The Mouth-Gut-Body Connection
This is a guest post by RD-to-be and dental hygienist, Joria Koons.
You have probably heard of the term “leaky gut,” but have you heard of “leaky mouth”?
The gut isn’t the only place in your body with its own microbiome. Our mouths are second only to our guts when it comes to hosting a complex ecosystem of bacteria, viruses, fungi, protozoa, and archaea.
When beneficial strains of these microorganisms are in healthy proportions, they actually work to keep our mouths in a healthy place of balance. On the flip side, if less beneficial strains are allowed to take over and thrive you end up with cavities, gingivitis (bleeding, swollen gums), and periodontitis (you literally start to lose the parts of your jaw that hold your teeth in place).
In this blog post you’ll learn:
About the connection between oral health and gut health
What having a “leaky mouth” puts you at risk for
And 8 health tips for keeping your mouth healthy and thriving
SIBO, Yeast Overgrowth, or Stomach Ulcers? Take a Peek at Your Mouth
Let’s get back to the leaky mouth thing. Think about it, if you have a whole party of disease-causing bacteria chilling in your mouth, what do you think will happen when you swallow?
In health, our stomach acid is equipped to kill unwanted guests that make it past the mouth. However, if your stomach acid is low, or if you just have an overabundance of bacteria coming down the line, they can make it past your stomach and into your small intestine—think SIBO contributors here (small intestinal bacterial overgrowth).
Optimally, stomach acid kills unwanted guests from the mouth that aren’t supposed to make it to the gut. However, if this system gets out of whack due to low stomach acid or bacterial overload in the mouth, unwanted bacterial species can make it into the small intestine, contributing to SIBO, or make it to the large intestine where they can crowd out beneficial species.
Bacteria that are well-known to be culprits in periodontal disease (e.g., P. gingivalis and A. actinomycetemcomitans), thrive in acidic environments. Thus, they are often resistant to the hydrochloric acid of the stomach. Both of these bacterial species have been shown to negatively affect the gut microbiome and contribute to gut dysbiosis and permeability (leaky gut).
And we know that having a healthy gut is super important for having a healthy immune system, balanced hormones, and for making our good-mood neurotransmitters!
Additionally, H. Pylori is commonly found in the mouth. An abundance of it setting up shop in the stomach leads to stomach ulcers.
Candida, which is normally present in small amounts in a healthy mouth, can grow out of proportion and cause candidiasis which is also known as thrush. Thrush often shows up as nasty, cottage cheese-like plaques on the tissues of the mouth that do not wipe off easily. They are also often accompanied by a burning sensation, redness, and sometimes dry and cracked corners of the mouth.
This colonization can lead to candida overgrowth in other areas of the body such as the gut, the sinuses, and the vagina. Alternatively, candida growth elsewhere in the body can contribute to overgrowth in the mouth.
The Mouth to Blood Expressway
Traveling from the mouth into the digestive track isn’t the only way that pathogens (disease-causing organisms) make it into the rest of the body.
Our mouths are full of blood vessels. Because of this, some substances (like certain drugs) can be absorbed directly from the mouth into the bloodstream.
Bacteria from a periodontal pocket (an actual pocket of bone loss and infection under your gums that has increased permeability due to inflammation) or an infection around the root of the tooth (abscess) from a severe cavity can sometimes directly enter the bloodstream.
If you have periodontal disease, this can occur by simply brushing your teeth or chewing.
Once these bacteria make it into the bloodstream, they are carried throughout the body where they can colonize and cause damage. Oral bacteria have been found in atherosclerotic plaques in the arteries and in the brains of people with Alzheimer’s.
Additionally, inflammation caused by the body trying to fight off infections in the mouth can contribute to oxidative stress and inflammation throughout the rest of the body. Because of this, diseases of the mouth such as periodontal disease have been linked to increased risk for other diseases such as:
Diabetes
Cardiovascular disease
Neurodegenerative diseases
Autoimmune diseases (or exacerbation if you already have one)
Some cancers
Respiratory diseases
Chronic kidney disease
Diabetes has a well-known two-way relationship with periodontal disease.
