease had the same distribution of the three strains of bacteria as chronic alcoholics. However, the concentration of bacteria in alcoholics was much higher. This fact may explain why chronic alcoholics are very sensitive to infections. Alcohol inhibits the immune system, but stimulates the growth of sub-gingival bacteria, which find their way into the system and in serious cases can kill the patient.

Mouth Flora And Your Health

Mouth Flora And Your Health

Conclusion

It is now a well-established fact that mouth bacteria play an important role in our health. Some of the healthy bacteria find their way into the gut providing the foundation of a healthy gut flora. But as described above there are also pathological bacteria that can multiply in our mouth cavity and our gums. This happens particularly in people who do not floss and who develop gingivitis and periodontitis. Tannerella forsythia was associated with esophageal adenocarcinoma. In contrast, the bacterium Porphyromonas gingivalis caused esophageal squamous cell carcinoma. Streptococcus viridans could cause subacute endocarditis, a dangerous infectious disease of the heart valves. Tannerella forsynthesis and Preventella intermedia showed an association with an increased risk for heart attacks.

Bacteria associated with alcoholism

Here are three mouth bacteria associated with alcohol consumption and with chronic periodontitis. They are Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Treponema denticola. Don’t let the strange sounding names of mouth bacteria confuse you. Fact is that these bacteria, when entered into the blood vessels and the rest of the body, will play havoc with your health. Keep brushing your teeth at least twice per day and floss your teeth conscientiously once or twice per day as well. This will improve your mouth flora and your health.

More info: https://www.askdrray.com/flossing-and-brushing-saves-your-heart/

Jul
27
2013

Flossing and Brushing Saves Your Heart

By | Dentistry, Health, heart attack, Heart Disease, Infectious Disease, Nutrition, Prevention

It was not until about the mid 1990’s when it became apparent that gum infections and severe tooth decay could cause inflammation in the blood measurable by using the CRP marker (C-reactive protein). As this link shows Dr. Joseph Muhlestein at the University of Utah demonstrated in 1996 that chronic gum infection could cause a heart attack. He isolated the bacterium Chlamydia pneumoniae in 79% of patients undergoing coronary bypass surgery, while samples from heart transplant patients isolated this bacterium in only about 5%. The new thinking was that bugs that multiply in diseased gums could migrate into the blood and cause platelets from the blood to clump together and block coronary arteries causing heart attacks. Harvard University researchers have confirmed this. In the past it was known that a bad tonsillitis with an aggressive bacterium, Streptococcus viridans, could cause subacute endocarditis, a dangerous infectious disease of the heart valves, which can be responsible for sudden death in younger persons. Neglected cavities in teeth can also harbor this bacterium. Another study in 2009 showed that two particular strains of bacteria in infected gums, Tannerella forsynthesis and Preventella intermedia, were associated with an increased risk for heart attacks; but it was more the overall burden of bacteria in the infected gums than the specific bacteria strains that mattered most.

Flossing and Brushing Saves Your Heart

Flossing and Brushing Saves Your Heart

 

Preventing heart disease by brushing and flossing

With this background it is easier to understand that we need to take good care of our teeth and gums, if we want to maintain good health. As a start most people should see their dental hygienist (who usually works in a dentist’s office) twice a year. The dental hygienist will probe the depth of gingival pockets with a periodontal probe. A normal depth measures up to and including 3 mm. Deeper pockets than that usually indicate that the patient did not floss regularly. One needs to floss at least once per day, better twice per day and it should not bleed after flossing (initially when a person flosses for the first time the gums tend to bleed a bit).

The hygienist will do scaling of plaques on the tooth enamel. Any cavity that is detected will be brought to the attention of the dentist. At the end of the scaling procedure fluoride is applied, which puts a coating on the tooth surfaces to prevent tooth decay.

When deeper pockets (6 mm or more) are detected a trial of subgingival root brushings has shown to have a very beneficial result within only 14 days.

Periodontal pockets were improved and bacterial counts of periodontal infections were shown to have improved as well.

Oral care and cavity prevention in the population

It has been accepted for quite some time that a combination of brushing and flossing are the best methods to control dental plaque, which is the precursor for cavities.

In order to test the knowledge of adults in families with small children these authors from the School of Public Health of the Maryland University investigated Maryland’s adult population knowledge regarding caries prevention. It turns out that there were deficiencies in knowledge about the prevention of dental caries and the importance of fluoride to create strong, decay resistant enamel.

A randomized, prospective study is planned in Hong Kong which will start teaching oral hygiene to kindergarten children aged 3 and will be reinforced several times later to instill good dental hygiene behaviors into these children’s health routine as outlined in this link. Not only is it important to teach brushing and flossing, but also food habits with cutting down on sugary and starchy snacks as these foods make the saliva acidy promoting caries producing bacteria in the plaque.

