Episode 74: The Oral Microbiome & Your Health

[Eon Engelbrecht – E-Radio-SA] (0:05 – 0:48)
Welcome to Save Your Money, Save Your Teeth. It is time again for the podcast where curiosity meets dentistry straight from the experts. I am Eon and I am once again joined by Dr Clifford Yudelman. We are taking a deep dive into the world of dental care from a consumer’s perspective. Today Dr Yudelman from OptiSmile delves into your oral microbiome, a bustling community of microbes in your mouth. They are there right now, and how its balance or imbalance can influence not just cavities and gum disease, but also your overall health. This is going to be very interesting. So let us explore. But firstly, let us say hi to Dr Yudelman. Hope you are well.

[Dr Clifford Yudelman – OptiSmile] (0:49 – 1:21)
Yes, I am great, thank you, and hope you are keeping well. Lovely to speak to you. This one is especially for listeners who are particularly interested in this type of thing. It is not an everyday subject that most dentists would talk about. I had to do some extra research for this one. All of the information that I am giving is based on proper medical and dental journals, so I did not just make this stuff up. Not all of it is very well known, so it could open up a few conversations.

[Eon Engelbrecht – E-Radio-SA] (1:22 – 1:32)
Right, I love it. Let us get into it. Firstly, I want to ask you, Dr Yudelman, what exactly is the oral microbiome and why does it matter?

[Dr Clifford Yudelman – OptiSmile] (1:33 – 2:51)
The oral microbiome is a complex, it is an ecosystem where things live together. In this case it is bacteria, fungi, viruses, all kinds of stuff living there, inhabiting your mouth. Believe it or not, over 700 different species coexist in balance. Is it not crazy to think that there are 700 different species? In a healthy situation it can form a protective biofilm that prevents colonisation by bad bugs when it is properly balanced. Disrupting it, or in this case what is called dysbiosis, can permit or encourage an overgrowth of acidogenic, which means acid-causing, species that trigger cavities, or inflammatory species which cause, or contribute to, gum disease. Now there is a lot more emerging evidence and there are direct links between oral bacterial microbes and systemic conditions like cardiovascular disease, diabetes and Alzheimer’s, and we have done a podcast on that.

[Eon Engelbrecht – E-Radio-SA] (2:52 – 3:01)
Okay, and how does a healthy oral microbiome protect you against tooth decay and gum disease?

[Dr Clifford Yudelman – OptiSmile] (3:01 – 4:24)
There are lots of beneficial bacteria. One of them is called Streptococcus sanguinis, S A N G U I N I S. It is quite a nice word, actually. I like it, it sounds like sanguine. I think that means relaxed. I do not know, it is a word I have not looked up. I think it is a French word. They compete with the acid-producing species for places to stick on your enamel. Those are the good bugs, the ones you have in your mouth when you do not drink too much Coca-Cola or eat too many sweets. Then the commensal microbes, the ones that all live together, produce alkaline compounds like ammonia from your diet and they buffer acids. Your saliva and your own bacteria can help to keep your mouth healthy. Over millions of years, they have evolved to be there. They are meant to be there. A balanced biofilm stimulates your own immune defences and helps your gums to be healthy. Lastly, salivary enzymes and antimicrobial peptides in your saliva work together with these bacteria to stop the bad bugs from causing problems. They are all there for a reason.

[Eon Engelbrecht – E-Radio-SA] (4:24 – 4:29)
Which factors can actually disrupt that balance inside your mouth?

[Dr Clifford Yudelman – OptiSmile] (4:29 – 6:19)
That is what I was alluding to earlier. If you take in sugar frequently, if you are continually snacking on chocolate bars or Smarties or any little gummy bear or any sugar, even lots of tea, every few hours you have a cup of tea with sugar in it, that feeds cariogenic species. Cariogenic species are cavity-causing bacteria. We have definitely isolated another streptococcus called Streptococcus mutans, or S M. These are the ones that start cavities. If you are eating a lot of sugar, the sugar makes that plaque build up a lot quicker, the bad plaque. Disruption of the balance, obviously antibiotics can mess up this whole balance. One of the worst ones is smoking and vaping, which change your pH and your oxygen levels. They have shown that this shifts your microbial populations, the type of bacteria in your mouth, towards the pathogenic ones, the ones that cause disease. Pathogenic means disease-causing. The one thing we have not mentioned yet is poor oral hygiene, which lets the biofilm mature. It becomes too, it should be kept fresh. These bacteria keep reproducing, but if you just leave it, it becomes like a stagnant mess. The bad bugs love that because deeper down there is no oxygen and it is the anaerobes, those are the bad ones. They live in the dark, wet places between your teeth and under the gum.