Periodontal disease reduces the body’s ability to balance blood sugar and increases insulin resistance.
Conversely, diabetics with poor blood sugar control are at an increased risk of getting periodontal disease and having it progress more aggressively than people without the disease.
Periodontal disease has also been linked to pregnancy risks such as:
Preeclampsia
Premature birth
And oral bacteria transfer from the mother into the placenta
Additionally, the gums and the rest of periodontium (the tooth socket, if you will) have receptors for estrogen and progesterone.
Spikes in both estrogen and progesterone can cause increased inflammation of the gums.
Progesterone, in particular, inhibits collagen formation in the tissues surrounding the tooth and increases the permeability of these tissues. Because of this, it’s not uncommon for women to see increased incidence of bleeding and sometimes overgrowth of the gums in pregnancy.
Women may also notice increased inflammation and bleeding around ovulation and in the luteal phase right before they get their period due to spikes in estrogen and progesterone.
This inflammation generally resolves after pregnancy or as the menstrual cycle progresses, and if you have good oral hygiene habits, you may not even notice any changes.
Also worth noting, estrogen is thought to have a protective effect in periodontal disease by inhibiting bone breakdown. If you are on birth control, your natural estrogen production is greatly reduced, but the synthetic hormones can still negatively interact with the periodontium and increase inflammation.
Because of these factors, birth control may put you at an increased risk for periodontal disease.
Remember that your mouth is the opening to the rest of your body! Your digestive system is one long, connected tube. What is going on with the health of the rest of your body will affect the health of your mouth and vice versa!
So now that you know how important having a healthy mouth is, what can you do about it?
8 Tips for Keeping Your Mouth Healthy
1. BRUSH YOUR TEETH.
Please. Twice a day. Every day. Optimally for 2 minutes. This is HUGE in keeping your teeth and gums healthy!
A level up on that would be to use an electric toothbrush. Electric toothbrushes have been shown to do a better job of removing plaque and reducing bleeding than manual toothbrushes.
I am personally a long-time fan of Sonicare toothbrushes. They are what I have used in my own mouth for the past 9 years.
If you want to decrease your plastic usage, try these eco-friendly and BPA-free replacement heads from Plus Ultra.
Another option would be to give this bamboo electric toothbrush a try. The bristles are made from castor bean oil (don’t ask me how) and the toothbrush is 100% recyclable. The toothbrush heads themselves are fully biodegradable.
Another toothbrush that has created some buzz in the dental hygiene world is the Burst electric toothbrush which boasts charcoal-infused nylon bristles.
*If your toothbrush bristles look like they got stomped on, you are overdue for a replacement (and probably brushing way too hard)! A good rule of thumb is to replace your toothbrush heads every 3 months or when they show signs of wear—whichever comes first.
2. FLOSS!
Or use interproximal brushes or picks--just work something in between your teeth to get where your toothbrush can’t reach. Despite what some news articles over the years have claimed, any dentist or hygienist (along with numerous studies) will tell you that cleaning in between your teeth is essential to keeping your gums healthy and decreasing your risk of cavities between your teeth.
If you still are feeling doubtful that flossing is necessary, do a self-experiment. Take your time flossing for this experiment and notice what the floss pulls out. Even if you did a great job brushing, I guarantee that you will still see plaque and little bits of food being pulled out with your floss—especially if you take the time to wrap it in what we dental hygienists refer to as a “c-wrap” around the tooth.
The more technical name for plaque is biofilm. Biofilms are a matrix-colony made up of bacteria, their by-products and toxins (I tell kids it’s their poop), components of your saliva, fluid from the space in between the tooth and your gums, bits of food, our own dead cells, and sometimes immune cells from the blood.
