Our oral cavity is a gateway to our gut microbiome.

As I meditated on the fossil fuels in our self-care routines during June's Beauty Detox theme, I spent more time than I expected on mouthwash. Upon further investigation, I realized that our oral healthcare can undermine our gut health!

Aware that triclosan in toothpaste has antibacterial effects (and that we should avoid unnecessary antibacterial products), I had never thought much about mouthwash. I just remembered that my dentist thought it was very important to use a popular brand of mouthwash because of the clinical studies he had read.

Since June, I have been exploring how our mouthwash may kill healthy bacteria in our mouth, which could otherwise benefit our overall microbiome, including our gut health. Below is a summary of my early findings.

Our microbiome

Before we dive into mouthwash though, let's zoom out and revisit our microbiome...

First discovered in the 1700s, our microbiome remains mysterious to us. Until recently, our human-associated microbes remained largely unstudied. 

It's now estimated that we embody "trillions of microorganisms (also called microbiota or microbes) of thousands of different species"(1). In fact, microbial cells outnumber human cells by about ten to one in a healthy human body.(4)  So it makes sense that learning more about our microbiome is essential to understanding health and wellness. 

In a healthy person, our microbiota exist peacefully in our body to support our biology. For example, they can help our immune system and digestion, break down certain toxic compounds, and fight certain pathogens. 

In this article, we will touch upon how our diet, habits, and environmental exposures create an internal environment that influences either good or threatening bacteria to thrive. Since our oral cavity is a major gateway of our microbiome, this article explores an overlooked influence on our gut health: our oral care. Also included below are insights and recommendations from three holistic dental experts.

Which factors influence our microbiome?

Fluctuating daily, our microbiome results from the dynamic interplay of our genes, early life experiences, diet, lifestyle, habits, household products, and more. For example, below is a sample list of microbiome influences.

• Antibacterial products. Antibacterial products can wipe out both good and bad bacteria.
• Antibiotics. Antibiotics wipe out both good and bad bacteria.
• Birth style. Whether you came into the world through your mother's birth canal influences your early microbiome: Going through the birth canal exposes you to healthy bacteria.
• Breastfeeding. Breastfeeding also influences your microbiome positively.
• Diet. Your diet influences your balance of bacteria in various ways. For example, what you eat can create a more acidic environment that encourages unhealthy bacteria to flourish (like a diet high in sugar and refined carbohydrates).
• Genes. Genetics influences your microbiota, but your microbiota is also influenced by other factors, including those on this list.
• Illnesses. Some illnesses, like diarrhea, can affect your microbiome.
• Oral care. Ingredients, like antibacterial ones, in your mouthwash and toothpaste can kill both bad and good bacteria.
• PH of the colon. The acidity of the colon influences which bacteria survive or thrive. Lower PH in the colon has been found to lower the growth of some harmful bacteria.
• Probiotics. Probiotics can sometimes be helpful in improving your microbiome. Even better than probiotics can be eating fermented foods. Ask your trusted healthcare provider if this is a good fit for you.
• Stress. "During stress, an altered gut microbial population affects the regulation of neurotransmitters mediated by the microbiome and gut barrier function," according to a 2018 article in the journal Advances in Mind Body Medicine.(5)

What is our oral microbiome?

A major gateway to the human body, the oral cavity is the initial point of entry to the digestive and respiratory tract. The scientific journal Protein & Cell(2) explains:

The human oral cavity contains a number of different habitats, including the teeth, gingival sulcus, tongue, hard and soft palates, and tonsils, and acts the tube which connect the outside and the digestive tract and respiratory tract of human body, which provides the appropriate space for the colonization of microorganisms. The microorganisms found in the human oral cavity have been referred to as the oral microflora, oral microbiota, or oral microbiome (Dewhirst et al, 2010).

Our oral microbiome is an overlooked micro-universe that is important to our health. It is increasingly being linked not just to oral diseases, but also systemic diseases (including cardiovascular disease, stroke, preterm birth, diabetes, and pneumonia), and gastrointestinal system diseases (such as inflammatory bowel disease (IBD), liver cirrhosis, and gastrointestinal cancers).(2,3)  

Mouthwash: An overlooked influence on our oral microbiome

In recent years, I always sought to purchase my dentist's recommended (conventional) mouthwash to one without artificial colors and alcohol. As I brushed my teeth and stared at this bottle of alcohol-free mouthwash, I wondered, What purpose does the alcohol serve in mouthwash? Is it better not to have it?

