Want to stay ahead of the curve and set yourself apart from the pack? This process starts with incorporating the latest information from the world of science into your office. What else is new besides CBCT’s and digital impressions? Let’s talk about the human micro-biome. What’s that you’re asking? Gut flora.
There are trillions of them. Most dental people know of S.mutans and P.gingivalis but those are only two of the 1,000’s of single celled organisms that add up to 100 trillion in total. And they out number your human cells 10 to 1. Yes, you are not alone.
This field is still very new. It’s only been around since 2012 when the National Institute of Health completed the first part of the Human Microbiome Project1. What’s it got to do with you… the practicing dentist? Well, we are oral physicians and the experts of one of the largest repositories of flora… the oral cavity.
The GI tract or specifically the gut has 60-70% of the total flora in the body. The gut plays a major role in the immune system – 70% of the cellular parts of the whole immune system are made here2.
Ever wonder why some people don’t heal well after an extraction or implant placement? It could be more than simply smoking or poor flossing technique if they suffer from reflux, constipation, irritable bowel, diverticulitis, etc.
When good bacteria are abundant, they contribute in a major way to the immune system. The immune system is more than simply putting out the fires of infections but concerns the day-today repair and maintenance that keeps us healthy and strong. Probiotics help stimulate the immune cells: T-cell, B-cells, macrophages and natural killer cells.
Our well-intentioned prescription for a broad spectrum antibiotic takes care of the abscess in the short term but our body’s flora take a hit for up to six months after – hence the new guidelines by the Canadian Dental Association on prophylactic antibiotics. “There is no reliable evidence that antibiotic prophylaxis prior to dental procedures prevents prosthetic joint infections”3. NOTE: Of course people need to speak to their surgeons to ensure their recommendations are taken into consideration.
Another reason for the new way of looking at antibiotic prescriptions is growing antimicrobial resistance. Global health care organizations like the WHO (World Health Organization) are relaying the message that the overuse and misuse of antibiotics makes us susceptible to a whole dearth of diseases that we thought would not come back4. Scientists are saying that if our arsenal of antibiotics doesn’t expand, drug resistance infections might kill more people worldwide than cancer by 20505. All the more reason to consider carefully the necessity of prescribing an antibiotic for that emergency patient with a toothache.
Bacteria are very successful organisms. Microbes have been on the earth the last three billion years while animal life only 800 million years. The microbes in our body collectively weigh only 4 pounds, but with roughly 1000 species, they have more than 3 million genes6. Their seniority on the planet makes them very versatile and their influence is powerful. Only recently they are thought to influence health as powerful as your genes stated Dr. Mazemanian PhD professor of microbiology California Institute of Technology.
Do you want a novel approach to halitosis? Probiotics (naturally occurring in vegetables and healthy fibrous foods) and in capsule (dietary supplement) form support overall oral health. Good bacteria added to the diet in food or capsule form can bring more balance or harmony to the mouth and prevent the proliferation of hydrogen sulfide (linked to halitosis)7. One study from Turkey demonstrated the group eating yogurt with Bifidobacterium had lower amounts of cavity-causing bacteria than the control group7.
There is increasing scientific evidence suggesting that when there is an imbalance of harmful and beneficial organisms, it supports the development of several serious chronic diseases: type 2 diabetes8, cancer9 and Inflammatory bowel disease10.Another reason to maintain balance to your resident microbiome.
Dentists know the value of saliva in its many roles: mastication, immune system (IgA), smooth speech, etc. With regards to mastication and nutrient absorption, did you know that there are only 30 human enzymes but over 6000 enzymes from our bacteria11?
Imbalances in our bacteria mean that enzyme numbers get reduced. Nutrient absorption would be altered and over time, growth and repair of the human body would be negatively impacted. This would be a suitable addition to the discussion with patients who are suffering from dry mouth and report that their chewing has been adversely impacted.
Knowing bacterial enzymes outnumber human enzymes two hundred to one, you could bring some hope or relief to their worry. As long as their gut flora is diverse and healthy, they are still going to be able to digest food. Going on an antibiotic at the same time for another condition, however, might disrupt their normal flora and impact their enzymatic action.
This is not meant to be an exhaustive piece on the subject but just an introduction to a new area of science that is coming to light. Looking at the bigger picture before you prescribe antibiotics and asking more expanded lifestyle questions about eating habits, exercise (known to boost healthy gut flora12) and sleeping patterns. One of the reasons I love being a dentist is that people come to us for their oral health concerns, but by helping patients with their oral care we are able to positively impact their entire health.
References:
Scientific American May 2015, Campbell SC “Exercise is a novel promoter of intestinal health and microbial diversity” Exercise Sports
Science Rev Vol 45, No1 41-417 2017
CDA Canadian Dental Association and AMMI Association of Medical Microbiological and Infectious Disease Canada 2017.
CDA Essentials “Antimicrobial Stewardship in dentistry – no time to waste” Issue 1 2017
Discover Magazine Jan/Feb 2016 “Stamping Out Superbugs”
Bermon S et al. “The microbiota: an exercise immunology perspective.” Exercise Immunology Review 2015 21:70-79
Steinberg B & Calre Fleshman M. Probitics: the Good Bacteria. Institute of Natural Resources © 2015
Cani et al. “Metabolic endotoxemia initiates obesity and insulin resistance” Diabetes 56(7): 1761-1771. 2007
Kostic AD et al. “Genomic analysis identifies association of Fusobacterium with colorectal carcinoma” Genome Res 2012. 22(2): 292-298
Strober W. “Impact of the gut microbiome on mucosal inflammation.” Trends Immunology 2013. 34(9): 423-430
Spector Tim PhD. “Diet Myth” 2015
Clarke SF et al. “Exercise and associated dietary extremes impact gut microbial diversity” Gut 2014; 63(12): 1913-1920.
Dr. Uche Odiatu DMD is an internationally recognized wellness & performance expert. This practicing dentist is also a certified personal trainer, media personality (ABC 20/20 & Canada AM), a professional member of the American College of Sports Medicine & the author of The Miracle of Health. He has lectured at the largest dental conferences in North America: ADA annual convention, AGD annual national convention, Pankey Alumni Weekend, Chicago Mid-Winter Meeting & more.