These colonies form rather organized little eco-systems with their own more acidic environment-- which breaks down tooth enamel. Biofilms can form in as little as 3 hours, and they reproduce rapidly.
The more the colony grows, the more it promotes the dominance of problematic bacterial strains.
So, to keep these biofilms from growing, floss daily. Twice a day is awesome, but if you floss once a day every day, your hygienist will be THRILLED.
I know wrapping that floss around your fingers and shoving your fingers into your mouth can be less than enjoyable. Don’t throw in the towel, there are other options! You can try proxabrushes, soft picks, wooden toothpicks (although they are likely not quite as effective as the brushes or soft picks), inexpensive reusable floss handles or this fancy metal one from Quip, or flossers (these ones are fully biodegradable).
Waterpiks or air flossers can be amazing tools! I just still recommended that you physically work floss or a picks in-between your teeth at least a few times per week.
Something else to keep in mind, many flosses on the market are coated with PTFE or PFOA (these stand for super long chemical names). Those acronyms might not be ringing a bell, but I bet Teflon does—think non-stick pans.
These chemicals have been associated with risk for certain cancers, thyroid disease, reduced semen quality, and ulcerative colitis. A study found increased serum concentrations of this compound associated with women who use Oral-B Glide floss (along with other factors of exposure).
Additionally, many of the waxes used on floss are petroleum-based and contain potentially unwanted chemicals used for flavoring and scent.
Nylon and polyester (which are often used to make the thread) are also petroleum-based but are hard to avoid in dental products. More research is needed, but petroleum-based products may have the potential for hormone disruption and may be contaminated with carcinogenic chemicals.
*Please do not use chemicals in floss as an excuse not to! The net gain from flossing is still likely to be more beneficial than the risk of minor exposure (compared to many other sources of potential exposure) to these chemicals via floss.
However, if you have the option to choose safer products, look for them! I am all for reducing exposure anywhere that we can.
Your best option is silk floss or nylon/polyester floss without Teflon or petroleum-based wax (which is more likely to get left behind in your mouth than the thread or a toothbrush bristle) like Risewell’s floss (use code KAELYRD10 for 10% off). Risewell’s floss also contains bonus ingredients like xylitol and hydroxyapatite crystals (more on those ingredients in a bit).
3. USE A TONGUE SCRAPER!
The tongue is quite the hiding place for plaque and bad breath-causing bacteria. You can brush your tongue with your toothbrush but using a tongue scraper will clean it even better. Incorporate it into your daily tooth brushing routine!
4. LOOK FOR NATURAL TOOTHPASTES THAT CONTAIN XYLITOL AND HYDROXYAPATITE CRYSTALS.
Xylitol (and erythritol is also looking promising) is a sugar alcohol with amazing anti-cavity benefits. Cavity-causing bacteria try to metabolize xylitol just like they would sugar. However, bacteria are unable to use xylitol for energy and trying will starve and kill them.
As a bonus, xylitol also stimulates salivary flow which also has protective benefits for your teeth and mouth.
*A note on saliva: it contains minerals which help maintain the strength of tooth enamel, antibacterial compounds, and raises the pH of the mouth to make it less acidic. Remember that disease-causing bacteria thrive in an acidic environment, and acid also eats away at your tooth enamel.
Hydroxyapatite crystals naturally exist in the structure of your enamel and bones. They have been shown to re-mineralize weakened enamel (the start of a cavity) just as well as, if not better than fluoride—without fluoride’s potential risks! As a bonus, it may also help whiten your teeth.
A couple of options for toothpastes using these ingredients are Risewell Co (use code KAELYRD10 for 10% off) and Boka.
Another toothpaste I like is Lumineaux’s whitening toothpaste. While it doesn’t have hydroxyapatite, it does contain xylitol and antibacterial and anti-inflammatory ingredients such as aloe vera and coconut oil. It also contains mineral-rich dead sea salt. I can also attest to its ability to gently whiten the teeth.
