After I graduated from dental faculty, no person talked concerning the oral microbiome. It wasn’t within the curriculum. It wasn’t within the journals. The prevailing concept — the one we have been all taught as settled science — was that cavities have been attributable to a single bacterium: Streptococcus mutans. One bug. One perpetrator.
Scientists have been so assured on this that by the mid-Nineteen 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 mistaken.
Cavities aren’t attributable to one rogue bacterium. They’re attributable to an ecosystem falling out of stability. And treating that ecosystem like a battlefield — carpet-bombing it with antiseptic rinse, declaring conflict 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 identified. The issue is what wasn’t identified but — and the way lengthy it’s taken dentistry as a occupation to meet up with what the science is now exhibiting 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 stress — your physique really 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 could 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. Individuals with periodontal illness have considerably increased charges of heart problems and inflammatory bowel illness.
Each of my dad and mom 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 after I puzzled if I used to be the one who had it mistaken. I wasn’t.
However dentistry continues to be catching up — and within the meantime, there are issues you can begin doing as we speak that the majority dentists nonetheless aren’t telling you.
First issues first: I’m begging you to cease carpet-bombing your mouth.
Bear in mind these TV advertisements exhibiting blue liquid swirling via the mouth, killing the whole lot in its path? That was the promise of mouthwash. Clear. Disinfected. Micro organism-free.
That was precisely the mistaken purpose.
There’s a gaggle of micro organism dwelling in your tongue referred to 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 stress regulated. Mouthwash wipes them out indiscriminately.
There’s a research I genuinely haven’t stopped eager about since I first learn it. Researchers gave older adults beet juice to decrease their blood stress — and it labored. Until they’d been rinsing with antiseptic mouthwash. Then the blood stress profit fully disappeared.
The biggest 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 major improve in hypertension danger, unbiased of weight loss program, 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 probably’t inform the distinction between the micro organism inflicting your gum illness and the micro organism defending your cardiovascular system.
Much less harmful just isn’t the identical as secure.
In case your dentist tells you the priority solely applies to prescription chlorhexidine rinse, ask them concerning the SOALS research.
This goes a lot deeper than mouthwash.
What I used to be by no means taught in dental faculty — and what I’ve spent many years studying via analysis and, frankly, via private loss — is that your mouth is in fixed dialog along with your total 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 recognized at 60 has roots that attain again many years. And the oral microbiome is woven into each of these timelines in methods we’re solely starting to totally perceive.
Nature, some of the 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 all the time unhealthy, all the time to be eradicated, solely to find that in a wholesome mouth, biofilm is protecting. That the purpose was by no means to eradicate micro organism however to domesticate the proper 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 really dwelling in your mouth, and let’s determine 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 generally include important oils which might be simply as disruptive to the oral microbiome as their typical 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 crucial nitrate-reducing micro organism reside. 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 useful micro organism and actively assist your nitrate-reducing neighborhood. 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 via your nostril. Day and evening. Nasal respiration retains saliva flowing, and saliva is your mouth’s pure protection system. Should you snore, get up with dry mouth, or suspect your airway is compromised, please discover a sleep dentist via AADSM.org or a myofunctional therapist via our Useful Dentist Listing. This is among the most missed — and most consequential — issues I can level you towards.
And for those who’re able to go deeper: add an oral probiotic with Streptococcus salivarius strains to assist repopulate your mouth with useful 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 all the time show: your mouth is the entrance door to your total physique’s well being. This isn’t about avoiding cavities. It’s about blood stress. Mind well being. Independence at 80. The standard of the many years forward of you. And, but, we now have in some way been led to imagine that dentistry is nearly a “fairly smile.” 😩
If you need a dentist who really understands the oral-systemic connection — somebody who will have a look at your mouth and take into consideration your entire physique — that’s precisely what my Useful Dentist Listing is for.
-Mark
Additional Studying & Citations
Campbell, Ok. (2021). “Oral microbiome findings problem dentistry dogma.” Nature Outlook: Oral Well being. The piece that vindicates the whole lot purposeful dentists have been saying for many years — revealed 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, Ok.J. et al. (2017). “Over-the-counter mouthwash use and danger of pre-diabetes/diabetes.” Nitric Oxide, 71, 14–20. Joshipura, Ok.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 exhibiting that 7 days of chlorhexidine mouthwash precipitated a significant shift within the salivary microbiome, diminished the mouth’s potential to transform dietary nitrate to nitrite, lowered plasma nitrite ranges, and was adopted by a development towards elevated systolic blood stress 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 stress. Researchers discovered that folks with increased ranges of nitrate-reducing micro organism on their tongues had measurably decrease resting systolic blood stress — and that common tongue cleansing was a major predictor of tongue microbiome composition. Managing the tongue microbiome isn’t nearly contemporary breath. Learn it right here.
Loughman, A., Adler, C.J., & Macpherson, H. (2023). “Unlocking Modifiable Danger Components for Alzheimer’s Illness: Does the Oral Microbiome Maintain A number of the Keys?” Journal of Alzheimer’s Illness, 92(1), 1–26. A rigorous overview proposing a framework for the way the oral microbiome interacts with each main modifiable danger issue for Alzheimer’s — together with blood stress, 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 Ailments: 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.” Probably the most 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, Scale back Irritation and Battle Illness. Ulysses Press. The one e book written particularly concerning the oral microbiome for a common viewers — accessible, rigorously sourced, and sensible. I imagine it needs to be required studying in dental colleges. If this text sparked one thing for you and also you need to go deeper, begin right here. Discover it right here.