Your mouth is home to billions of microbes that live on your teeth, gums, tongue, cheeks, and everywhere in your mouth. Normally, these microbes live in symbiosis with you, helping to train your immune system, digest food, and maintain your health. This community is in a constant state of flux, being bombarded by the changes in the environment, food, drinks, and anything that enters the mouth throughout the day.
The microbes that dwell in your mouth provide health benefits ranging from producing compounds that maintain your health to training your immune system. A normal and healthy oral microbiome is in symbiosis with you, its host. The commensal microbiota are the microorganisms that help with health and balance. Even potentially harmful bacteria are important for your health. At low levels, these bacteria train your immune system and occupy niches to prevent outgrowth of more harmful pathogenic bacteria.
However, the balance between harmful and helpful is narrow, and the oral microbiome can easily shift into a state of imbalance, also known as oral dysbiosis. If the oral microbiome is a garden, it needs constant maintenance to keep the ecosystem healthy. Daily routines are required to remove fallen leaves and pull weeds when too many grow. Some plants require fertilizer and additional nutrients to thrive. The health of some plants may be improved in the presence of others, like a fruit tree guild. A garden left unmaintained allows invasive weeds and plants to take over, eventually killing the ecosystem.
So how can you keep your mouth microbiome healthy? The first step is through diet. The oral microbiome is significantly impacted by the food you eat.
General recommendations for diet and the microbiome
These are general recommendations to improve your oral microbiome. However, everybody’s microbiome is unique, so changes specific to your microbiome will depend on knowing the status of your oral microbiome, and the microbes that live in it.
- Reduce your sugar intake. Yes, I know. It’s a very obvious change that has been touted for years now, but I feel it’s important enough to be said again. Sugar has a powerful effect on the oral microbiome because it serves as an immediate food source for the microbes in your mouth. Bacteria and fungi can rapidly grow from simple sugars, and create byproducts like acid that erode your teeth or volatile sulfur that causes bad breath and damages tissues. In contrast to simple sugars, complex carbohydrates are not easily fermentable by those bacteria, reducing the sudden buildup of damaging byproducts. In fact, sugar intake is associated with oral imbalance and shifts in bacterial community toward acid-resistant and acid-producing species that cause cavities. However, sugar isn’t the only cause of oral disease.
- Increase hydration. Water is an incredible tool in helping to keep your oral microbiome healthy. Water is essential for optimal saliva flow, and saliva keeps your oral microbiome stable. Proteins in saliva, like lysozymes and antibodies, help reduce the overall level of bacteria in your mouth, and reduce their ability to adhere to surfaces in your mouth. Additionally, saliva contains minerals that are critical to helping to prevent cavities.
- Take a microbiome test. It’s impossible to improve if you don’t know what to improve! We advocate for data-driven decisions, and that means having the data to make an informed choice about what changes to make. Taking an oral microbiome test is the best place to get the data you need to get started.
For people with high levels of bacteria that cause gum inflammation
- Add more nitrate to your diet. Several studies have now shown the importance of nitrate to the oral microbiome. For example, a lack of nitrate-reducing bacteria is associated with hypertension, and high levels of anaerobic periodontal pathogens are also associated with hypertension (1, 2, 3, 4, 5). Nitrate can serve as a prebiotic, and increase levels of nitrate-reducing species in the mouth. Beet root juice supplementation improves the oral microbiome by reducing anaerobic pathogens and increasing aerobic nitrate reducers. This change was also associated with improvements in cognitive health and a reduction in blood pressure. Similarly, lettuce juice supplementation lead to improvements in gingivitis inflammation, potentially through a similar mechanism.
- Reduce sulfur-containing foods. Sulfur is a key component to bad breath, as it can be metabolized and become a volatile sulfur gas like hydrogen sulfide, which causes bad breath. At low concentrations, hydrogen sulfide can improve health. However, for people with high levels of bacteria that cause gum inflammation, hydrogen sulfide can reach concentrations high enough to cause cellular damage, and worsen gum disease. People with high levels of gum inflammation bacteria should reduce intake of foods high in sulfur such as: beef, fish, and eggs.
- Add omega-3 fatty acids. Omega-3 fatty acids can reduce inflammation and improve gum health. They may even have antibacterial activity against specific pathogens that can cause gum inflammation. Oral health optimized diets often include omega-3 fatty acids for their effect in improving gum health.
For people with high levels of tooth decay bacteria
- Add arginine to your diet. Arginine is an amino acid that is metabolized by beneficial bacteria in your mouth into ammonia. Ammonia is an alkali compound that can neutralize acid produced by cavities-causing bacteria. Arginine has a profound effect on the ecology of the oral microbiome by reducing the levels of acid-tolerant species (such as Streptococcus mutans and sobrinus) and increasing species that utilize arginine to help remineralize teeth (such as Streptococcus sanguinis and parasanguinis). Foods high in arginine are poultry, nuts, and whole grains.
- Reduce sticky and starchy foods. These sticky foods can linger on the surface of teeth. Enzymes in your saliva and from your oral microbiome slowly breakdown the carbohydrates in these sticky foods and turn them into sugar. If sugar remains on the surface of your teeth, cavities-causing bacteria will thrive, eat the sugar, and create acid as a byproduct. The acid will erode your enamel and cause cavities, especially if you have a high abundance of these species in your mouth.
- Eat cheese. Cheese has been shown to reduce the risk of cavities, through removing sugar on the surface of teeth, and promoting remineralization of enamel. Cheese is high in calcium and phosphorous, two elements that help build enamel.
- Chew xylitol gum. Xylitol is a sugar-free sweetener that cannot be metabolized by bacteria into acid. Importantly, xylitol is actually absorbed by S. mutans and converted into a molecule that can inhibit S. mutans growth, and inhibit fermentation pathways. One additional important benefit to chewing gum is it stimulates saliva production!
For people with high levels of bad breath causing bacteria
Bad breath can come from a number of sources such as:
- pathogenic bacteria at your gums
- smelly bacteria on your tongue
- fungal causes
- enteric bacteria outgrowth
The first step in fighting bad breath is knowing where the source comes from. A Bristle microbiome test can pinpoint the cause of your bad breath, and we will tailor a care plan based on your specific microbiome. However, these general recommendations can be useful at reducing bad breath:
- Add more nitrate to your diet. Please see the rationale above.
- Reduce sulfur containing foods. Please see rationale above.
- Chew xylitol gum. Please see rationale above. Xylitol has additionally been found to inhibit the growth of some enteric bacteria such as Klebsiella, which can cause bad breath.
- Eat yogurt and fermented foods. Fermented food has been shown to have a beneficial impact on gut health, but did you know it can also affect your oral microbiome? Lactobacillus species in yogurt produce bacteriocins, which are antimicrobials that can have specific activity against other species, such as anaerobic bacteria. Anaerobes are known to cause bad breath due to their ability to create volatile sulfur and putrid smelling organic compounds. Alternatively, you can also introduce bacteriocins through oral and dental probiotics.
