Hy­giene won’t dis­rupt oral mi­cro­biome

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Dear Doc­tor: Our dad is a sci­ence geek, and his new ob­ses­sion is the gut mi­cro­biome. But now he’s telling any­one who will lis­ten that the mouth mi­cro­biome is just as im­por­tant as the one in the gut. Is that re­ally true? Am I help­ing or hurt­ing it when I brush my teeth?

Dear Reader: Ku­dos to your sci­ence-minded fa­ther, who is clearly stay­ing cur­rent on the lat­est re­search. The oral mi­cro­biome, which ac­cord­ing to most sci­en­tists in­cludes the mouth and the as­so­ci­ated nasal re­gions and cav­i­ties, turns out to be sec­ond in size only to the mi­cro­biome in our guts. It’s home to more than 700 dif­fer­ent bac­te­rial species, as well as viruses, fungi and pro­to­zoa. That means it’s one of the most densely pop­u­lated anatom­i­cal sites in our bod­ies.

Stud­ies have shown that dif­fer­ent ar­eas of the mouth and its as­so­ci­ated ar­eas, in­clud­ing the phar­ynx, esoph­a­gus, tra­chea, nasal pas­sages, Eus­tachian tubes, mid­dle ear and si­nuses — are col­o­nized by mi­cro­bial com­mu­ni­ties that are unique from one an­other. And thanks to sta­ble tem­per­a­ture and mois­ture, a con­sis­tent food sup­ply, and a pH range of 6.5 to 7.5, which hits the bac­te­rial sweet spot, the oral-nasal cav­ity is the ideal bac­te­rial en­vi­ron­ment.

Not only do these con­di­tions al­low the many mil­lions (some say it’s bil­lions) of bac­te­ria in the oral mi­cro­biome to thrive, the lo­ca­tion it­self means they are uniquely mo­bile. Thanks to saliva pro­duc­tion and the vas­cu­lar sys­tems that keep our gums, tis­sues and nasal mem­branes healthy, bac­te­ria from our mouths and noses wind up in the GI tract and in the blood­stream. The pas­sage of air through the nose and mouth car­ries bac­te­ria to the tra­chea and lungs. That places the var­i­ous com­po­nents of the oral mi­cro­biome into prime po­si­tion to travel through­out the body. Not only are res­i­dents of the oral mi­cro­biome known to be re­spon­si­ble for con­di­tions like morn­ing breath, plaque and gum dis­ease, re­searchers have es­tab­lished con­nec­tions be­tween oral bac­te­ria and a va­ri­ety of car­dio­vas­cu­lar is­sues.

New re­search is now fo­cused on ex­plor­ing po­ten­tial con­nec­tions to out­comes as di­verse as preg­nancy com­pli­ca­tions, di­a­betes, res­pi­ra­tory dis­eases, var­i­ous can­cers and even cer­tain neu­ro­log­i­cal con­di­tions like Parkinson’s dis­ease and mul­ti­ple scle­ro­sis.

In an­swer to your sec­ond ques­tion, no, you’re not killing your oral mi­cro­biome when you brush your teeth. Please, don’t stop brush­ing. And do con­tinue floss­ing. Use a good tooth­brush and prac­tice proper tech­nique. If you think that maybe you’re do­ing ei­ther one wrong, your den­tist will be happy to guide you.

Also, as sci­ence con­tin­ues to de­code the im­por­tance of the tril­lions of mi­cro­scopic crea­tures we host in our bod­ies, the con­sen­sus is grow­ing that an­tibac­te­rial prod­ucts are not a great idea. In our opin­ion, ditch­ing the harsh and pow­er­ful kill-them-all an­tibac­te­rial mouth­washes would be wise. Rinse with wa­ter, which with a pH of 7 matches the ideal en­vi­ron­ment in your mouth.

While in the fu­ture it’s quite pos­si­ble that den­tistry will rou­tinely in­clude per­son­al­ized treat­ments based on sam­pling the bac­te­rial pro­file of a pa­tient’s mouth, right now we’re limited to more tra­di­tional meth­ods. The key is to ac­tu­ally use them. Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health.

Send your ques­tions to ask­the­do­c­tors@med­net.ucla.edu, or write: Ask the Doc­tors, c/o Me­dia Re­la­tions, UCLA Health, 924 West­wood Blvd., Suite 350, Los An­ge­les, CA, 90095. Ow­ing to the vol­ume of mail, per­sonal replies can­not be pro­vided.

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