May 28, 2019
by Uche Odiatu, DMD; Mahsa Bakhshandeh, RDH
Want to add some variety to your chairside conversations? Would you like to share cutting edge scientific findings with your patients? Would you like to be seen as a person of influence with a broad knowledge of nutrition and healthy living strategies? “Some patients still see us hygienists as teeth cleaners and aren’t aware of the scope of our education, which includes an intense nutrition component,” says Mahsa.
Caution: this article contains foundational strategies to support oral health and total patient health.
“All disease begins in the gut” – Hippocrates 300BC
How did the first physician who the Hippocratic Oath is named after have such insight into what has only been recently scientifically uncovered? He didn’t have a microscope or access to the National Institute of Health’s groundbreaking initial Human Microbiome Project findings but he proclaimed, “Let food be your medicine and medicine be your food”.
Key Gut Players
Mind your guts. Not the outer abdominals but the gut flora on the inside of your belly. You see we live in harmony with over 100 trillion single celled bacteria. Eighty per cent of them live in your digestive tract1 and a recent groundbreaking article in Scientific American reported their influence on our health is shaking the very foundation of medicine and nutrition.2 The bacteria in your gut play an important role in immune system modulation. Three quarters of the cellular constituents of your whole immune system are located in this area.3 If you want to build the strongest foundation for your immune system, you need to do these things to keep your gut flora in good shape: a) eat 25 to 30 grams of fiber each day (the average North American consumes half that amount). Justin Sonnenburg, PhD and Assistant Professor in the Department of Microbiology and Immunology at the Stanford University School of Medicine reports that fiber is the gut bacteria’s number one choice of nutrition on which all other interactions depend.
“The human microbiome is only recently thought to influence health as powerful as your genes.” – SK Mazemanian, PhD, Professor of Microbiology, California Institute of Technology
What is the number one influence on the human microbiome? “The food we eat dictates what bacteria grow in our body. And our human microbiome is predominantly (99 per cent) made up beneficial bacteria,”4 says gastroenterologist Robynne Chutkann.
What does this have to do with dental patients? Why should we talk food and gut health in its relationship to oral health and overall health? Because the gut flora, our microbiome or our gut garden, play a major role in our immune system health, nutrient absorption, energy levels, and our emotional well-being.
“Our gut microbiome guides our immune system, metabolism & even our mood and behaviour.” – J. Sonnenburg, PhD, Microbiologist Stanford University School of Medicine5
Now you know why food is so important. Our single celled passengers have an intimate relationship with them. Their very survival depends on a regular supply of healthy food. And which health care industry professionals are in charge of the eating apparatus? Is it the chiropodist? Is it the optometrist? The cardiologist? The physiotherapist? No. It is the dental professional – the dental hygienist, the dentist and the dental assistant. We are the care givers of the teeth, the jaw, the muscles of mastication. If people want to be able to break down food, digest it, and absorb it (6000 of our enzymes have bacterial origin)6, they need optimal masticatory function. Eating, digesting and absorption of nutrients is one of the most intimate things we do with our environment.
Questions from patients are a good opportunity to share our total health knowledge about the body-mouth connection. Our answers can go beyond the usual: apples and cheese are healthy snacks and be sure to avoid juice and pop.
What else can I do between hygiene visits to keep my gums healthy?
In the days following a dental hygiene appointment – especially if it is a patient that has not been in for regular hygiene, their soft tissues may feel tender for 24 hours or more after the appointment. For adequate healing, their immune systems need to be in optimal health. We sometimes receive calls from patients asking, “Why were my gums tender after the last cleaning?” We can respond by saying that the healing depends on the ability of your immune system to do its job in the healing and repair process. An impeccable diet provides you with the building blocks for healing. Did you know that only five per cent of the population eats the recommended 25g of fiber daily?7 Our gut flora needs a regular intake of fiber – this is a keystone foundational relationship. This is where our gut bacteria produces short chain fatty acids. Bob Hutkins, PhD, and Food Scientist at the University of Nebraska, claims these are some of the body’s most powerful anti-inflammatory agents. Ian Chapple stated most of the destruction of periodontal structures were from the host and dental professionals need to include host factors when they are creating their treatment plans.8 Ninety-seven per cent of the population does not eat the recommended amount of fiber. Without this keystone, there will be a poor supply of SCFA’s and nutrients for the gut flora. And the body cannot put out the fires of inflammation burning in the bodies of our patients. Rollercoaster elevations in blood sugar from poor eating habits promote post-meal dysmetabolism, which support inflammation and disease.9 Scientists now report that chronic inflammation is a major player in most modern degenerative diseases.
