Can your mouth be a telltale sign of your health? Undoubtedly, according to dentist Dr. Michael Glick, who said that the “mouth is a mirror” of the body, health, and disease.¹ Former Surgeon General David Statcher released a report titled Oral Health in America, which highlighted the importance of oral health as the “gateway” to general health and well-being. The truth is that you can tell a lot about a person’s health by looking in their mouth. Along those lines, poor oral hygiene —and an unhealthy mouth—can be a major indicator and predictor of disease and chronic health issues.

Even more, we are now learning that some of the traditional “best practices” for oral health are, in fact, detrimental. On top of that, it’s becoming increasingly clear that diet, lifestyle, and gut health are critical, yet vastly underappreciated, players in the oral hygiene equation.

In this article, we’ll touch on the prevalence of oral health issues, the growing list of health problems that stem from poor oral hygiene, the probable suspects at play, and top tips for good oral health—polishing the ol’ pie hole mirror, if you will.

What is Oral Health?

To understand what poor oral hygiene looks like, we need to have a good understanding and working definition of what oral health is. We are taught from an early age that proper oral health means maintaining healthy teeth. In fact, my almost two-year-old daughter has been brushing her teeth twice daily for over a year now. Along those lines, the simple acts of brushing and flossing are instilled in us so we can maintain our “pearly whites.”

But the fact is that oral health goes way beyond clean teeth. It involves the gums and their supporting tissues, the palate, the lining of the mouth and throat, the tongue, the lips, the salivary glands, the chewing muscles, the nerves, and the bones of the upper and lower jaws. In other words, oral health refers to the health of our entire mouth and, ultimately, supports and reflects the health of the entire body.

The Consequences of Poor Oral Hygiene

Shockingly, it’s estimated that upwards of 90% of the adult American population has some form of periodontal disease, with nearly half of U.S. adults having some degree of periodontitis, the most serious form of periodontal disease.^2–4 Periodontal disease, which is called gingivitis in its early stage, is the most common oral condition and clear indication of poor oral hygiene.

Practically speaking, if you have gums that bleed (to any degree—no bleeding of gums is normal) when you brush or floss and/or you have an infection underneath the gums, then you have some extent of periodontal disease. The chronic inflammatory condition of the periodontium (the gums) is the main cause of tooth loss. Along with tooth decay (i.e., dental caries/cavities), periodontal disease is one of the two biggest threats to oral health—and the most glaring and prevalent indication of poor oral hygiene in adults.

Considering that the overwhelming majority of the population is dealing with some degree of oral health issues, which are largely preventable, this has severe implications, especially when you consider that poor oral hygiene goes way beyond clean teeth and bad breath. In fact, former Surgeon General Dr. Regina Benjamin has referred to oral health as “the silent epidemic.”⁵ After all, we are now learning that poor oral hygiene and health are associated with other very serious health issues, including:^2,5