[Eon Engelbrecht – E-Radio-SA] (6:20 – 6:21)
It sounds quite scary, actually.

[Dr Clifford Yudelman – OptiSmile] (6:22 – 6:25)
I try to sound scary. I am pleased it sounded that way.

[Eon Engelbrecht – E-Radio-SA] (6:28 – 6:34)
Doctor, what are the oral systemic connections driven by microbiome imbalances?

[Dr Clifford Yudelman – OptiSmile] (6:35 – 8:55)
Periodontal pathogens are the bacteria that cause gum disease. There is a nice name coming for you, Porphyromonas gingivalis, P O R P H Y R O M O N A S, Porphyromonas gingivalis, your gums are called your gingiva. They have shown that these can actually get into your circulation if your gums are inflamed and they promote atherosclerosis and cardiovascular disease. Is it not amazing, something from your gums can get into your circulation and into your blood vessels. Atherosclerosis is where you get thickening or hardening of your arteries and the cholesterol builds up, but a lot of that is started by, or contributed to by, these bacteria that live in your gums if your gums are unhealthy. Obviously you get cardiovascular disease, which means heart attacks and strokes. This is serious stuff. There is also translocation of your bacteria in your mouth into your gut, which can then cause inflammatory bowel disease and metabolic disorders. I did not actually know that. That is something I found out when I was researching for this podcast. Chronic oral inflammation will raise something I get tested regularly, because I am very proactive with my health, called CRP, C-reactive protein. When you get your blood test you can get a CRP level done. If your CRP is high, that means you have inflammation somewhere in your body. That is a big link to diabetes and arthritis. Some oral bacteria make neurotoxins, which are basically poisonous to your nerves. Interestingly, they have been implicated as a possible cause of Alzheimer’s when these neurotoxins go to the brain. All of this is crazy to think about, that brushing your teeth could save you from a lot of these problems.

[Eon Engelbrecht – E-Radio-SA] (8:55 – 9:05)
Amazing how it is all linked. Can probiotics or prebiotics play a role in your oral health?

[Dr Clifford Yudelman – OptiSmile] (9:05 – 10:57)
Definitely in places like America where they sell these things widely, they can. In South Africa, it is not easy to get them. So the answer is, not easily, but you can get them online and there is toothpaste now. I was reading research on certain probiotics. One of them is called Lactobacillus reuteri, which you can actually get in South Africa. I have not seen it or recommended it for dental use, but they have shown that it can help in reducing gum inflammation and pocket depth. After researching for this podcast I will definitely look into that. We do not get a lot of patients who have advanced gum problems now. We used to see a lot more of it 10 to 15 years ago, but I am sure in many practices they still see a lot of it. It depends where you are and so on. Then there are prebiotic compounds, something called arginine. These can help to feed the good bacteria and shift your biofilm favourably towards a healthy biome. Clinical trials report that even a modest reduction in Strep mutans is achieved when you chew probiotic lozenges, that they actually compete with the bacteria that cause cavities. That sounds interesting for me as well. There are a lot of long-term studies, sometimes to try to sell us more supplements. I do not think it is going to be widespread, but it is interesting to see where the research is going, using good bacteria to fight bad bacteria.

[Eon Engelbrecht – E-Radio-SA] (10:58 – 11:04)
How do everyday oral care products influence microbial communities?

[Dr Clifford Yudelman – OptiSmile] (11:05 – 12:40)
We often give patients antimicrobial mouthwashes that have chlorhexidine, not the over-the-counter ones, but special ones. We make sure we give them in low concentrations so they are not too powerful, and they are only used if you have got bleeding gums, just to get the balance back in your mouth. We do not let patients use these antimicrobial mouthwashes long term because they can also suppress the good bacteria in your mouth. Fluoride toothpaste is very good for inhibiting acid-causing bacteria and promoting enamel remineralisation. By doing that it supports a more balanced microbiome. We did a recent podcast about fluoride versus non-fluoride toothpaste. There are some new pastes with arginine that raise the pH, which is more favourable for better bacteria in your mouth. I am not familiar with any of these in South Africa, but I will be looking into that. Using an alcohol-free formula that does not disturb the balance of your microbiome is a good idea. I am not a big fan of general use of mouthwash, unless it is a minty mouthwash that does not have too many chemicals in it. I generally do not recommend it.