Aware of the many benefits of essential oils and baking soda, I started wondering if there could be a mouthwash made of them. So I interviewed a few holistic dental experts for their insights, which are shared below.

What are the goals of mouthwash?

First, I clarified the key benefits, or goals, of mouthwash. Mouthwash helps prevent or reduce:

• Bad breath: Mouthwash kills bacteria associated with causing bad breath
• Cavities
• Gingivitis (early-stage gum disease)
• Plaque
• Tartar

... the need for alternative mouthwashes is becoming increasingly clear, especially since methyl salicylate—the active ingredient in conventional mouthwashes—is known for its high toxicity levels. While you don’t swallow mouthwash, the chemicals stay in your mouth and a small percentage is eventually absorbed into the body. 

Intrigued, I asked Nate to answer four more questions. You can read our brief interview below.

Q1. What are the concerns with conventional mouthwashes?

A1: There are a multitude of concerns surrounding conventional mouthwashes. The biggest concern is that they have a negative impact on your oral microbiome. Many harsh ingredients destroy all the bacteria in your mouth, but this also includes the good bacteria which contribute to your optimal oral health. Additionally, conventional mouthwashes often contain potentially toxic ingredients. For instance, methyl salicylate, the active ingredient in conventional mouthwashes, is known for its high toxicity levels. While you don’t swallow mouthwash, the chemicals stay in your mouth and a small percentage is eventually absorbed into the body.

Q2. Is nontoxic and effective mouthwash possible? Please include which essential oils are good for mouthwash. Which natural or DIY mouthwashes do you recommend?

A2: Nontoxic yet effective mouthwashes are a possibility as long as you are using essential oils that contain antibacterial properties. There are a variety of essential oils that are effective in mouthwashes. Oils like peppermint, tea tree, and myrrh are all ideal options as long as you make sure to use a recipe that includes a diluting carrier oil like coconut oil or almond oil.

Q3. Any concerns, tips or warnings with natural mouthwashes or essential oils?

A3: Some oils are more potent than others so make sure to dilute them well and to spit them out thoroughly when rinsing your mouth. If you experience any adverse reactions to your natural mouthwash, you might want to dilute them further or check with your dentist that they’re safe for your mouth.

Q4.  What do you wish more people knew about oral health?

A4: Your oral health is about more than just white teeth and good breath. Included in your oral health is your gum health, respiratory health and digestive health. Your mouth is the ‘beginning’ or opening to a lot of bodily functions which means that it’s important to make your oral health a priority.

Recommended Mouthwash

The fact that there is an abundance of essential oils known for their antibacterial qualities combined with the knowledge that mouthwashes are made to eliminate bacteria from your teeth and gums, means that there is no reason why a DIY mouthwash can’t be effective for oral health... A DIY mouthwash ensures that you’re controlling what you put into your mouth and your body. That being said, some oils are more potent than others so make sure to dilute them well and to spit them out thoroughly when rinsing your mouth.

1. DIY Mouthwash

Dr. Drut recommended experimenting with the effects from using a DIY mouthwash using the ingredients below. Most are readily available at home. 

Baking Soda

Readily available, baking soda neutralizes acids and odors and can fight bacteria and stains. It changes PH balance thus reducing acidity. Bacteria thrive in acidic environments, therefore reducing acidity could fight bacteria. Take one teaspoon and mix it with water, but be careful if swallowed baking soda can cause vomiting and nausea.  

Aloe Vera Juice

Aloe vera juice works similarly to baking soda--reducing acidity and helping cleanup bacteria. It can be used to rinse the mouth.

Tea Tree oil

With soothing and cleansing effects on gums and teeth, tea tree oil has questionable effects in helping gum disease. 

3% hydrogen peroxide 

An antiseptic that is also readily available in any pharmacy, hydrogen peroxide has proved very effective in fighting gum disease. When used as a mouth wash, it kills bacteria, fights gum disease and periodontal disease, and whitens teeth. Beware that this should not be swallowed, and it can cause gum sensitivity.

Hydrogen peroxide should not be used daily, and only used occasionally. It could be used 3 times per week, and if any sour spots develop, patient could stop for a few days and continue after.

Once hydrogen peroxide is used, Dr. Drut's patients love it. Buy 3% food grade hydrogen peroxide that sells on Amazon. In addition it bleaches the teeth as well and helps to remove the stains. 