• Heart disease. Researchers have found that people with periodontal disease have a 34% greater risk of developing cardiovascular disease.^6,7 It’s believed that the two may be linked by bacteria and inflammation. For instance, unhealthy oral bacteria may “leak” into the bloodstream, triggering inflammation and leading to the formation of arterial plaque (i.e., hardening of the arteries). Along these lines, oral bacteria has been found in the fatty deposits of people with atherosclerosis.⁸
• Type 2 diabetes. There’s a “bi-directional” relationship between periodontal disease and diabetes. These separate diseases augment each other (in a not-so-good way). In other words, diabetes makes people more likely to have problems with oral health. In turn, periodontal disease appears to exacerbate insulin resistance. The common denominator between the two appears to be cellular inflammation.^2,9
• Stroke. There is evidence that periodontal disease is associated with increased risk of stroke. Just as with the two health issues above, the striking similarity between periodontal disease and stroke seems to be inflammation—more specifically, vascular inflammation. One review study found that participants with periodontitis had a 2.63 TIMES greater risk of stroke than those folks with better oral health.¹⁰
• Dementia. Periodontal disease and dementia—particularly Alzheimer’s, which accounts for about 80% of all cases of dementia—share many common risk factors. Not surprisingly, studies have shown a link between the two. In fact, one recent study showed that folks with periodontitis (for ≥ 10 years) were at a 70% greater risk for developing Alzheimer’s.¹¹ While it’s unclear how (or if) gum disease leads to dementia, researchers (once again) believe it comes down to persistent unhealthy levels of inflammation. This results from poor oral hygiene whereby unhealthy mouth bacteria “leak” into the body and trigger the immune system and the inflammatory cascade.¹²
• Respiratory infections. Recent studies have linked periodontal disease to various lung-related issues. For example, periodontal disease is recognized as an independent risk factor for chronic obstructive pulmonary disease (COPD). What’s more, gum disease may play a causal role in pneumonia, bronchitis, and empysema.² Researchers believe there are several potential explanations for this connection. For example, it’s possible that pathogenic bacteria may be aspirated directly into the lungs.¹³
• Joint discomfort. Believe it or not, taking care of your teeth may be a good way to take care of your joints. Periodontal disease is prevalent among folks with rheumatoid arthritis, an autoimmune condition. Research suggests that gum disease, which is thought to trigger the immune response and unhealthy levels of inflammation, may predict rheumatoid arthritis and its severity. One small study found when patients with rheumatoid arthritis and gum disease were treated for periodontal disease, they experienced significantly greater relief from rheumatoid arthritis symptoms compared to patients who were treated only for rheumatoid arthritis.¹⁴
• Mood issues and poor quality of life. If your mouth hurts, your breath stinks, or you’re missing teeth—all telltale signs of poor oral hygiene—that can take an understandable toll on your mood and quality of life. Beyond that very obvious connection, a recent study published in the journal Molecular Biology highlights this connection saying, “Dental health and ‘leaky teeth’ [more on this in just a moment] may be intimately linked to the etiology and course of depression while significantly impacting quality of life.”¹⁵ That’s a mouthful (no pun intended). But what the researchers found is that gum disease results in increased levels of endotoxins (called lipopolysaccharides, or LPS for short). LPS, which is often associated with leaky gut, triggers oxidative stress and inflammation, and research shows that major depression is typically accompanied by high levels of LPS. This highlights the importance of both the gut and the oral health and their respective microbial communities for promoting a healthy mood.
• Adverse pregnancy outcomes. Unfortunately, periodontal disease is related to several undesirable pregnancy outcomes, including maternal infection, pre-term birth, low birth weight, and pre-eclampsia. And with the above, bacteria- and immune-related (i.e., inflammation) factors are thought to be at play.²
• Obesity. What kind of list would this be without mentioning weight-management issues? Not surprisingly, there’s a noteworthy association between obesity and periodontal disease. In this case, however, it’s largely believed that obesity is a risk factor for gum disease (as opposed to the other way around). Having said that, as you’ll see momentarily, these two unwelcome conditions share quite a bit in common. For example, it is speculated that excessive oxidative stress and persistent unhealthy levels of inflammation—which play a role in the development of insulin resistance—are implicated in both conditions.¹⁶

While researchers have found that periodontal treatment significantly improves various biomarkers associated the health issues mentioned above, there is still uncertainty whether poor oral hygiene causes these problems or they share underlying “probable suspects,” such as excessive oxidative stress and unhealthy levels of inflammation. Along those lines, there’s no shortage of evidence showing there is a strong connection between periodontal disease (and poor oral hygiene) and markers of systemic inflammation.⁶

Perhaps you’re familiar with leaky gut. Well, along these lines, some scientists have recently coined the term “leaky mouth.” This may explain, at least in part, the connection between poor oral hygiene and various systemic conditions. Basically, much like a leaky gut (i.e., increased intestinal permeability) triggers the immune system, inflammation, and allows potentially harmful compounds (e.g., endotoxins) and organisms (e.g., bacteria) into the bloodstream, leaky mouth (i.e., increased gingival epithelium permeability) may allow potentially harmful bacteria into the bloodstream. This again may trigger systemic inflammation, immune dysfunction, and ultimately, various problems throughout the body.