[Eon Engelbrecht – E-Radio-SA] (12:40 – 12:47)
What clinical tests assess a patient’s oral microbiome status, Doctor?

[Dr Clifford Yudelman – OptiSmile] (12:47 – 14:37)
You can get DNA-based saliva tests and measure the bacteria. Some dentists who focus on this are well known for it and the patients who are keen on that approach will find those dentists. Everyday dentists, I do not think, do much of this testing. I do not want to say anything good or bad about it. When I was in Australia, I did a lot of saliva testing. In the end, patients need to brush and floss and take some of the advice we have given in this podcast and previous ones. If it is a specific case where a patient has gum disease and they go to the periodontist and the periodontist cannot figure out how to treat them, they might do these tests and find there is a particular bacterium they need to give an antibiotic for or treat specifically. I am sure in the future there will be new treatments with genetic engineering and so on. These profiles can be very expensive and I am not sure that they are for everyday use. You can culture a patient’s microbiome and monitor for yeast overgrowth. Again, in my practice it would be overkill, but these things are available. The other thing is you always have to interpret this along with the clinical signs. You cannot just go in somewhere, have someone test your plaque, wave a magic wand or give you a tablet to chew or a mouthwash to rinse with, and then avoid going to the dentist for the rest of your life. It sounds like a nice idea, but I think we are a little way from that.

[Eon Engelbrecht – E-Radio-SA] (14:38 – 14:44)
How can your diet support a healthy oral microbiome?

[Dr Clifford Yudelman – OptiSmile] (14:44 – 16:07)
Now we are talking, that is a much better route to go because this also helps your general health. Eating high-fibre fruits and vegetables, carrots, celery, apples, stimulates your saliva and you get mechanical disruption, the coarseness of the celery or the apple or the carrot actually helps to stir things up in your mouth. It is very good to keep your microbiome healthy. Eating yoghurt has been shown to be very good and things like that. Fermented foods, kombucha and sauerkraut, you have to be careful because the pH is quite low and they can cause sensitivity and irritation, but when they are taken with meals and you do not overdo it, I think that is a good idea. Funnily enough, green tea has been shown to be very helpful for certain bacteria. Limiting sugars and frequent snacking will starve the bacteria that cause cavities. They really love sugar. Limit free sugars and very frequent snacking, that will starve the bacteria that cause cavities.

[Eon Engelbrecht – E-Radio-SA] (16:07 – 16:15)
Which emerging therapies target the microbiome for disease prevention?

[Dr Clifford Yudelman – OptiSmile] (16:15 – 17:19)
I did some research on this. There are sprays in clinical trials, so they are not marketed yet, where you would spray this in your mouth and it will explode the cavity-causing bacteria. There are peptides and antimicrobials being developed that will target the bad bacteria without disturbing the good ones. They are talking about probiotic varnishes that we can paint on your teeth. Obviously some dentists do not have much else to do, this sounds like a lot of fun. I am looking forward to maybe using them in the next five to ten years. The last one is microbiome modulation via mouthwash formulas. They are making up mouthwashes that have prebiotics and enzymes. That is something else to look forward to in the future.

[Eon Engelbrecht – E-Radio-SA] (17:19 – 17:27)
Finally, what are your simplest daily habits to nurture a balanced oral microbiome?

[Dr Clifford Yudelman – OptiSmile] (17:28 – 17:58)
Brush twice a day with a fluoride toothpaste. You can chew sugar-free gum with xylitol. That is good for keeping away the cavity-causing bacteria. Follow some of the other tips, the commonly available things that are over the counter, and always check with your own dentist. Do not spend too much money on some of these products that are still being researched because they have not been proven as far as I can tell.

[Eon Engelbrecht – E-Radio-SA] (17:58 – 18:31)
Dr Yudelman, thank you so much once again for another very insightful podcast. We really appreciate you joining us and sharing your knowledge with us.

[Dr Clifford Yudelman – OptiSmile] (18:31 – 18:50)
Pleasure. Thank you for having me on again. Thanks to our listeners for tuning in. Remember, while we strive to provide valuable insights, always consult with your own dental professional for advice tailored to your personal health. Do not forget to subscribe for more discussions and join us again next week. Until next time, keep your mouth and your health in good balance.

[OptiSmile Announcer] (18:51 – 19:36)
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