Managing Your Patients’ Oral Microbiome

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  Posted by: Dental Design      14th May 2022

Oral microbiome is a significant contributing factor to oral health. Scientists have discovered that aspects such as diet, tobacco consumption, and stress can alter a person’s microbiome which can be a risk to one’s health.[i] However, when everything is working as it should be it supports the following:

  • A healthy digestive tract
  • Antioxidant activity
  • Additional metabolic potential
  • Anti-inflammatory properties
  • Host defence functions
  • Regulates the cardiovascular system
  • Confers resistance to colonisation by pathogens

As a clinician you want the best for your patients. Of course, you can’t be there every time they make a decision that might negatively impact their oral microbiome but you can educate them as much as possible.

Making Healthy Choices

Modifiable factors that will contribute to the balance of your patients’ oral microbiome are the lifestyle choices they make.

One lifestyle choice that all clinicians hope their patients abandon is smoking. Smoking can directly affect the balance of one’s oral microbial ecology by influencing the oxygen availability. A study that compared the oral microbiome of smokers and non-smokers found that proteobacteria levels were significantly lower in smokers.[ii] This would cause an imbalance of the microorganisms which could lead to health complications such as, head and neck cancer, and pancreatic cancer – two smoking related diseases. The study revealed that 49.3% of the participants who smoked went on to develop a smoking related cancer.

After the stomach, the oral cavity is the second most diverse biome of the body. Making it clear to your patients that their mouth is the gateway to all other organs may cause them to think twice about what they ingest. Further education will be useful to them too – some signs of imbalanced oral microbiome include bad breath, bleeding gums, and tooth decay.[iii]

It has become clear to researchers that diet can impact the balance of a patient’s oral microbiome. Some nutritional factors that affect this include:iv

  • A diet high in refined carbohydrates and sugar
  • A low fibre diet
  • Vitamin D deficiency
  • Low levels of folate (Vitamin B9)
  • Acidic foods and drinks: fizzy drinks, coffee, alcohol, and energy drinks

The bacterial levels found in patients with imbalanced microbiome have been linked to periodontitis and other oral diseases.[iv] However, a large research study carried out in 2019 revealed that bacteria in the mouth affects those in the gut too. Therefore, imbalanced microbiome in the mouth can have an impact on the general health of a patient – especially as these bacteria have been linked to systemic diseases such as inflammatory bowel disease, colon cancer, diabetes, arthritis, and more.v

Another factor that can impact a patient’s microbial balance is stress. A recent study found that the stress hormone, cortisol, directly impacts the profile of one’s oral microbiome.[v] It showed that when cortisol is present Fusobacteria is more active. This is a concern because Fusobacterium nucleatum have been associated with a variety of human diseases such as periodontitis, cardiovascular disease, and rheumatoid arthritis.

Stress can affect anyone at any time and if your patient is exhibiting signs of imbalanced microbiome it might be a good idea to ask them how they’re feeling, especially if they are otherwise in good health. You could suggest

  • Ensuring they have a support network – sometimes simply talking about things can help people
  • Yoga and meditation – these methods are known to reduce stress as well as improve general health
  • Counselling or therapy – sometimes professional intervention is needed. You can advise your patient to speak to their GP or find a private therapist

What Else Can You Do?

In any case, you can support your patients by ensuring that their oral hygiene routine is optimised. The Waterpik® Water Flosser is a sure way to improve the care of your patients’ mouths. This incredible device allows your patients to clean interdentally and subgingivally with ease. All they need to do is hold the Water Flosser and point the tip in the right direction – their teeth and gums will feel exceptionally clean in just one minute a day. As well as this, the Water Flosser is proven to remove up to 99.9% of plaque and is twice as effective as string floss for reducing gingival bleeding.[vi] [vii]

In summary, helping patients maintain healthy oral microbiome is integral for sustaining good dental and general health. There are various factors that impact this and a lot of them come down to lifestyle choices that can be modified. However, high quality dental products can improve oral health.


For more information on Waterpik® products please visit Waterpik® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.

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Helen Astill is qualified as a dental hygienist and holds a BSc (Hons) in applied science / nutritional therapy. She Currently works at two dental practices in Dorset along with working part time as a registered vaccinator and a professional educator for Waterpik.


[i] Kilian, M., Chapple, I.L.C., Hannig, M., Marsh, P.D., Meuric, V., Pedersen, A.M.L., Tonetti, M.S., Wade, W.G. and Zaura, E. (2016). The Oral Microbiome – an Update for Oral Healthcare Professionals. British Dental Journal, [online] 221(10), pp.657–666. Available at: [Accessed 2 Feb. 2022].

[ii] Wu, J., Peters, B.A., Dominianni, C., Zhang, Y., Pei, Z., Yang, L., Ma, Y., Purdue, M.P., Jacobs, E.J., Gapstur, S.M., Li, H., Alekseyenko, A.V., Hayes, R.B. and Ahn, J. (2016). Cigarette Smoking and the Oral Microbiome in a Large Study of American Adults. The ISME Journal, [online] 10(10), pp.2435–2446. Available at: [Accessed 3 Feb. 2022].

[iii] Löfgren, A. (2020). The Connection between Nutrition and the Oral Microbiome. [online] Available at: [Accessed 3 Feb. 2022].

[iv] Olsen, I. and Yamazaki, K. (2019). Can Oral Bacteria Affect the Microbiome of the Gut? Journal of Oral Microbiology, 11(1), p.1586422.

[v] Duran-Pinedo, A.E., Solbiati, J. and Frias-Lopez, J. (2018). The Effect of the Stress Hormone Cortisol on the Metatranscriptome of the Oral Microbiome. Npj Biofilms and Microbiomes, 4(1).

[vi] Gorur A, Lyle DM, Schaudinn C, Costerton JW. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 – 6.

[vii] Rosema NAM et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011; 13(1):2-10.

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