There’s no question excessive oxidative stress and unhealthy levels of inflammation (as well as mitochondrial dysfunction and poor gut health) are linked to virtually all chronic health issues, including periodontal disease and the others mentioned above.^17,18 Understanding these common denominators is huge because they highlight the fact that poor oral hygiene may have just as much to do with an unhealthy lifestyle as it does with skipping teeth cleanings, neglecting flossing, and not brushing regularly. In other words, oral health goes way beyond brushing, flossing, and twice-a-year visits to the dentist.

Remember, problems in the mouth are an indicator of whole-body health problems. Along those lines, the very same lifestyle factors that contribute to disease can just as well be considered components of poor oral hygiene. Take, for example, the fact that being overweight or obese—typically associated with a sedentary lifestyle and less-than-stellar eating habits—seems to increase the risk (both directly and indirectly) for periodontal disease and oral health issues.¹⁹ In other words, when it comes to poor oral hygiene, we have to think outside the mouth.

Dental Plaque and the Mouth-Gut Axis

According to Nutritional Periodontist Dr. Alvin Danenberg, who I would consider among the top resources when it comes to oral health and hygiene, “Dental plaque is healthy, until it’s not.” This may come as a surprise to many, especially since dental plaque (i.e., bacterial plaque) is typically implicated as the culprit for gum disease and tooth decay. Along those lines, most of us have been told we need to eradicate all the plaque off our teeth using antimicrobial toothpastes and mouthwashes… Or we’ll be staring dental disease in the face.

But just like we now know about the significance of establishing and maintaining a healthy balance of microbes in the gut microbiome, it’s all about keeping dental plaque in a healthy state and supporting a healthy balance of microbes in the oral microbiome. NOT destroying everything in sight, so to speak. Besides the gut, the mouth contains the second most diverse microbial community in the body with more than 700 species of bacteria residing on the hard surfaces of the teeth and soft tissues of the mouth.20 Along those lines, what may be surprising to some is that good oral bacteria and healthy levels of dental plaque serve three very important functions:

1. Promote a stable pH around the teeth.
2. Help re-mineralize the tooth surface around-the-clock with beneficial nutrients.
3. Protects against pathogenic bacteria, which could potentially affect both oral and systemic health.

Again, it’s about maintaining a healthy balance of oral microbes. As Dr. Mark Burhenne says, “Contrary to what you’ve been told, the goal is not to kill, kill, kill all the germs in your mouth. Some bugs promote good health in your mouth and the rest of your body—like the heart.” According to Dr. Danenberg, there are three different stages of dental plaque:

• A good stage, which helps maintain biochemical balance around the teeth
• A bad stage, which begins the infectious process of dental decay and early gum disease (gingivitis)
• An ugly stage, which causes gingivitis to progress to periodontitis

Speaking of the gut, there’s a 45% overlap of bacteria population between the gut and oral microbiome. Considering that the mouth can be viewed as the first section of the gut, this connection shouldn’t be terribly surprising, but it is tremendously important. After all, there’s an extreme appreciation for gut health. Along those lines, this suggests that everything we might practice to support a healthy gut also applies to oral health.²¹

To Dr. Danenberg’s point, dysbiosis of the oral microbiome allows disease-promoting bacteria to manifest and lead to periodontal disease and tooth decay. As opposed to a healthy balance of oral bacteria (known as symbiosis), dysbiosis means that the diversity or relative proportions of bacterial species in the oral microbiome are imbalanced. For example, one of the most aggressive types of oral bacteria is called Porphyromonas gingivalis, and as this bug overgrows, it leads to increased production of LPS—that same endotoxin mentioned above that creates severe inflammation.

Speaking of dysbiosis, it’s becoming increasingly clear that gut dysbiosis contributes to oral dysbiosis, and vice versa.^21,22 Just like we now know the gut and brain communicate (known as the gut-brain axis), the oral microbiome talks to the gut microbiome (known as the mouth-gut axis).