Isn’t a once-a-year hygiene visit enough?
Sixty per cent of the population reports not getting sufficient sleep to feel rested each night. This raises the red flag that “poor sleepers are poor healers”.10 Seventy per cent of the adult population don’t eat a single piece of fruit each day.7 Red flag: less phytonutrients, fiber and antioxidants to help douse the flames of inflammation. Only five per cent of the population exercises regularly.11 Red flag waving: 95 per cent of patients don’t enjoy the anti-inflammatory benefits of exercise. Anyone who doesn’t have healthy lifestyle habits need to think about increasing their hygiene frequency to lower their inflammatory burden.
I am at a loss. My gums seem to bleed and be tender no matter what I do?
Dental hygienists scale, root plane, debride, floss. All these procedures need our patients to have a high-functioning immune system to recover and heal after our treatments. Seventy per cent of our immune system is located in our GI tract. Our gut flora influences our immune cells. They do this through the TREG cells. This communication can only work well if the gut bacteria are stable and diverse in variety. This communication is facilitated if they haven’t been recently decimated by a recent course of antibiotics. Antibiotics have shown to disrupt a third of a person’s good bacteria and it can take up to a year to bounce back.12
My mouth has become drier over the last year. Should I be worried?
Epidemiologist Tim Spector, PhD, who studied 15,000 twins over ten years, said there are many reasons for the human body deteriorating. A number of aging theories exist. He listed the loss of muscle, changing social circumstances but also affirmed the loss of dental integrity and lower amounts of saliva.6 This epidemiologist reported that all other factors accounted for, nutrition and diet stood out as the major factor in influencing the microbiome and its impact on senior’s health. How many times have you heard from patients as they sit down slowly in the chair, “Getting old is not for sissies” or “The golden years aren’t so golden.” By focusing on the importance of maintaining all their teeth and acknowledging the side effects of medicines that cause dry mouth, we can be their health champion. We can encourage them to preserve arch integrity and replace missing teeth, stay hydrated and help them choose OTC products to keep their mouths moist.
1. Eat free range hormone free meat
Eating hormone free, free range, antibiotic free meat used to be a very expensive food choice. Gastroenterologist Emaran Mayer, MD, reports that it is rather now seen as a good investment in our overall health, and in particular, our gut health. Antibiotics are fed to animals, as animal growth enhancers have the ability to disrupt our delicate gut flora.
2. Exercise Regularly
Regular exercise makes your gut bacteria more diverse in their make-up. This adds to the stability and potency, and most of all, keeps pathogens in balance.13
3. Manage Stress
Unmanaged stress also decreases diversity in your gut flora, and therefore, hampers fabrication of the cellular constituents of your immune system. Poorly managed stress or life events that not only rock us emotionally, can thin the mucus lining of our patients stomachs and bring pathogenic bacteria in closer proximity to the general circulation.14
4. Limit Sanitizing and Being Hyper-Clean at Home
Limit your use of hand sanitizers outside the operatory. Robynne Chutkan, MD, author of The Microbiome Solution, wrote that part of developing a balanced gut flora means having them less disrupted by our patient’s extreme sanitization practices at home.
