Health Connections to Sink Your Teeth Into

Why is it more important than ever to take care of the health of our teeth, gums, and mouth? Because modern research has found a direct correlation between oral health and whole-body health and markers of disease. For example, certain oral bacteria correlate with bacteria found in atherosclerotic plaque.^{1 2} In one recent study, researchers used rRNA sequencing to survey the bacterial diversity of atherosclerotic plaque, oral, and gut samples from 15 patients with atherosclerosis. The researchers found that the abundance of certain strains of bacteria in atherosclerotic plaques directly correlated with their abundance in the oral cavity. They also identified several strains of bacteria that were common in the atherosclerotic plaque as well as in the oral and gut samples. They summarized, “Bacteria from the oral cavity, and perhaps even gut, may correlate with disease markers of atherosclerosis.”³

Another study examined the association between oral health problems and all-cause mortality, cardiovascular disease (CVD), and respiratory mortality in individuals 71-92 years old. Data from two studies, The UK’s British Regional Health Study (BRHS) and the U.S.’ Health, Aging, and Body Composition Study (HABC), both showed an association between poor oral health and mortality. In the BRHS study, tooth loss was associated with all-cause mortality, while in the HABC study, tooth loss, dry mouth, and having more than three oral problems was associated with all-cause mortality and high respiratory mortality. In addition, periodontal disease was associated with increased CVD mortality. Results from these studies “highlight the importance of improving oral health to lengthen survival in older age.”⁴ A 2020 study found that those with moderate to severe periodontitis are two to four times more likely to have a heart attack, demonstrating a relationship between the levels of periodontitis severity and cardiovascular conditions.⁵

There is also a correlation between periodontal disease and hypertension—a concept called dental hypertension. Nitric oxide (NO) is a small molecule that’s involved in maintaining metabolic and cardiovascular health, including the regulation of blood pressure, but without a healthy balance of bacteria in the mouth, our bodies are not able to effectively make NO. It’s believed that a decrease in the quantity of oral nitrate-reducing bacteria and an increase in the quantity of pathogenic bacteria are responsible for a link between periodontitis and CVD.

Notably, research has indicated that daily use of antibacterial mouthwashes, essential oils, and routine tongue brushing can negatively affect oral concentrations of nitric oxide-reducing bacteria, while probiotics may be the answer to restoring good oral flora. One review concluded, “Restoring the oral flora and NO activity by probiotics may be considered a potential therapeutic strategy to treat HT [hypertension].”⁶

Periodontal Disease & Cranberry’s Counteroffensive

Periodontal disease is the result of an overgrowth of bacteria in the mouth that can lead to inflammation, bleeding and swollen gums, bone loss, and tooth loss. The process starts when the bacteria form a film on the teeth—plaque—that, left unchecked, eventually moves under the gum line and hardens into tartar. Both plaque and tartar are loaded with bacteria that increase inflammation and drive the development of periodontal disease. Furthermore, this bacteria and inflammation can become systemic, affecting whole body health (as seen in the studies previously mentioned). According to the Centers for Disease Control and Prevention, 47 percent of US adults older than 30 have some form of periodontal disease.⁷ This includes a common, mild form of gum disease called gingivitis. 

But exciting research has shown that regularly drinking cranberry juice can improve periodontal disease due to its anti-adhesive, immunomodulatory, and antioxidant properties. An eight-week, randomized controlled study examined the daily consumption of 750 ml (three cups) of cranberry juice on individuals with gingivitis, and found that markers of gingivitis (like inflammation) and measurements of plaque were significantly lower in the cranberry group compared to the control group. The cranberry group also saw a reduction in the number of cavity-causing Streptococcus mutans.⁸ Several in vitro studies show that the compounds in cranberry juice can inhibit biofilm formation and cavity-forming oral bacteria that live in biofilm, such as S. mutans.^{9 10 11}

Be Proactive with Probiotics

Two meta-analyses and one review determined that probiotics could be beneficial for oral health due to their ability to decrease numbers of oral pathogens.¹² Furthermore, regular consumption of probiotics has been shown to significantly reduce the risk of cavities by inhibiting bacteria that lead to tooth decay and promoting beneficial microbes in the oral cavity.¹³ These strains stand out for oral health: Streptococcus salivarius K12 suppresses oral pathogens that cause infection and autoimmune disorders, provides immune support to help reduce symptoms of respiratory viral infections, and maintains ear, nose, and throat health. Limosilactobacillus reuteri reduces pro-inflammatory immune responses and can improve symptoms of gingivitis and gum bleeding.¹⁴