This English study shows that a primary school based caries prevention program reduced caries by 35% when sugar intake was limited in the interventional group and brushing of teeth was done twice per day along with flossing.

An addition to flossing for those with narrow tooth intervals or those with braces is a waterpik system. This can be used to clean food residues from the spaces between your teeth and from gum pockets. Flossing once or twice per day is still needed to remove plaque to avoid tartar build-up. Before bedtime it is advisable to floss first, then use a waterpik, then use your electric toothbrush with a fluoridated toothpaste. During the day use the waterpik after meals followed by brushing with an electric toothbrush with non-fluoridated toothpaste.  Water Picks are also called “water flossers”; they are easier on your gums.

Other measures helpful in preventing tooth decay

Xylitol is a natural sweetener originally derived from birch. Sugarless gum often is sweetened with Xylitol. This study has shown that chewing Xylitol containing gum can effectively reduce caries. This paper describes that the increased saliva production from chewing gum provides a slightly alkaline environment for teeth. This helps to clear out sugar faster from the oral cavity after a meal, inhibits bacterial growth, neutralizes the pH in plaque that is on the acidy side after sugar consumption. The authors concluded that chewing Xylitol gum is a useful addition to the other known preventative measures of dental decay prevention, such as brushing and flossing teeth.

The techniques the dentist is using to treat plaque and dental decay have been refined by a new technique describe in this Australian publication as a minimum intervention caries prevention program.

The four methods used in minimum intervention dentistry are described here.

1. Recognition: to recognize potential caries factors early through lifestyle factor analysis and saliva testing.

2. Reduction: alter the diet and lifestyles to increase the pH of the saliva, which will reduce the risk factors for caries.

3. Regeneration: to arrest and reverse minimum lesions at the earliest stage. Use agents such as fluorides and casein phosphopeptides-amorphous calcium phosphates to achieve this.

4. Repair: when a cavity is present, a technique of “conservative caries removal” involves using bioactive materials to allow healing of the dentine layer of the tooth.

Reduction of cariogenic bacteria

I already mentioned above that alkalization of saliva by chewing Xylitol gum could significantly help prevent tooth decay. It does so by raising the pH, while chewing on sugary foods or starchy foods lowers the pH (making it more acidy). Growth of caries producing bacteria, which are called “cariogenic bacteria” is stimulated by acidy saliva and inhibited by alkaline saliva. For this reason people whose diet consists of a lot of vegetables and greens will have more alkaline saliva and are less prone to develop cavities. The worst foods to get cavities are sugar in its many disguises and starchy products (candies, bread, rice, potatoes, pasta, bagels, cookies, cakes).

What can cause bacteria from the mouth to appear in the blood? One common condition is periodontitis, which is a chronic inflammatory condition of pockets of the gums around the teeth. This originates from neglecting your teeth and not flossing. Smokers are more afflicted by this as well. Dental procedures called scaling and root planing are often done for chronic periodontitis. This study from January 2013 shows that there is about the same amount of bacteria that leak into the blood following these procedures when compared to flossing.

Sometimes a dentist will recommend using a short-term antibiotic to reduce the leakage of bacteria into the blood, particularly with people who have heart valve problems or had porcine heart valve replacement in the past. This publication from 2009 also describes that dental flossing causes bacteria to be shed into the blood (bacteremia).

Conclusion

Dental self-care should be taught to children at an early age to educate them to brush their teeth twice a day and floss them at least once per day. At the same time they need education what causes cavities in terms of food intake and that fluoride can help make teeth more cavity resistant. They should avoid sugar in pop, candies and cookies etc. Parents best teach by example! Regular visits to the dentist’s office will safe money on the long term. Regular scaling by a dental hygienist every 6-month will remove plaque from which cavities develop when bacteria thrive in them and produce acids that affects the enamel. Minimum intervention dentistry discussed above (4 methods used) can prevent your teeth from decaying. Regular flossing will keep your gums healthy and reduce the colonization of the mouth with bad, cariogenic bacteria. With all this in place you likely will keep your teeth for a long time and not need dentures or tooth implants because of lost teeth. At the same time you will prevent your immune system being overwhelmed by mouth bacteria, which could have lead to a heart attack had you neglected your teeth. As mentioned in the beginning, a CRP blood test is a useful tool to rule out chronic infection.

