Maria Papavergos paints the preventative picture and explains why and how we can all nurture our oral microbiome.
The education is in nutrition. With dental diseases being the most prevalent non-communicable diseases globally, it is alarming that dental caries is wholly preventable.
As routine dental care grinds to a halt, there has never been a more important time to anchor the message of diet and nutrition within the general population. We are in an oral health crisis, so as people are being told to stay at home, it is time to empower them with knowledge.
Master your microbiome
Let us consider the mouth as a microbiome. The oral microbiome is a gateway to the gut – a microbiome that has sparked much public interest, that people expressly want to nurture. Our oral environment is an extension of this.
In oral health, a symbiosis with the host is in play. Frequent fermentable carbohydrate (sucrose) intake or reduced saliva flow (buffering potential) leads to a drop in pH of the biofilm. This drives acid-producing and acid-tolerating bacterial selection (for example streptococcus mutans) and inhibits the growth of beneficial species. Dysbiosis ensues. It is this dysbiosis that increases cariogenic potential and can cause pathology. We want to promote symbiosis.
The role of nutrition does not stop with dental caries. Periodontitis can be modulated through diet in those genetically predisposed patients. Since we now know of several perio-systemic links, it is of no surprise that nutrition extends to a vital role of down regulation in many chronic inflammatory conditions.
Antioxidants, present in fresh fruits and vegetables, along with omega-3 fatty acids, abundant in oily fish, show evidence-based improvement on our baseline inflammatory status. Particularly foods rich in alpha-lipoid acid, such as spinach, broccoli and brussels sprouts, show a positive affect on modulating the immune response in hyper-inflammatory cases, as with periodontitis.
By encouraging healthy macro nutrition, we can empower patients to improve their periodontal disease progression. Similarly, foods rich in refined carbohydrates are a major cause of chronic inflammation. Diets high in processed food and rich in glucose and lipids induce oxidative stress – thus enhancing inflammatory cascades, having a direct negative impact on periodontal status. Which brings me back to caries.
How do we prevent this preventable, prevalent disease? How do we nurture our oral microbiome? This is a multifactorial, complex question, but with the nation’s increased interest in holistic wellbeing from the confines of our homes, let us look at a few simple ways we can all benefit our oral health by adjusting some lifestyle choices.
Knowledge is power
First, know your sugars. Indulge in intrinsic sugars and exercise restraint on extrinsic sugars. Intrinsic sugars are present in natural, whole food sources, contained within a fibrous matrix of cells. Extrinsic sugars are free sugars, released from their protected form through processing, whether that be juicing, blending, drying or freezing.
Extrinsic sugars are the ones that are potentially damaging to our teeth, that form the fermentable substrate for our damaging oral bacteria. Identifying these hidden sugars found in fruit juices, dried fruit and fruit smoothies as well as table sauces like ketchup and pickles is key for our patients. Our role is to empower our patients with the knowledge to navigate through mixed marketing messages. Check labels on packaged foods and remember the word ‘fruit’ is not always synonymous with health.
Secondly, being mindful. We can all indulge in some extrinsic sugar food sources from time to time; in fact, it is good for our wellbeing to indulge! However, it is the long-term frequency of intake over the course of a day that causes the swing from symbiosis to dysbiosis to occur. So the key is to get smart with snacks. Swap your raisins for fresh fruit or opt for savoury snacks like vegetable sticks with hummus or peanut butter oatcakes. These small changes to lifestyle choices can have a huge impact on protecting the oral microbiome.
Thirdly, for those who do have a sweet tooth, try to maintain oral symbiosis by boosting your buffering potential. By brushing our teeth with a fluoride toothpaste, rinsing with a fluoride mouthwash or chewing some sugar-free xylitol chewing gum after eating, we are offering an opportunity to remove these fermentable substrates and fermentation products in our oral microbiome, supporting beneficial bacterial growth and restoring symbiosis. By adopting some additional oral health promoting practices, we can help to mitigate against the damaging effects of dental caries.
As our population self-isolates, we are seeing people and communities coming together like never before. Reaching out to our communities; communities of patients, communities of friends, communities of neighbours and offering support, help and advice where possible.
While we may not be able to offer treatment through direct contact with our patients, we have an opportunity to extend our duty of care through social media and online communication. Whether it be compiling a ‘stay home’ prevention poster or delivering a personal podcast message, by sharing our top tips for staying healthy at home and preventing dental disease, we have the means to make a difference.
The nation’s appetite for protecting their own health has never been higher. Let us come together as a profession. In what we are unable to deliver in patient care, let us shout out for oral health education and prevention in the population. Nutrition seems like a good place to start.