Once I graduated from dental college, no one talked in regards to the oral microbiome. It wasn’t within the curriculum. It wasn’t within the journals. The prevailing idea — the one we have been all taught as settled science — was that cavities have been brought on by a single bacterium: Streptococcus mutans. One bug. One offender.
Scientists have been so assured on this that by the mid-Seventies, they have been creating a vaccine in opposition to it.
The vaccine by no means labored.
And we now know why: the premise was fully fallacious.
Cavities aren’t brought on by one rogue bacterium. They’re brought on by an ecosystem falling out of stability. And treating that ecosystem like a battlefield — carpet-bombing it with antiseptic rinse, declaring struggle on each microbe in sight — wasn’t fixing the issue. It was making it worse.
I’m not blaming my professors. They taught me what was recognized. The issue is what wasn’t recognized but — and the way lengthy it’s taken dentistry as a occupation to meet up with what the science is now displaying us.
Right here’s what I want I’d discovered on day one:
Your mouth isn’t soiled. It’s alive.
It’s an ecosystem of round 700 bacterial species, most of them working for you. They regulate the acidity of your mouth. They assist handle your blood strain — your physique truly outsourced the job of changing dietary nitrate into nitric oxide to your oral micro organism, as a result of we don’t have the enzymes to do it ourselves. They defend your gums. They’re, in each significant sense, a part of you.
And they’re in fixed dialog with the remainder of your physique. When your gums bleed — even just a bit — that’s not merely an indication you have to floss extra. It’s an open doorway the place micro organism can enter your bloodstream and journey to each different system.
The implications of that single truth are staggering.
Fusobacterium nucleatum — an oral bacterium — has been discovered inside colorectal tumors. Porphyromonas gingivalis, the first driver of gum illness, has been detected within the brains of individuals with Alzheimer’s. Folks with periodontal illness have considerably increased charges of heart problems and inflammatory bowel illness.
Each of my mother and father had Alzheimer’s. Each time a brand new research hyperlinks oral pathogens to cognitive decline, I really feel it in my chest. It’s a part of why I can’t cease speaking about this.
I’ve been saying this for many years, lengthy earlier than the analysis was there to again me up. And I’ll be sincere: there have been years once I questioned if I used to be the one who had it fallacious. I wasn’t.
However dentistry remains to be catching up — and within the meantime, there are issues you can begin doing at the moment that almost all dentists nonetheless aren’t telling you.
First issues first: I’m begging you to cease carpet-bombing your mouth.
Keep in mind these TV adverts displaying blue liquid swirling by way of the mouth, killing every little thing in its path? That was the promise of mouthwash. Clear. Disinfected. Micro organism-free.
That was precisely the fallacious purpose.
There’s a bunch of micro organism dwelling in your tongue known as nitrate-reducing micro organism. They convert nitrates from meals like beets, spinach, and arugula into nitric oxide — the molecule your physique makes use of to maintain blood vessels relaxed and blood strain regulated. Mouthwash wipes them out indiscriminately.
There’s a research I genuinely haven’t stopped interested by since I first learn it. Researchers gave older adults beet juice to decrease their blood strain — and it labored. Except they’d been rinsing with antiseptic mouthwash. Then the blood strain profit fully disappeared.
The most important longitudinal research on this — 945 adults tracked over three years at Harvard and the College of Puerto Rico — discovered that utilizing over-the-counter mouthwash twice a day was related to a 55% elevated danger of prediabetes and a big improve in hypertension danger, unbiased of weight-reduction plan, train, weight, and each different main variable the researchers measured (Joshipura et al., Nitric Oxide, 2017; Blood Strain, 2020).
And in 2024, Listerine’s personal producer funded a research describing their product as “non-selectively resetting” the oral microbiome. They framed that as a constructive. However “non-selective” means it will possibly’t inform the distinction between the micro organism inflicting your gum illness and the micro organism defending your cardiovascular system.
