In our January 17, 2019 post titled Gums Up,  we went over the basics of gum (periodontal) disease. We eyed the signs, the symptoms, and the progression from gingivitis to periodontitis.  It’s not, after all,  an especially pleasant topic. But it’s one all of us must face. As we showed in Gums Up, gum disease can snowball from a minor annoyance to serious medical conditions. Bad breath is one thing. Coronary artery disease and stroke are quite another. In this gum disease update, we’ll look at an interesting new approach to prevention. First, let’s do a quick recap.

GUM DISEASE, AGAIN

Gum disease is very common.  In it’s mildest form, it’s called gingivitis. As a matter of fact, it’s more likely than not you have it.  More than 50% of American adults do. Many people with gingivitis have no idea there’s anything going on with their gums. That is, there are no symptoms. A dental health professional, however, can see the signs of gingivitis in people with no symptoms. Early signs are slight reddening and swelling of the gums. Even if we check ourselves daily in the mirror while brushing or flossing, it’s easy to miss. That’s because these early signs develop slowly. Today looks like yesterday. A professional, however, sees these signs right away.

Absent detection by a hygienist or a dentist, we usually become aware of the problem when discomfort begins. Tenderness comes with easy bleeding. Especially when brushing. People around us start to act like we have bad breath. In truth, at that point, we do. Very bad breath.

Unless we act, things go downhill from there. The infection, up to now on the outer surfaces of the gums,  penetrates below the gumline. This is periodontitis. The gruesome details are described in Gums Up.

THE BILL COMES DUE

One key point we brought forth in Gums Up is that gum disease can have serious health consequences. Research links periodontitis to a slew of awful diseases. Treatment of advanced periodontitis can be very unpleasant. And very costly.   We recommended regular brushing and flossing as the first line of defense. Regular dentist checkups are the second line. “Regular” meaning at intervals prescribed for each individual by the dentist. Some people need them more often than others.

The fact is, there’s no final victory in this struggle against gum disease. The success of a given individual in keeping the upper hand depends on many things. Some are controllable, like diet, oral hygiene, and regular dentist visits. Others, like genes, medical conditions, and medications are less controllable. Or are beyond our control. The bottom line is that no matter how good we are with brushing, flossing, and checkups, gingivitis is always developing. Some people are diligent and lucky and control it very well. Others, however, are diligent but still struggle with it.

WHAT ELSE CAN WE DO?

There’s been growing interest in another tool available for home self-care to thwart gum disease.  Probiotics are consumable live microorganisms. They’ve long been popular as a way to restore healthy balance to the gut flora. Our digestive system depends on the colonies of bacteria that live in our gut. Live-culture yogurts transport “friendly” bacteria to our intestines. Oral probiotics, in contrast, are delivered in lozenges and restore balance to the oral microbiome.

THE ORAL MICROBIOME

To understand the role of oral probiotics in combating gum disease, we need to dive a little more deeply into the oral microbiome. This would be the population of living microorganisms(bacteria, mainly) that take up more-or-less permanent residence in our mouths. Bacteria are alive, to be sure, but are neither plants nor animals. If you’re squeamish, you may want to skip the next sentence. A typical adult human being’s oral microbiome has 600-700 different species of bacteria in-house. That’s quite a garden, or zoo, whichever you prefer to call it.

One reason there’s such a variety of bacterial species is that there are several different kinds of neighborhoods in our mouths. It’s actually a fascinating topic, and there’s reading about it in everyday English. In brief, different strains thrive near the gumline, below the gumline, between teeth, in plaque, in tartar, and so on.

Evidence suggests that the makeup of the oral biome is a very personal thing.  Yours is different from mine. As a matter of fact, mine today is probably different from mine last year. Individuals’ microbiomes change over time.  Among all those hundreds of species of bacteria, there are the good guys and the bad guys. The good guys, in fact, actually protect and support our teeth and gums. The bad guys, on the other hand, cause tooth decay and gum disease. Our oral health, then, depends on the balance between these two forces.

THE IMMUNE SYSTEM, TOO

There’s another invisible force at work in our mouths. The human immune system. This incredibly complex network of sensors, labs, workshops, and transport is always active. In brief, the immune system identifies foreign matter, analyzes it, decides whether it’s good, bad, or uninteresting. It decides how to respond. Responses to hostile invasion include custom-made microscopic “hitmen” sent out to kill the invaders. Inflammation is a more generalized response. The immune system walks a fine line between killing our microscopic enemies and killing us along with them.  A weak immune system yields the advantage to the bad guys. A strong, overly-aggressive one leads to autoimmune disease. Balance is everything.

So – for each of us, there’s a “best” makeup of our oral microbiome, in terms of minimizing tooth decay and gum disease. Factors such as diet, self-care, genetics, age, stress, medications and others affect this balance. We discussed the controllable factors ( mainly, brushing and flossing) in Gums Up We’ll now consider a more direct approach.

ORAL PROBIOTICS?

What if we increase the team of “friendly” bacteria in the mouth in the most direct way? By just putting them there. That’s the concept behind oral probiotics for fighting gum disease.  Researchers have identified two strains of bacteria that seem especially promising. Their names are jawbreakers, though.

 Streptococcus salivarius M18 :

• Competes with harmful bacteria for nutrients
• Directly kills harmful bacteria
• Breaks down dental plaque
• Promotes a neutral aciditity in the mouth
• Inhibits inflammation

Lactobaccillus plantarum L-137, in contrast, stimulates and enhances the activity of the human immune system on the oral front.

Research has shown that these two probiotics, applied by sucking a lozenge, are effective and safe for prevention of gum disease. Perhaps even for treatment.  There’s growing acceptance of these findings in the dental and medical communities.  Lozenges containing one or both are widely available. As always, and properly so, there are responsible doctors and dentists who remain skeptical. With the data we currently have available, it would in truth be premature to hail oral probiotics as the “silver bullet” for gum disease.

GUM DISEASE UPDATE

While scientists work to better understand how oral probiotics work, and perhaps don’t work, your Orlando dental office is your best resource. Our dentists keep up to date with the research. And, of course, bring years of experience to the table. If you’d like to learn more about the potential benefits of oral probiotics for you, we’d be happy to discuss it with you.