“The roots of education are bitter but the fruit is sweet.” Aristotle
When I began the initial research phase for part 2 I pondered the possibility that the subject matter pertaining to the aims and goals of Whole Dental Health and the principles I want to pursue professionally here in Nelson had already been undertaken and, even, heaven forbid, published! I came up this nugget of theological gold courtesy of Joellen Coates, a thirty plus page of her Honours Capstone Project. This is undertaken in the final year of tertiary learning by some educational establishments. It is a unique and very personal and self-directed process by which the individual learner can develop a thesis, develop and establish new knowledge, test it and formulate a learning premise that ultimately goes towards the final grade and graduation. 1, 2
Her thesis looks closely at the human oral microbiome, its constituent parts, it’s history, present and potential future in regards to unlocking its potential to impact the direction of oral health in the future by understanding its very nature better. She begins by setting the historic scene, back to the hunter gatherer days, progressing into the Neolithic Period where Palaeolithic man moves from a seasonal and mobile dietary life into that of an agriculturally based one, land locked within the confines of the cereal sown and cattle raised nearly starting about ten thousand years ago. With this change in dietary life style comes a shift in dietary behavioural changes with eventual oral microbial changes and, following on from that, dysbiotic changes to oral floral and increasing archaeological evidence of dental diseases, namely caries and periodontitis.
“For the first half of geological time our ancestors were bacteria.” Richard Dawkins
The several hundred or so bacterial species of our oral microbiome combine with other microorganisms such as fungi, viruses, archaea and protozoa to construct our complex and diverse ecological communities, and have done so from days in memorial. In healthy subjects they display great diversity and health benefits. It begins before birth with some early pioneering bacterial species culturing the unborn mouth via the umbilical cord, amniotic fluid onward into the developing foetus. During birth further seeding is initiated by contact the mother’s vaginal microbiome and contact with the skin, being further reinforced through breast feeding and so on and so forth throughout life. The development of a functional and balanced oral microbiome has begun. How this community of diverse microorganisms can afford dental and general health benefits is the subject of modern research and, more so, how its disturbance can lead to a host of dental diseases is the subject of my interest.
“The important thing is not to stop questioning. Curiosity has its own reason for existence.” Albert Einstein
Within ancient dental calculus holds the clues and answers within highly preserved bacterial types, their cellular components and DNA. Careful analysis reveals that Neolithic farmers saw a significant increase in the consumption of fermentable carbohydrates as opposed to their cave dwelling ancestors, in this case the greater consumption of cereals, such as we do today. This has also seen the documented rise of dental diseases, both caries and periodontitis in archaeological evidence, but also comparatively to modern man. Studies have determined that the modern microbiome is “less diverse compared to ancient samples and could be composed of more opportunistic cariogenic bacteria”. Pre – Neolithic populations were rarely affected by dental diseases. 3
Baumgartner and co-workers in 2009 designed a simple study that took Swiss students from a modern Swiss diet and for a period of a month ate a Stone Age type diet to determine the effects of a lack of modern oral hygiene on the oral microbiome and presence of gingivitis. The results indicated a change and growth in the oral microbiome, less pathogenic bacteria and a significant decrease in the signs and symptoms of gingivitis. This simple and less rigorous research brings up many further questions as well as a need for more detail regarding its process. The next paragraph will look a little deeper into it.
The sample size was small, ten subjects, in one group and the study length was just four weeks. Microbiological samples were collected at the mesio-buccal aspects of all teeth and from the dorsum of the tongue. All ten subjects had no periodontitis. The results from samples gathered after four weeks demonstrated a mean bleeding on probing deceased from 34.8% to 12.6%, plaque scores increased from 0.68 to 1.47. Periodontal depths also showed changes which decreased at sites of sampling by 0.2mm. All three measured a P value of <0.001, indicating that the results have less than one in a thousand chance of being wrong. The bacterial profiles, had a higher growth count for 24 of 74 species despite the reduction of pathogenicity.
The elimination of refined sugars decreased the risk of gingivitis in the absence of traditional oral hygiene methods, despite the increase in plaque levels. This demonstrates that beneficial and symbiotic bacteria thrived in the oral microbiome in the subjects tested over a four week period without the benefit oral hygiene or the consumption of a modern style Swiss diet. 4
The oral microbiome is constantly exposed to the elements and pressures of the external environment and needs to treated, in the same way, as a precious ecosystem. The oral microbiome utilises nutrition supplied from the hosts diet, their saliva flow, enzymes and minerals. It is ecological disruption and dysbiosis can stem from poor saliva flow rates, quantity and quality, illness, stress, poor diets and even genetics.
“Is your diet really nutrient dense”? Dr. Weston A. Price
Importantly, dietary changes since hunter gatherers have dramatically changed. The simple food staples they once gathered have become processed, starting in Neolithic though to the modern, Industrial Periods. These have fundamentally altered seven crucial nutritional characteristics of our ancestral dietary habits. These include glycaemic load, fatty acid composition, macro nutrient composition and micronutrient density, acid balance, sodium-potassium ratio and fibre content. Glycaemic loading, fatty acids (Omega 3’s),acid balance and macro and micro nutrient contents will in particular prove important regarding the oral systemic interface of dental health and development. The controversial works and research of Weston A Price will need further examination in a quest for greater knowledge and connection to modern day alternative lifestyle and medical cultural ideology and practice. 5
The future of dentistry in relation to the oral microbiome, let along everything that appears to be happening in the world right now, is ripe for discovery. The benefits of a balanced, beneficial and healthy oral microbiome and, in turn, how we decide to directly or indirectly affect and influence it to our dental and general health benefit requires our attention. Poor nutritionally based diets with emphasis on the consumption of processed rich foods and in particular fermentable carbohydrates promote less diversity and imbalance of our oral ecology. This must become an innate message to our clients who suffer from dental diseases no matter how mild or severe they present.
“Natural ecosystems regulate themselves through diversity.” Big Little Farm
Finally, the materials we use to help control and manage oral health issues and the negative effects of poor oral flora may lie not solely in the realms of the mouthwashes which fill the pharmacy shelves or the cleverly marketed and boxed oral hygiene devices specifically but, more so, in the way we chose to live and eat. The stresses and pressures we put upon ourselves in our everyday lives, the type of nutrition we chose consume and the ability to manage not only our everyday oral hygiene habits effectively but how we sustain and maintain the diversity and symbiosis of our oral microbiome as a whole is vital.
1. Coates J, 2017. Got Teeth? How the Oral Microbiome and Diet Affects Our Oral Health and the Future of Dentistry.
2. Capstone Project. https://youtu.be/CWxwwLP2THU
3. Alder CJ et al, 2013. Sequencing ancient calcified dental plaque shows changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions. Nat Genet 45: 450-455.
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