Much less damaging just isn’t the identical as secure.
In case your dentist tells you the priority solely applies to prescription chlorhexidine rinse, ask them in regards to the SOALS research.
This goes a lot deeper than mouthwash.
What I used to be by no means taught in dental college — and what I’ve spent a long time studying by way of analysis and, frankly, by way of private loss — is that your mouth is in fixed dialog together with your complete physique. The oral microbiome is the headwaters of the intestine microbiome. What occurs within the mouth doesn’t keep within the mouth.
The mind modifications related to Alzheimer’s at 75 start at 40. The heart problems identified at 60 has roots that attain again a long time. And the oral microbiome is woven into each of these timelines in methods we’re solely starting to completely perceive.
Nature, probably the most rigorous scientific journals on the earth — ran a function in 2021 with the headline: “Oral Microbiome Findings Problem Dentistry Dogma.” The piece described researchers who spent their careers being instructed that oral biofilms have been at all times unhealthy, at all times to be eradicated, solely to find that in a wholesome mouth, biofilm is protecting. That the purpose was by no means to remove micro organism however to domesticate the best ones.
The way forward for dentistry — and I imply this — is the dentist who sits throughout from you and says: let’s have a look at what’s truly dwelling in your mouth, and let’s work out what it’s telling us about the remainder of your physique. It’s why I’m a scientific advisor for this oral microbiome take a look at (code DRB for 10% off). Focused probiotic interventions are coming. The drill-fill-bill mannequin is on its approach out.
I simply want it might hurry up.
My day by day non-negotiables
Ditch the mouthwash. All of it — even the “pure” ones, which usually comprise important oils which might be simply as disruptive to the oral microbiome as their standard counterparts. Rinse with coconut oil as a substitute—I love the style and really feel of this oil pulling mix.
Tongue scrape each morning. Your tongue harbors the biofilm the place these vital nitrate-reducing micro organism stay. Scraping removes dangerous buildup with out destroying the ecosystem. I take advantage of this stainless-steel one, however any stainless-steel scraper works.
Drink inexperienced tea between meals. The polyphenols skinny biofilm with out disrupting the helpful micro organism and actively help your nitrate-reducing group. That is the one I drink day by day.
Eat on your oral microbiome. Nitrate-rich greens — arugula, beets, spinach. Fermented meals — yogurt, kefir, sauerkraut (I’m a giant sauerkraut fan personally). Polyphenol-rich meals — berries, cacao, pomegranate. These feed the micro organism that defend your gums, your cardiovascular system, and your mind.
Breathe by way of your nostril. Day and night time. Nasal respiratory retains saliva flowing, and saliva is your mouth’s pure protection system. If you happen to snore, get up with dry mouth, or suspect your airway is compromised, please discover a sleep dentist by way of AADSM.org or a myofunctional therapist by way of our Practical Dentist Listing. This is without doubt one of the most ignored — and most consequential — issues I can level you towards.
And should you’re able to go deeper: add an oral probiotic with Streptococcus salivarius strains to assist repopulate your mouth with helpful micro organism.
Why does any of this matter?
As a result of the science is telling us what I’ve believed for many years however couldn’t at all times show: your mouth is the entrance door to your complete physique’s well being. This isn’t about avoiding cavities. It’s about blood strain. Mind well being. Independence at 80. The standard of the a long time forward of you. And, but, we’ve got in some way been led to consider that dentistry is nearly a “fairly smile.” 😩
If you’d like a dentist who truly understands the oral-systemic connection — somebody who will have a look at your mouth and take into consideration your complete physique — that’s precisely what my Practical Dentist Listing is for.
-Mark
Additional Studying & Citations
Campbell, Okay. (2021). “Oral microbiome findings problem dentistry dogma.” Nature Outlook: Oral Well being. The piece that vindicates every little thing practical dentists have been saying for many years — printed in one of many world’s most rigorous scientific journals. The S. mutans vaccine story alone is well worth the learn. Learn it right here.