And just like we know that food influences the gut microbiome, the same is true for the mouth. For instance, research shows that diets rich in refined grains and added sugars (the typical American diet, which is based on processed foods) results in overgrowth of bad bacteria in the gut and mouth. On the other hand, a diet restricting carbohydrate (particularly refined grains and added sugars) has been shown to significantly reduce markers of inflammation, including mouth-related inflammation.^23,24

Tips for Good Oral Hygiene

I know I’ve thrown a lot at you… let me boil it down to several points you’ll want to appreciate:

• Oral hygiene and mouth health is tremendously important for overall health and quality of life.
• Poor oral hygiene goes way beyond the mouth. An unhealthy balance of oral bacteria may negatively affect overall health and increase the risk of disease.
• At the very least, if not directly causative, oral health issues share some common threads with other chronic systemic diseases.
• Mouth bacteria are essential and serve very important functions. We do not want to exterminate all oral microbes. We want to promote a healthy balance of mouth bacteria.
• While standard oral hygiene practices are important, poor oral hygiene is also characterized by a bad diet and an unhealthy lifestyle.
• The gut and mouth are intricately related. Many of the strategies we practice to optimize gut health also apply to pristine oral health.

With all that under your belt, now we can get into the practical stuff. How do we nip poor oral hygiene in the bud and practice healthy oral habits? Let’s start with some fundamentals.

• Brush your teeth. Regularly brushing your teeth is a linchpin of good oral hygiene. Believe it or not, it’s estimated that only about half the population brushes their teeth twice a day. The goal of brushing is simply to remove unhealthy bacteria from around the tooth. Along those lines, you do not need any toothpaste to brush your teeth effectively according to Dr. Danenberg. If you do want toothpaste, you’ll want to skip out on products you find at the store, as they typically contain chemicals and even antimicrobial agents that can kill off potentially beneficial bacteria. Instead, use a mixture of coconut oil and baking soda. Brush your teeth gently, angling the bristles into the space where the gums meet the teeth on both the cheek and tongue sides. Brush twice a day.
• Floss and/or use interdental brushes. You’ll also want to clean between the teeth, and even though flossing isn’t much fun for most people, it’s darn effective for the job. Alternatively, you can use interdental brushes, such as the TePe® interdental brushes.
• Clean your tongue. Most of the odor-forming bacteria in your mouth is located on the top and back areas of your tongue, near your throat. According to Dr. Danenberg, one of the most effective ways to remove this overgrown bacteria and other odor-causing remnants is to scrape your tongue with a teaspoon.

  Place the inverted teaspoon as far back as is comfortable on the upper side of your tongue. Gently glide the teaspoon forward, removing the bacterial film and microscopic food particles. Repeat this 2 – 3 times, then wash off the teaspoon. Do this twice daily, in the morning and before bed.

• AVOID antimicrobial mouthwashes. Remember, we don’t want to kill all the bacteria in our mouths. We simply want to support a healthy balance of oral microbes. Most mouthwashes kill bacteria indiscriminately, upsetting the delicate balance of bacteria, which can increase the likelihood of tooth decay, gum disease, and systemic health problems. For example, healthy mouth bacteria play an important role in the body’s production of nitric oxide (via the nitrate-nitrite-nitric oxide pathway), which is critical for cardiovascular health and blood pressure (among other things). In fact, research has shown using antimicrobial mouthwash for just three days significantly reduces nitric oxide production and increases blood pressure.²⁵ Additionally, research has shown that regular use of over-the-counter mouthwash significantly increases the risk of pre-diabetes and diabetes.²⁶
• Be careful with oil pulling. Some people practice oil pulling, which essentially involves swishing coconut oil around in your mouth for up to 20 minutes. The rationale? Coconut oil contains natural antimicrobial agents (e.g., lauric acid). In fact, one study showed it was just as effective as a standard antimicrobial mouthwash at killing off bad mouth bacteria.27 But, just like mouthwash, we want to be very cautious with coconut oil, which may kill off bacteria indiscriminately. If you do practice oil pulling, you’ll want to do it only occasionally, and you’ll want to keep it to just a minute or two. And, remember, spit the oil into a paper towel or napkin, not the drain where it could clog the pipes.

