Oral Health and Overall Well-being
I’ve been meaning to write about oral health for a long time, because it plays such a central role in systemic health. In my practice, I regularly send patient’s to a holistic dentist, particularly, if their gut microbiome tests come back showing high levels of a particular bacteria called Fusobacterium. Studies have been linking poor oral health and an out of balance oral microbiome to different health conditions, particularly chronic disease of the body and the brain as well as our mental health.
Andrew Huberman recently placed oral health right next to the other pillars of health, i.e. sleep, nutrition, exercise, relationships, stress modulation and light exposure. Just as we do with those pillars, we should attend to our oral health on a daily basis.
Here’s why!
Oral health is far more than just a matter of clean teeth and fresh breath. It's a cornerstone of systemic health, intricately linked to conditions such as heart disease, diabetes, and even Alzheimer's. The connection lies largely in inflammation—a common denominator in many chronic diseases. Poor oral health can lead to a constant, low-grade inflammatory state, which, over time, contributes to the development and progression of serious chronic conditions
“Poor oral health leads to poor or substandard amounts of inflammatory environment, and that’s the driver of these diseases. ” - Peter Attia
The layers of a tooth
We have 32 teeth, each of them playing a specific role in chewing, tearing, and grinding food. But beyond these mechanical functions lies a complex structure. The outermost layer, enamel, is the hardest substance in the human body, designed to withstand the wear and tear of daily life. Beneath the enamel is the dentin, a sensitive layer that cushions the tooth. At the core lies the pulp, rich in nerve endings and blood vessels, connecting the tooth to the body’s immune system and signaling when something is wrong.
The pulp is highly vascularized and innervated, so there’s two direct links from each tooth to the rest of the body: our blood and our nervous system.
The oral microbiome
Our mouths are further home to a vast community of bacteria—over 700 species, to be precise. While many of these microorganisms are harmless or even beneficial, others, like Porphyromonas gingivalis and Fusobacterium, can be harmful if allowed to thrive. P. gingivalis has been linked to cardiovascular disease, Alzheimer’s, rheumatoid arthritis and others, whereas Fusobacterium is potentially connected to endometrioses, pregnancy complications and colorectal cancer.
Oral hygiene is about more than just teeth; the tongue, gums, and oral mucosa need attention too. For instance, flossing is particularly effective at removing anaerobic bacteria that thrive between teeth and can lead to gum disease if not properly managed.
Sugar: The nemesis of enamel
All sugars—whether from fruit, dairy, or refined sources—pose a threat to our teeth. When cariogenic bacteria metabolize sugar, they produce acids that erode the enamel, leading to demineralization. This process can eventually result in cavities. Fortunately, our teeth are constantly undergoing remineralization, a natural repair process that can reverse early decay if supported by good oral hygiene and a balanced diet.
When you do eat sugar, rinsing your mouth out afterwards with plain water or plain water and a little bit of salt, can help alleviate the negative effects.
Demineralization vs. remineralization
Our teeth are in a constant state of flux, shifting between demineralization and remineralization. Demineralization occurs when acids from bacteria weaken the enamel. On the flip side, remineralization is the body’s way of repairing this damage by depositing minerals back into the enamel. Fluoride enhances enamel by converting hydroxyapatite into fluorapatite, which is more resistant to acid erosion. However, this fluorapatite differs from the natural enamel because it forms a denser and more tightly bonded crystalline structure. While this makes teeth more durable against decay, it alters the natural composition of the enamel. In a low-sugar diet, where the risk of acid attacks is minimized, the body’s natural remineralization process using hydroxyapatite can be sufficient to maintain strong, healthy teeth. Without the constant challenge of sugar-induced demineralization, the need for fluoride decreases, allowing natural enamel to regenerate in its original form, which is more biologically compatible. This approach reduces the risk of fluoride-related toxicity, such as dental fluorosis, while still supporting oral health.
Fluoride toothpaste or not?
If you want to avoid fluoride in your toothpaste, look for a product with hydroxyapatite and xylitol. These often also contain a mild abrasive, that can help break up the biofilms that bacteria can form.
Also baking soda and water make a pretty good tooth paste, which is low on the abrasive scale, especially if you brush softly.
Most mouthwashes are detrimental to oral health
Especially alcohol based and antiseptic mouthwashes are bad for microbiota in the mouth and the gut. Unless you have an infection in the mouth that must be treated, you should steer away from them. If you feel that you need to use a mouthwash for the feeling of freshness, you should look for a mouthwash that has no acohol and is not antiseptic. Or simply diligently keep up with your oral health routine and you probably won’t need to.
Intermittent fasting
There are certain times, in which the mouth makes the ideal saliva in terms of pH for remineralization of teeth. This generally happens during the day. Therefore, constant grazing, sipping on acidic drinks (unfortunately, black coffee counts as an acidic drink!) can disrupt this process. Keeping 2-6 hour windows of not eating anything and not drinking anything acidic actually help our teeth remineralize.
Alcohol and stimulants
Alcohol changes the pH of our saliva and places the teeth in a demineralization state. Also stimulants, that increase adrenaline and noradrenaline, disrupt our oral health. Stimulants chemically change the pH of our saliva, making the mouth more acidic, taking our teeth from the remineralization state into the demineralization state. Also, stimulants encourage mouth breathing because their autonomic nervous function shifts. This leads to a drying of the mouth, which again shifts the mouth towards a demineralization state. Unfortunately, stimulants such as tea and coffee will decrease the quality of our saliva and are not beneficial to oral care, when consumed in abundance and particularly when lacking an oral hygiene routine.
Don’t be a mouth breather
Oral health includes oral airway health. This is about keeping the oral cavity dry and moist. At night, mouth tapes are your friend. Use them.
Smoking and vaping both are bad for you. Period.
Maybe vaping is less harmful. Still, both are bad for you and your oral health. Stop doing it. Simple as that.
The Intersection of sexual and oral health
The link between oral health and sexual health is particularly evident in the case of HPV, which is responsible for approximately 70% of oropharyngeal cancers (in the U.S.). Poor oral hygiene can exacerbate the risks, as bacteria like P. gingivalis create environments that facilitate viral growth. Regular dental care and maintaining a healthy oral microbiome are therefore crucial in reducing the risk of HPV-related cancers.
Your optimal oral care routine
An effective oral care routine involves more than just brushing your teeth twice a day. Incorporate the following steps for comprehensive care:
Swish your mouth after you eat anything, particularly sugar or acidic foods and drinks.
Use a water pik to remove food particles and plaque that brushing might miss.
Floss to clean between teeth, focusing on anaerobic bacteria. Glide gently down the side of the tooth, slightly under the gum, and use a circular motion before lifting up from between the teeth.
Brush for two minutes, morning and night. Brushing at night is particularly important to combat the growth of bacteria while you sleep.
Scrape your tongue to remove bacteria that accumulate there.
Rinse with olive oil or tea tree oil, which has natural antibacterial properties.
Remember, dental visits every six months are crucial for professional cleanings and to catch any issues before they develop into serious problems.