Rebuilding the Oral Microbiome

For the week of National Dentist Day, enjoy this guest blog post from Holly Moons, CRDH

Our mouth is more than a beautiful smile or the beginning of the GI tract. It’s the host for a bustling and diverse microbiome capable of shifting the body towards disease or health. Within the mouth, the battle continues as bacteria stake their claim on territory and fight for resources.

Specific oral bacteria can lead to cavities, bad breath, and periodontal disease.1 Even more concerning, oral pathogens like Porphyromonas gingivalis are implicated in diabetes, heart disease, dementia, and more.2

If allowed to flourish, these pathogens can overwhelm the natural flora and wreak havoc within the body’s systems. As the gap between medicine and dentistry closes, increasing numbers of dental health providers are working on ways to lessen those risk factors. Unfortunately, the non-selective eradication of all oral bacteria cascades into a version of dysbiosis diminishing the production of Nitric Oxide (NO).

NO is a signaling molecule responsible for an exhaustive list of benefits not limited to neuronal, immune, and vascular functioning. As we age or become burdened with disease, we lose the ability to produce this invaluable molecule. Fortunately, our bodies have evolved with a backup system called the Nitrate-Nitrite-Nitric Oxide pathway. Nitrate-reducing bacteria on the surface of the tongue provide an indispensable contribution to this alternate source of NO.1

Nitrates from the food we eat are processed in the GI system. What’s not excreted gets recycled back into circulation and accumulates in the salivary glands. In the mouth, the nitrates are used as a fuel source for nitrate-reducing bacteria and are converted into nitrites. The nitrites are the final component of the end product: NO.

Several ideas to encourage a healthy mouth include staying hydrated so our salivary system can cycle nitrates. Using tongue scrapers to expose the nitrate-reducing communities from under plaque debris and avoiding daily uses of harsh dental chemicals are also recommended. Re-population of healthy bacteria is also possible.

What’s not as well known is that nitrate-reducing species belong to stages of health. Growing a commensal community like Neisseria and Rothia is possible with the application of nitrates. They are significant for two reasons: aiding NO production and competing with oral pathogens.

Combating pathogens with current antibacterial treatments inherently includes risks for resistance and the potential to be toxic to human cells.4 Remarkably, studies show that applying nitrates can also reduce species linked with oral disease. Some of these include Streptococcus and Lactobacillus which are associated with cavities. Further, data supports that nitrate metabolism increases alkalinity and lowers lactate formation, which can also limit cavities.1 Tougher species associated with bad breath and periodontal disease such as Porphyromonas, Fusobacterium, and Prevotella succumb to the pressures of nitrate.1

Certainly eating a bowl of arugula or drinking lettuce juice can be options to introduce nitrates to the oral microbiome, but they might not sound very appealing. We lead busy lives so taking a trustworthy form of nitrate in a standardized dose may be an easier option.

Author Bio:
Holly Moons, CRDH has been a clinical hygienist in the field of periodontics since 2000. Dentistry has been one of her greatest joys as is furthering her education in oral systemics, microbiology, and airway. Discovering Nitric Oxide as a way to biohack health has become a new passion. She’s served several roles on her local board including president and was a Florida delegate. Her motto is “when in doubt, check it out.” Connect with her at [email protected].
1. Rosier BT, Buetas E, Moya-Gonzalvez EM, Artacho A, Mira A. Nitrate as a potential prebiotic for the oral microbiome. Sci Rep. 2020;10(1):12895. Published 2020 Jul 30. doi:10.1038/s41598-020-69931-x

2. Mei F, Xie M, Huang X, et al. Porphyromonas gingivalis and Its Systemic Impact: Current Status. Pathogens. 2020;9(11):944. Published 2020 Nov 13. doi:10.3390/pathogens9110944

3. Koch CD, Gladwin MT, Freeman BA, Lundberg JO, Weitzberg E, Morris A. Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health. Free Radic Biol Med. 2017;105:48-67. doi:10.1016/j.freeradbiomed.2016.12.015

4. Backlund CJ, Sergesketter AR, Offenbacher S, Schoenfisch MH. Antibacterial efficacy of exogenous nitric oxide on periodontal pathogens. J Dent Res. 2014;93(11):1089-1094. doi:10.1177/0022034514529974