Lastly, Revitin toothpaste contains prebiotics!
5. DITCH THE HARSH ALCOHOL-CONTAINING MOUTH RINSES.
We don’t want to open ourselves up to candida overgrowth by killing off 99.9% of the bacteria in our mouths—including the beneficial bacteria. Additionally, alcohol-based mouth rinses can dry out your mouth which is the opposite of what we want for a healthy oral environment.
Instead, try oil pulling! Oil pulling is an ancient Ayurvedic remedy. Studies have linked antimicrobial and anti-inflammatory benefits to sesame, sunflower, and coconut oil.
While traditionally oil pulling is prescribed for 10-20 minutes at least once per day, studies have shown benefits equal to the heavy-hitter prescription rinse chlorhexidine (without potential side effects like tooth staining, altered taste sensation , and burning tongue) in as little as 1-3 minutes.
It is worth noting that the oil fully emulsifies in about 5 minutes, so you may want to shoot for that if you can!
Oil pulling also moisturizes and reduces dry mouth. Lauric acid in coconut oil acts by reducing the overall microbial load in the mouth and coats the teeth and tissues, making it harder for biofilms to re-adhere themselves.
Oil pulling may also promote tissue regrowth in periodontal disease while reducing bleeding and inflammation.
An added benefit, from personal experience, is that oil pulling will help lift stains from your teeth—a godsend for us coffee-drinkers.
If you want to use a more traditional rinse, Risewell (use code KAELYRD10 for 10% off) and Lumineaux both have gentle options for reducing harmful bacteria and acid.
You can also make your own mouthwash! Add about ¼ of a tsp of baking soda (it’s basic as in chemistry not that it’s lame) and a pinch of Redmond’s Real Salt (for antibacterial properties and minerals) to a glass of water.
6. VISIT YOUR DENTIST REGULARLY!
Just think of getting your teeth cleaned as a spa treatment for your mouth—make it a self-care thing! If you can find a biological dentist in your area to see, even better.
7. TRY ORAL PROBIOTICS IF YOU ARE FEELING FANCY!
If you have a healthy mouth, oral probiotics are not something that you need to get. However, if you are fighting bad breath, periodontal disease, yeast overgrowth, cavities, or possibly even tonsil stones, the research regarding oral probiotics looks promising!
Some of the strains being studied for oral health are Lactobacillus reuteri, Lactobacillus salivarius, Streptococcus salivarius K12, and Streptococcus salivarius M18. They typically are given as lozenges or tablets. I have personally tried Burst’s oral probiotic.
*Don’t forget that eating probiotic foods is also a great way to diversify strains of good bacteria throughout your whole body!
8. LAST BUT CERTAINLY NOT LEAST, AVOID OVERCONSUMPTION OF REFINED GRAINS AND SUGARS.
Sugary foods promote oral dysbiosis and contribute to cavities. Even complex carbohydrates such as whole grains can be problematic if you are constantly snacking on them throughout the day.
When bacteria feed on the components of starch, they produce acid. Your saliva can help buffer this acid, but it takes some time.
If you are constantly snacking, your mouth will spend a great deal of its time in an acidic state which promotes enamel breakdown and the growth of bacteria.
Also don’t forget about what you drink! Even unsweetened coffee, flavored sparkling water, and lemon water can be rough on the teeth due to the acid content in these beverages. Use straws as often as you can to protect your enamel. Also swish your mouth with water to speed up the acid neutralizing process.
*Pro tip: Don’t immediately brush your teeth after drinking soda or coffee. This will just spread the acid around on your teeth. It is better to first rinse your mouth out with water and wait around 30 minutes before going in with the toothbrush.
BONUS:
Mouth breathing dries out your mouth and increases the proportion of undesirable microbes in your mouth—including the ones responsible for bad breath. To reduce mouth breathing while you sleep, give mouth taping a try! Check out our recent post on mouth taping to learn more.