The Best Defense is a Good Offense with Vitamin D

This fat-soluble vitamin helps your body absorb and retain calcium for bone and tooth mineralization, and low vitamin D levels are associated with oral health disorders that can weaken your teeth, making you highly susceptible to cavities, fractures, and decay.¹⁵ A 2020 study of 4,244 participants aged 20–80 showed that the likelihood of dental cavities was significantly higher in those with a severe deficiency, mild deficiency, and even an insufficiency of vitamin D.¹⁶ A 2020 review found that low vitamin D status can lead to gingivitis and an increased risk of periodontal disease, as it interacts with the immune system and modulates inflammation on the tissue surrounding teeth. The review summarized that supplementation with vitamin D to correct vitamin D deficiency, “may contribute to a successful treatment of periodontitis.”¹⁷

References

1. Koren O, Spor A, Felin J, Fåk F, Stombaugh J, Tremaroli V, Behre CJ, Knight R, Fagerberg B, Ley RE, et al. Human oral, gut, and plaque microbiota in patients with atherosclerosis. Proc Natl Acad Sci. 2011;108(Supplement 1):4592–4598. 
2. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135–1143. 
3. Gao, Lu, et al. “Oral Microbiomes: More and More Importance in Oral Cavity and Whole Body.” Protein & Cell, U.S. National Library of Medicine, May 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5960472/#CR62.
4. Kotronia, Eftychia, et al. “Oral Health and All-Cause, Cardiovascular Disease, and Respiratory Mortality in Older People in the UK and USA.” Scientific Reports, U.S. National Library of Medicine, 12 Aug. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8361186/.
5. Gomes-Filho IS;Coelho JMF;Miranda SS;Cruz SS;Trindade SC;Cerqueira EMM;Passos-Soares JS;Costa MDCN;Vianna MIP;Figueiredo ACMG;Hintz AM;Coelho AF;Passos LCS;Barreto ML;Scannapieco F; “Severe and Moderate Periodontitis Are Associated with Acute Myocardial Infarction.” Journal of Periodontology, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32219849/. Accessed 27 Aug. 2023.
6. Pignatelli P, Fabietti G, Ricci A, Piattelli A, Curia MC. How Periodontal Disease and Presence of Nitric Oxide Reducing Oral Bacteria Can Affect Blood Pressure. Int J Mol Sci. 2020 Oct 13;21(20):7538. doi: 10.3390/ijms21207538. 
7. https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html
8. Woźniewicz M, Nowaczyk PM, Kurhańska-Flisykowska A, Wyganowska-Świątkowska M, Lasik-Kurdyś M, Walkowiak J, Bajerska J. Consumption of cranberry functional beverage reduces gingival index and plaque index in patients with gingivitis. Nutr Res. 2018 Oct;58:36-45. doi: 10.1016/j.nutres.2018.06.011.
9. Razak FA, Rahim ZHA (2013) Oral microbes and its environment: A review article. Esteem Academic Journal 9: 67-75.
10. Kriebel K, Hieke C, Hilke B M, Nakata M, Kreikemeyer B (2018) Oral biofilms from symbiotic to pathogenic interactions and associated disease-connection of periodontitis and rheumatic arthritis by peptidyl arginine deiminase. Front. Microbiol 9: 53.
11. Jiao Y, Tay FR, Niu L, Chen J (2019) Advancing antimicrobial strategies for managing oral biofilm infections. IJOS 11: 28.
12. Seminario-Amez M;López-López J;Estrugo-Devesa A;Ayuso-Montero R;Jané-Salas E; “Probiotics and Oral Health: A Systematic Review.” Medicina Oral, Patologia Oral y Cirugia Bucal, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/28390121/. Accessed 27 Aug. 2023.
13. C;, Sivamaruthi BS;Kesika P;Chaiyasut. “A Review of the Role of Probiotic Supplementation in Dental Caries.” Probiotics and Antimicrobial Proteins, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32307660/. Accessed 27 Aug. 2023.
14. Linda. “The Top 5 Probiotic Bacteria for Good Oral Health.” Complete Dental Works, 16 June 2022, completedentalworks.com.au/the-top-5-probiotic-bacteria-for-good-oral-health/.
15. “How Vitamin D Effects Your Oral Health: Colgate®.” How Vitamin D Effects Your Oral Health | Colgate®, www.colgate.com/en-us/oral-health/threats-to-dental-health/vitamin-d-an…. Accessed 27 Aug. 2023.
16. J;, Zhou F;Zhou Y;Shi. “The Association between Serum 25-Hydroxyvitamin D Levels and Dental Caries in US Adults.” Oral Diseases, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32304260/. Accessed 27 Aug. 2023.
17. Botelho J;Machado V;Proença L;Delgado AS;Mendes JJ; “Vitamin D Deficiency and Oral Health: A Comprehensive Review.” Nutrients, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32438644/. Accessed 27 Aug. 2023.