TIME TO REPLACE
TODAY’S ORAL CARE
Invented by soap makers more than one hundred years ago, toothpaste as we know it is flavored detergent used in the mouth to scrub the surfaces clean of bacteria. With the addition of anti- microbial agents, toothpaste wipes out the oral microbiome by sterilizing your mouth. The common approach to managing the oral microbiome today is to strip it down to the pellicle with detergents in combination with antimicrobial agents to slow or prevent recolonization.
The alcohol in mouthwash disturbs, denatures, and dehy- drates your oral ecosystem. Both toothpaste and mouthwash clear the way for pathogens to proliferate, because they kill off the microbes that exist to keep opportunistic invaders in check. Oral hygiene today turns on a pathogenic switch. Everyday oral care is more than ineffective; it is harmful. Despite the use of antimicrobial oral products, the number of adults with gum disease has not changed forty years later. Though tooth decay is down, gum disease has stayed at just about the same level. You would expect a better outcome if the scorched earth policy actu- ally worked.
Even more alarming, I believe there is an historical connection between sterilizing the mouth, which came into practice in the 1970s, and the catastrophic rise we have witnessed in diseases such as obesity, diabetes, cardiovascular disease, and metabolic syn- drome. Of course, many factors are responsible for the epidemic proportions these illnesses have reached, but rendering the oral microbiome ineffective in its protective role and creating a cli- mate in the mouth in which pathogens thrive certainly contribute to the health crisis today. You have read about the effects of the mouthbody connection. The epidemic rise of many diseases today parallels the use of antimicrobials in oral care.
Since the antimicrobial concept of oral care took hold, many studies have found that sterilizing the mouth has improved oral health, but no one was aware of the importance of the oral micro- biome in overall health when these studies were done. New research is examining what we may be sacrificing by wiping out the microbial communities in the mouth. Overzealous oral hygiene is being recognized as a cause of disease.
An aspect of cardiovascular disease, the No. 1 killer in the United States for men and women, illustrates this dynamic. The oral microbiome has a role in nitrate metabolism, which affects cardiovascular health.
About a quarter of the nitrate you consume in food is returned to your mouth in saliva. Facultative anaer- obes in the tongue biofilm reduce nitrate to nitrite, which is then swallowed. Some of the nitrite is converted in the stomach to nitrous oxide. Essential for vascular health, nitrous oxide helps to keep blood vessels pliant and supple, which prevents high blood pressure. The central role of oral bacteria in this process has been confirmed. Studies have found that the increase in nitrite in the bloodstream after eating foods that contain nitrate is markedly reduced when antimicrobial mouth rinse is
used. This natural mechanism for maintaining cardiovascular health appears to stop working efficiently when the oral microbi- ome is thrown off-balance by antimicrobial mouth rinse.