5. Eat More Fruits and Vegetables
There is irrefutable scientific evidence that food and its macro and micronutrients can ramp up or dial down inflammation in the body. Vegetables and fruits are loaded with phytonutrients, antioxidants, polyphenols and most of all fiber, which our gut flora need to make SCFA’s – one of the body’s most important anti-inflammatory agents. Health Canada’s brand-new Food Guide makes it perfectly clear – half the plate ought to be fruit and vegetables to enjoy optimal health.16
6. Get A Good Sleep
When you’re awake, your body’s repair/recover/rebuild system is running on standby mode. It is only while you’re sleeping that your body launches its powerful offense, where close to 95 per cent of resources are poured into regeneration mode. Without adequate sleep, opportunistic gut bacteria can get the upper hand and cause disruption.15 We encourage patients to reevaluate their sleep habits to ensure they are getting adequate quality and quantity for optimal GI function.
7. Take A Good Probiotic
Probiotics are good bacteria and can be found in cheese, yogurt, kefir, sauerkraut, miso soup and assorted vegetables. If consumed regularly they will support optimal gut health and the fortification of an empowered immune system. How about probiotic supplements? Great question. Everyone seems to be interested in this popular supplement. There’s sound scientific evidence for the value of probiotics helping prevent antibiotic associated diarrhea. It is a developing science and many different companies are vying for top of mind in the consumer. Is it for everyday use? In a placebo controlled, double-blind, random assigned study in the Journal of Strength and Conditioning Research (January 2017),17 it looked at 30 hard-driving athletes and showed that probiotic supplementation would help rebuild the first line defense or humoral immune system that gets beaten up from intense training in the winter months. The athletes who took the probiotic had less respiratory illnesses. The authors went on to say the findings could make a case for the consumption by immunocompromised populations (the very young and the very old) who tend to get sick each winter. There are different formulations and numerous brands available in high-end health food stores, grocery stores and pharmacies. We prefer room temperature stable varieties with multiple strains that are easy to swallow.
Patients enjoy and welcome their dental professionals emphasizing total health, along with focused attention on oral health. Talking nutrition that is relevant to oral health and overall health is within our scope of practice, and lastly, our patients are hungry for it.
1. Bermon S et al. “The microbiota: an exercise immunology perspective. Exercise Immunology Review 2015.
2. Scientific American 2015 Special report. Pp S1-S15
3. Campbell SC & Wisniewski P “Exercise is a novel promoter of intestinal health and microbial diversity” October 2016 American College of Sports Medicine Journal.
4. Chutkan R. MD., The Microbiome Solution
5. Sonnenburg J & Sonnenburg E., The Good Gut © 2015 Penguin Books
6. Spector T. Diet Myth: the Real Science Behind What we Eat © 2015 Weidenfeld and Nicolson
7. Greger M MD., How Not to Die © 2015 Flatiron Books
8. Chapple L., Potential Mechanisms Underpinning the nutritional modulation of periodontal inflammation” JADA 2009; 140(2): 178-184
9. O’Keefe J, Bell D., Postprandial hyperglycemia/hyperlipidemia is a cardiovascular risk factor. Am Journal Cardiology 2007;100(5):899-904
10. O’Brien M MD., The Healing Power of Sleep © 2009 Biomed General
11. Chek P., Can Fit Pro Annual Personal Trainer Summit. Toronto August 2018
12. Mayer E., The Mind Gut Connection. © 2016 Harper Collins
13. Clarke SF et al. “Exercise associated dietary extremes impact on gut microbial diversity.” Gut 2014
14. Enders G., Gut: the Inside Story of Our Body’s Most Underrated Organ © 2016 (audio) Brilliance Audio
15. Stevenson S., Sleep Smarter © 2016 Rodale
16. Canada Food Guide. https:/food-guide.canada.ca
17. Michalickova DM et al “Lactobacillus Helveticus Lafti L10 Supplementation Modulates Mucosal.
About The Author
Dr. Uche Odiatu is a Toronto area dentist and a professional member of the American College of Sports Medicine. He lectures throughout North America on total patient health.
Masha graduated from Durham College and has been in private practice for nine years. She enjoys travelling and exploring the world, its many cultures, and their variety of wonderful cuisines.