After reading through that list, how do you stack up? Would you say you have good or poor oral hygiene? As I alluded to, the above is only the foundation of maintaining the proper environment in the mouth. There are several other key components of good oral hygiene that bear mentioning:

• Eat a nutrient-dense anti-inflammatory diet. We want to support healthy levels of inflammation and support the body’s ability to manage oxidative stress. We want to provide the body with microbiome-friendly nutrients. And we want to starve unhealthy bacteria of the junk (e.g., refined grains; added sugars; refined, bleached, and deodorized vegetable oils) they need to proliferate.
• Supplement with probiotics. We’ve talked about the importance of fortifying and maintaining a healthy microbiota—both in the gut and in the mouth—and both probiotics and prebiotics are essential. In terms of the former, spore-forming probiotics have been shown to be very effective at improving the body’s balance of bacteria, promoting healthy levels of inflammation, and even reducing leaky gut-related symptoms.²⁸ Bacillus subtilis, which is found in Pro-X10, is a good option.
• Fertilize healthy bacteria with prebiotics. Prebiotics essentially serve as “food” for the body’s healthy bacteria. They further promote a healthy microbial balance by supporting the reduction of potentially pathogenic bacteria. Eating a nutrient-dense microbiome-friendly diet is a huge step in the right direction, and most people will do well with additional prebiotic support. MetaboGreens is a nice option because it not only contains prebiotic fibers, it also provides a robust array of plant-based polyphenols, which we now know can have beneficial prebiotic-like effects on the microbiota.
• Manage stress. Stress can have both direct and indirect effects on oral health (and of course, overall health). For starters, stress reduces the flow of salivary secretions, which in turn can enhance the formation of unhealthy levels of dental plaque.² We also know stress can do a number on gut health and digestion. For example, stress contributes to gut dysbiosis and leaky gut. Of course, stress can also negatively impact food choices. Practice mindfulness, meditate, do yoga, take a walk outdoors, practice breathing exercises, set boundaries, and take care of yourself all in an effort to reduce/manage stress.
• Prioritize restorative sleep (with your mouth SHUT). We’ve talked a lot about sleep hygiene and the importance of circadian rhythms for overall health. Not surprisingly, that all applies here as well. Dr. Mark Burhenne often talks about the importance of nasal breathing over mouth breathing. In fact, he encourages mouth taping at night during sleep. Why? Nasal breathing is important for nitric oxide production. The body produces 25% of its nitric oxide from nose breathing. Dr. Burhenne also suggests that mouth breathing can lead to dry mouth, which impedes remineralization (the saliva bathes the teeth in minerals), makes the pH of the mouth more acidic, and can also cause bad breath. If you’re interested in trying mouth taping, check out SomniFix®.
• Intermittent fasting and regular exercise. These are potentially beneficial tools to add to the oral hygiene toolbox because they help promote mitochondrial health and function, support a healthy microbiota, support the body’s management of oxidative stress, and promote healthy levels of inflammation—to name just several of the many upsides. Don’t have time to exercise? Consider high-intensity interval training and circuit training.

Poor Oral Hygiene and Health: A Recap

Thanks for sticking with me through all of this. I know there’s a lot to sift through here, but I hope you found it the least bit enlightening and helpful. Appreciate that good oral hygiene goes beyond brushing and flossing (although those are important), and your diet and lifestyle choices can have tremendous effects on the health of your mouth, which in turn can have an enormous impact on the rest of your body. On the other hand, poor oral hygiene can be the trigger to a litany of health problems that go way beyond your mouth.

If you’re interested in digging into this topic in more depth, here are a few resources I recommend:

• Nutritional Periodontist Dr. Alvin Danenberg’s blog and book Crazy Good Living! Healthy Gums, Healthy Gut, Healthy Life.
• Dr. Steven Lin’s blog. Dr. Lin is known as “The Functional Dentist.” He believes a functional approach (incorporating a healthy diet and lifestyle) is key to a healthy mouth.
• Dr. Mark Burhenne’s Ask the Dentist website.