How to Support the Oral Microbiome

The intimate relationship between the microbiome and the host is dynamic and influenced by many environmental factors such as diet, tobacco usage, and stress. These—along with many other aspects of modern lifestyle—influence and alter our microbiome and its respective properties that cause a shift within the body’s ecosystem from a balance of health to disease, and vice versa. The oral cavity is one of the most heavily colonized parts of the human body and, therefore, susceptible to this shift equally if not more so than other areas of the body. To counteract this shift for disease prevention, clinicians must focus on the host and its microbiome residents as one, rather than separate entities.

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The Oral Habitat

The mouth hosts a variety of bacteria due to the distinct habitats such as the tongue, attached gingiva, gingival sulcus, teeth, cheeks, lips, and hard and soft palates, which allow for microbial colonization. Therefore, the oral cavity represents a heterogenous ecological system that supports different microbiome communities. The moist areas of the mouth offer nutrients, such as salivary proteins, gingival crevicular fluid, and glycoproteins, that support the growth of many microorganisms. As teeth erupt, microbial colonization occurs almost in­stantly on new surfaces, which starts a major ecological event in the mouth of a child. This occurs again as primary teeth are replaced with their respective succedaneous teeth, which significantly alters the oral microbiome. The occlusal surface of teeth, including the pits and fissures, provide a shelter for microorganisms to persist in an extensive biofilm formation. Fixed dental prosthesis, including dentures, crown and bridgework, and implant restorations, can also influence the formation of a biofilm as well as affecting the composition of the microbiome.

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Oral Hygiene

According to the American Dental Association, general recommendations for all patients include toothbrushing twice daily using either a manual or power toothbrush to remove plaque from all surfaces and the tongue. Recent studies show that regular oral hygiene instruction, toothbrushing, interdental cleaning, and rinsing with an antimicrobial mouthrinse, such as one containing 0.075% cetylpyridinium chloride (CPC) have been demonstrated to significantly reduce the amount of pathologic plaque bacteria, eliminate supra­gingival plaque, and improve gingival health when compared with toothbrushing alone.

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Diet

The consumption of refined carbohydrates results in microbial fermentation that produces lactic acid and, thus, a more acidic environment that shifts the oral microbiome toward caries-causing bacteria such as Streptococcus mutans, Lachnospiraceae, Veillonellaceae, and Actinomycetales. As health care providers, it is our duty to provide diet and nutritional counseling to our patients to promote a more healthy oral environment. A recent study showed drinking alcohol may influence the bacterial composition by causing a depletion of beneficial commensal bacteria and an increased colonization of potentially pathogenic bacteria in the oral cavity. Such changes could potentially contribute to several diseases such as periodontitis, head and neck cancer, and digestive tract cancers. A study by Wu et al, showed smoking may promote a more anaerobic oral environment and change the oral bacterial community, promoting a more pathogen-friendly environment, increasing the risk for oral diseases.

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Probiotics

Probiotics contain live microorganisms that are intended to improve the microbiome by replenishing the beneficial microbiota and increasing their biodiversity. Although they were developed to change the gut microbiota, limited evidence has shown they could be used to prevent periodontal diseases. A study on probiotics containing Lactobacillus reuteri showed efficacy in reducing both gingivitis and plaque in patients with moderate to severe gingivitis.

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Mechanical Debridement

A prolonged interval between periodontal therapy appointments allows for the pathogenic microbiome to recolonize from the untreated diseased sites to the recently treated diseased sites. Patients with periodontal diseases should be treated presumably through standard periodontal care (plaque control, scaling and root planing) in a single visit when possible in order to prevent the recolonization of pathogenic bacteria in treated sites.

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Mouthrinses

A recent study showed an increase in the pH in the oral cavity following the use of chlorhexidine and povidone iodine rinses. The use of a variety of mouthrinses, including chlrohexidine and povidone iodine, was shown to decrease the number of S. mutans, decrease caries activity, and reduce the plaque index in the oral cavity. Another study by Akande et al on mouthrinses, showed twice daily use of mouthrinses containing cetylpyridinium chloride reduces oral microbial load counts in healthy subjects when used as an adjunct to their normal oral hygiene procedures.

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Saliva

Saliva plays an important role in maintaining a healthy oral environment. Some of saliva’s functions include maintaining a favorable pH for microbial growth, removing exogenous substrates, and providing a continuous supply of endogenous nutrients for the beneficial resident oral microbiota.

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