More information on:

1. Tooth decay: http://www.nethealthbook.com/articles/dentistry.php#Tooth_Decay

2. Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Reference: http://www.webmd.com/heart-disease/features/your-guide-gum-disease

Last edited Nov. 7, 2014

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Mar
01
2008

The Culprits For Periodontal Disease

By | Dentistry, Heart Disease, Men's Health, Substance abuse, Women’s Diseases

When people think of hazards to dental health, the first thought will be about tooth decay, lack of brushing and flossing and eating candies and other sugar-laden foods. Periodontal disease is often neglected, and yet it is just as threatening to teeth and gums. Destructive periodontal disease will lead to loss of the supporting tissues of the teeth and as a result, there will be loose or shifting teeth and ultimately tooth loss. Generally these findings were seen in older population groups. It was thought that the disease would rarely occur in patients younger than 35 years of age and the theory was that dental plaque was the likely cause. Lifestyle choices were not thought to play a large role. Recent findings told a different story. A cohort study consisting of 903 participants examined self-reported tobacco and marijuana smoking and dental examinations were also done. The authors of the study found that tobacco smoking as well as cannabis (marijuana) smoking was linked with a higher incidence of destructive periodontal disease before the age of 32 years.

The Culprits For Periodontal Disease

The Culprits For Periodontal Disease

In comparison to this dental plaque was not contributing to a higher incidence of periodontal disease in this younger age group. Another risk for destructive periodontal disease in the youngest age group (as young as 12 to 18 years of age) was impaired glucose intolerance (a condition leading to diabetes). Due to those findings it is obvious that brushing and flossing are not the only weapons against periodontal disease. Healthy eating habits and cessation of smoking are equally important for dental health. This is particularly important as heart disease, which is also an inflammatory condition is closely linked to inflammatory disease of the gums and you likely have heard that heart attacks can be prevented by brushing and flossing teeth.

More information about periodontal disease: http://nethealthbook.com/dentistry/periodontitis/

Reference: Journal of American Medical Association 2008; 299(5): pages 574-575

Last edited November 3, 2014

Oct
01
2004

Gum Disease Increases Stroke Risk

By | Health, Infectious Disease, Prevention

Gum disease is common, particularly in the Western civilization. It has been known for a number of years that heart attacks are associated with chronic gum infections, but whether or not strokes would also be more common in these patients was not known for certain. The purpose of a University of Helsinki study by Dr. Pussinen was to see whether patients with periodontal gum disease were objectively more at risk to develop a stroke over a period of time. Blood samples of 6950 people aged 45 to 64 were collected between 1973 to 1976. The patients were followed for 13 years and 173 developed a stroke. Blood samples for antibody studies had been taken at the beginning of the study. Two types of antibody tests were done in order to check out whether or not the body’s immune system had reacted to two of the typical pathogens that are associated with bad and chronic gum disease.

Other studies had shown earlier that the pathogens Actinobacillus actinomycetemcomitans (in the illustration above called “type 1”) and Porphyromonas gingivalis (above called “type 2”) are associated with the initiation of hardening of arteries (atheromatous plaque formation).

Gum Disease Increases Stroke Risk

Flossing Decreases Stroke Risk

Dr. Pussinen and his group looked at indiviuals that were free of stroke or heart disease at the baseline. Among those individuals who were positive for the type 1 antibody and after adjusting for heart disease risk factors, there was a 1.7-fold risk of developing a stroke (shown as dark blue bar above). When type 2 antibody titers were tested among these stroke patients, the probability of finding a positive type 2 test was 2.6-fold higher than in appropriate controls. The authors concluded that aggressive forms of periodontitis (=bad gum disease) are an independent risk factor to develop a stroke.

Stroke risk in patients with gum disease compared to controls without gum disease (see text for details)

Gum Disease Increases Stroke Risk1

Gum Disease Increases Stroke Risk

Comments: It has been known, based on the original research from Switzerland several decades ago, that tooth decay can be prevented or slowed down by brushing our teeth following meals and in particular after sugar consumption.

Regular flossing once per day has been shown in more recent years to counteract gum disease (periodontitis). Only recently has it been shown that heart disease is directly related to infection of atheromatous plaques with Chlamydia pneumoniae and the other two pathogens mentioned above. It is here that we can make a big difference to our health. How do we prevent periodontal disease? By brushing and flossing our teeth daily. It is that simple. Well, not quite. There is one other thing: We need to cut down the amounts of sugar and starch we consume every day as this provides the micro-chemical climate in the mouth for these bacteria to multiply and this is what we want to change. This will tip the balance in our favor: healthy teeth, healthy gums, healthy blood vessels, hearts and intact brains.

To learn more about this topic, here are more links regarding gingivitis and periodontal disease.

Reference: Dr. Pussinen et al., September issue of Stroke (Stroke 2004;35:2020-2023)

Last edited Oct. 27, 2014