Dr. Drut answers additional questions below:

Q1: Any concerns about essential oils being more harsh on the gums than conventional mouthwash?  

A1: Not at all. 

Q2: What are your recommendations on fluoride use? How important is fluoride in toothpaste and mouthwash, especially if it’s in our drinking water?  

A2: I do not feel that flouride is an important factor to have in mouthwash. If someone has braces, we recommend toothpaste with fluoride. Otherwise, I do not recommend to use fluoride in the paste or mouthwash. In large quantity it could cause more harm than good. 

Q3: Should people with veneers/crowns be careful with any of the DIY ingredients?  

A3: Not really. A good placed veneer or a crown should not be damage by a mouthwash. 

Q4: Would the DIY ingredients be more/less/equally as abrasive to discoloration of veneers and crowns? 

A4: Peroxide have some bleaching effects fighting coffee or tobacco stains, the rest of DYI not reported to have any effects on teeth color. 

2. Off-the-Shelf Mouthwash

Harvey S. Shiffman DDS of Boynton Laser Dental Center recommended Dr. Hisham's Alkaline Mouth Rinse. He described it as well-researched , natural, and neutralizes acidic conditions that cause inflammation and oral disease. He shared the following:

Benefits

• Actively cleansing by breaking down plaque biofilm
• Banishes bad breath by inactivating bad bacteria & VSC’s Colour-free to prevent staining while naturally whitening teeth
• Creates healthy alkaline oral balance
• Helps prevent tooth decay & cavities
• Helps prevent tooth wear from acid erosion
• Soothes sensitive teeth & sore gums
• Helps alleviate dry mouth (Xerostomia) by stimulating & nourishing natural saliva
• Prebiotic formulation to help you suppress bad bacteria & express beneficial bio-flora
• Eco-friendly, food-grade ingredients
• Vegan, Halal, Kosher & Paleo friendly
• Actively cleansing by breaking down plaque biofilm
• Banishes bad breath by inactivating bad bacteria & VSC’s
• Colour-free to prevent staining while naturally whitening teeth
• Creates healthy alkaline oral balance
• Helps prevent tooth decay & cavities
• Helps prevent tooth wear from acid erosion

No Bad additives

• No abrasives or toxins
• No alcohol or irritants
• No SLS or detergents
• No fluoride
• No parabens
• No petrochemicals
• No plastic microbeads
• No Triclosan
• No Titanium Dioxide
• No animal testing or by-products
• No gluten, sugar, saccharin or aspartame 

What am I doing?

This is a topic that I will spend more time figuring out. My regular dentist is not a holistic dentist, but I prioritized his expertise in other areas. Since I balance a number of concerns, I diversify my risks.

I can't advise you on what's best for you. But, in case it helps, this is what I'll be doing: I'm mixing it up.

I brush my teeth first thing in the morning and last thing before bedtime with the protocol of my regular dentist: fluoridated toothpaste and Listerine (the one without alcohol, which I wish came without artificial colors too).

I often floss after each meal or snack, and brush throughout the day with more natural toothpaste and sometimes rinse with a mouthwash with essential oils. I've really enjoyed the one below by doTERRA.

I then pay attention to the effects on my gums and teeth and assess if I can reduce the conventional products. I'll see how my next dental visit goes! Please share your experiences and tips with me at [email protected]

Books to learn more about natural oral healthcare

Your oral healthcare should be discussed with your trusted dentist since we each have unique situations. To consider more holistic perspectives that you can talk through with your trusted dental experts, below are some books for you to consider.

References

(1) Harvard T.H. School of Public Health. "The Microbiome." https://www.hsph.harvard.edu/nutritionsource/microbiome/

(2) Gao et al, 2018. Protein Cell. 2018 May; 9(5): 488–500. Published online 2018 May 7. doi: 10.1007/s13238-018-0548-1. "Oral microbiomes: more and more importance in oral cavity and whole body." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960472/

(3) Dewhirst et al, 2010. JOURNAL OF BACTERIOLOGY, Oct. 2010. "The Human Oral Microbiome." https://jb.asm.org/content/192/19/5002

(4) Human Microbiome Project. Page last reviewed on March 20, 2017. https://commonfund.nih.gov/hmp/overview

(5) Househam et al. Advances in Mind Body Medicine. "The Effects of Stress and Meditation on the Immune System, Human Microbiota, and Epigenetics." 2017 Fall;31(4):10-25. https://www.ncbi.nlm.nih.gov/pubmed/29306937