Joshipura, Okay.J. et al. (2017). “Over-the-counter mouthwash use and danger of pre-diabetes/diabetes.” Nitric Oxide, 71, 14–20. Joshipura, Okay.J. et al. (2020). “Over-the-counter mouthwash use, nitric oxide and hypertension danger.” Blood Strain, 29(2), 103–112. The SOALS research — 945 adults, three-year follow-up, Harvard and the College of Puerto Rico. The foundational analysis behind the mouthwash part of this text. Two papers from the identical cohort, each value bookmarking. Critically, this analysis studied over-the-counter mouthwash — not prescription chlorhexidine — and measured actual well being outcomes over years, not a single biomarker over hours. Learn the 2017 paper right here. Learn the 2020 paper right here.
Bescos, R. et al. (2020). “Results of chlorhexidine mouthwash on the oral microbiome.” Scientific Reviews, 10, 5254. A managed crossover research displaying that 7 days of chlorhexidine mouthwash triggered a serious shift within the salivary microbiome, decreased the mouth’s capability to transform dietary nitrate to nitrite, lowered plasma nitrite ranges, and was adopted by a development towards elevated systolic blood strain in wholesome people. That is the mechanistic hyperlink between mouthwash, microbiome disruption, and cardiovascular danger made seen in actual human topics. Learn it right here.
Tribble, G.D. et al. (2019). “Frequency of Tongue Cleansing Impacts the Human Tongue Microbiome Composition and Enterosalivary Circulation of Nitrate.” Frontiers in Mobile and An infection Microbiology, 9:39. The research that connects your tongue scraper to your blood strain. Researchers discovered that folks with increased ranges of nitrate-reducing micro organism on their tongues had measurably decrease resting systolic blood strain — and that common tongue cleansing was a big predictor of tongue microbiome composition. Managing the tongue microbiome isn’t nearly recent breath. Learn it right here.
Loughman, A., Adler, C.J., & Macpherson, H. (2023). “Unlocking Modifiable Danger Elements for Alzheimer’s Illness: Does the Oral Microbiome Maintain A few of the Keys?” Journal of Alzheimer’s Illness, 92(1), 1–26. A rigorous overview proposing a framework for a way the oral microbiome interacts with each main modifiable danger issue for Alzheimer’s — together with blood strain, sleep, glucose regulation, and bodily exercise. The connection between oral nitrate-reducing micro organism and cardiovascular health alone makes this important studying. Learn it right here.
Giordano-Kelhoffer, B. et al. (2022). “Oral Microbiota, Its Equilibrium and Implications within the Pathophysiology of Human Illnesses: A Systematic Overview.” Biomedicines, 10(8), 1803. A scientific overview of 79 peer-reviewed research analyzing the oral microbiome’s function in heart problems, neurodegeneration, and Alzheimer’s. Significantly helpful for understanding the mechanisms behind the associations — not simply the associations themselves. Learn it right here.
Frontiers in Mobile and An infection Microbiology (2025). “Oral microbiota in cardiovascular well being and illness.” One of the vital present overviews of how particular periodontal pathogens — together with P. gingivalis and F. nucleatum — contribute to hypertension, atherosclerosis, and myocardial infarction danger. The analysis has moved nicely past affiliation; it’s now describing exact inflammatory mechanisms. Learn it right here.
Nelson-Dooley, C. (2019). Heal Your Oral Microbiome: Steadiness and Restore Your Mouth Microbes to Enhance Intestine Well being, Cut back Irritation and Struggle Illness. Ulysses Press. The one guide written particularly in regards to the oral microbiome for a common viewers — accessible, rigorously sourced, and sensible. I consider it ought to be required studying in dental faculties. If this text sparked one thing for you and also you wish to go deeper, begin right here. Discover it right here.
