What Gum disease has to do with your gut bacteria

Dental hygienists are some of the only preventive specialists who are in the position to discuss patients’ oral health in conjunction with other overarching health issues. In addition to oral and systemic health, gut health is one of the most important topics that they should be broaching with you their patients.

Gut health is defined by the balance of bacteria and combination of many organs that work together to adequately and efficiently perform functions of the gastrointestinal tract, such as eating and digesting food comfortably. An area that was once under researched, new insight into gut health now presents a wealth of information that supports a link between a healthy or unhealthy gut and a person’s oral health.

As hygienists know, periodontal disease is a multifactorial disease that not only develops from bacteria present in the mouth, but also from the immune and inflammatory response of the host.

Current scientific literature shows that the bacteria alone are not solely responsible for the many types of periodontal disease and it is becoming increasingly apparent that it is the host inflammatory response to the subgingival bacteria that is responsible for the tissue damage and, most likely, progression of the disease.

One of the contributing factors to periodontal disease lies in the bacteria in the gut.

What the gut does

The gastrointestinal system is not only responsible for consumption and digestion of food; it also plays a central role in immune system homeostasis, constantly interacting with bacteria, viruses, fungi, protozoa, and helminths, as well as toxic substances and useful flora. More than 70% of our immune response comes from the cells within the gut.

A single drop of fluid from your colon contains over a billion bacteria.

Your gut microbiome reflects everything about you, including your parents’ health, how and where you were born, what you’ve eaten (including whether your first sips were breast milk or formula), where you’ve lived, your occupation, personal hygiene, past infections, exposure to chemicals and toxins, medications, hormone levels, and even your emotions (stress can have a profound effect on the microbiome).

Gut bacteria play an essential role in keeping our bodies healthy. Our gut bacteria have a role to play in the following processes:

  • Converting sugars to short-chain fatty acids (SFCAs) for energy
  • Crowding out pathogens
  • Digesting food and absorbing nutrients such as calcium and iron
  • Keeping pH balanced
  • Maintaining the integrity of the ​gut lining
  • Metabolizing drugs
  • Modulating genes
  • Neutralizing ­cancer-causing compounds
  • Producing digestive enzymes
  • Synthesizing hormones and vitamins
  • Training the immune system to distinguish friend from foe

When trying to determine what factors are contributing to a patient’s disease, the health of the gut microbiome must be evaluated due to its many functions and contributions to the body.

Promoting a healthy gut

Though our culture craves wellness, health protocols usually revolve around fitness and diet and rarely discuss how to increase the health of the billions of microscopic friends in our gut.

When looking to promote a healthy gut there are many things that can have a positive effect, including:

  • Fibre. It creates short-chain fatty acids (SCFAs) and lowers the inflammatory reaction. Prebiotics and probiotics help feed the microbiome. A variety of fresh vegetables and fruit in the diet can help tremendously.
  • Exercise. Weightlifting increases SCFAs for the following 18 hours and reduces inflammatory responses.
  • Intermittent fasting. This has been clinically proven to reduce inflammation.
  • Reducing stress. When stressed, long-term healing is reduced, the mucus layer in your gut thins out, cortisol is elevated, sleep quality and quantity decreases, and gut bacteria decrease in diversity.
  • Getting adequate sleep. Our bodies heal when we sleep. Digestive issues are common in people with regularly disrupted sleep.

Gut health and periodontal disease

We already know about the proven relationship between periodontal disease and

  • diabetes,
  • obesity, and
  • Alzheimer’s and
  • cardiovascular diseases

but the gut is less discussed. However, an unhealthy gut results in many diseases and disorders.

Inflammation is the key player in most disease processes, including periodontal diseases and the diseases of the gut (e.g., Crohn’s, celiac, etc.). When the body is overridden with inflammation, each system functions less effectively.

When bacteria invades the Gingival sulcus, the space between a tooth and surrounding tissue, it travels through the epithelial lining of the pocket and is then circulated through the body. It triggers an immune response, which prompts the production of proinflammatory cytokines in the pocket, which then can also enter into systemic circulation, causing systemic inflammation.

The bacteria in the mouth (whether by traveling from the mouth through the digestive tract or from seeping into systemic circulation), then arrive in the gut where they causes additional inflammation. The dysbiosis of the gut microbiota is one of the first reactions that can happen after periodontal disease. Once these pathogens become predominant, they wreak havoc in the gut microbiome, causing inflammation and organ dysfunction.

Oral pathogens such as P. gingivalis have been proven to show inflammatory changes in adipose tissue and liver, decrease gut barrier function, and significantly alter microbial communities in the gut, showing higher numbers of pathogenic bacteria and less diversity in the microbiome.

By affecting the gut, oral pathogens thus affect all the functions the gut carries out. When the gut is unhealthy, it’s unable to perform these operations efficiently. The immune system is compromised and is unable to defend the body against pathogenic microbes, including those in the mouth.

The oral environment is likewise affected by the dysbiosis of the gut microbiome. The overgrowth of harmful bacteria can cause local and systemic inflammation, contributing to oral health issues. The mouth will often be the first representation of disease, which can be true of poor gut health as well. For example,

  • a swollen tongue can be a sign of vitamin deficiency or immune imbalance.
  • Overgrowth of certain bacteria or fungi can present as lesions or candida infections.
  • Red and inflamed gums that are not plaque-induced can be indicative of poor mineral absorption.

All of these oral dysfunctions point back to gut health.

Though brushing, flossing and proactive oral hygiene are a big part of the picture, they’re not the whole picture, and periodontal diseases happen as a result of many things.

Many periodontal diseases can be easily remedied by increases in diligent home care and enacting strict protocols, but for the disease that is not reduced or eliminated, other factors must be considered.

When determining where a patient’s gum disease stems from, systemic health issues may need to be addressed, and specifically, gut health. This includes how the gut contributes to disease, how the oral pathogens can affect the gut, and how the patient can improve their gut microbiome, and therefore, their oral health.