Oral Bacteria

Reviewed By: Kathryn Gilliam, BA, RDH, FAAOSH

Date: September 19, 2019

The new model of Periodontal Disease?

Polymicrobial Synergy and Dysbiosis (PSD)

“This refers to the entire colony of multiple different bacteria (polymicrobial)  working together (synergy) to initiate periodontal disease (dysbiosis) rather then by a few select bacteria known as ‘periodontal pathogens’.” Kathryn Gilliam; A paradigm shift that will change clinical practice.

RED COMPLEX BACTERIA:

Aggressive, transmittable, tissue invasive,

Must be treated with Laser, Antibiotics, Ozone Therapy (or another adjunctive therapy),

SRP alone does not kill the bacteria that has invaded the tissue,

ALL of the salivary tests will identify these pathogens.

Porphyromonas gingivalis

Key concerns:

Amplifies the pathogenicity of other bacteria (change change “benign” bacteria into pathogens, impairs host immunity, difficult to eradicate

Oral signs/symptoms:

Periodontal Disease (PD)

Systemic Signs and Symptoms:

CAUSAL: CVD and possibly Alzheimers. Associated with: RA, infertility, aspiration pneumonia, cancer, dementia, Low birth weight, diabetes, macular degeneration

Tannerella

forsythia

Key concerns:

Initiates connective tissue destruction and alveolar bone resorption

Oral signs/symptoms:

Aggressive and Chronic Periodontal Disease (PD), Gingivitis

Systemic Signs and Symptoms:

Increased risk of MI, increase in total cholesterol, atherosclerosis

Treponema

denticola

Key concerns:

Tissue invasive spirochete

Oral signs/symptoms:

Periodontal Disease (PD)

Systemic Signs and Symptoms:

CVD, Alzheimer’s disease, low birth weight

ORANGE COMPLEX BACTERIA:

ALL of the salivary tests will identify these pathogens.

Prevotella intermedia

Key concerns:

Virulence properties similar to Pg

Oral signs/symptoms:

Acute necrotizing ulcerative gingivitis, dental abscesses, pregnancy gingivitis, Periodontal Disease (PD)

Systemic Signs and Symptoms:

CVD, Increased risk of MI, bacterial vaginosis, nasopharyngeal infection, intra-abdominal infection

Peptostreptococcus micros

Key concerns:

Oral signs/symptoms:

Periodontal Disease (PD)

Systemic Signs and Symptoms:

Gastrointestinal infections, genitourinary infections

Fusobacterium nucleatum/

periodonticum

Key concerns:

Increases blood vessel permeability; increased abundance in smokers

Oral signs/symptoms:

Periodontal Disease (PD) and endodontic infections

Systemic Signs and Symptoms:

Ulcerative colitis, colorectal cancer, appendicitis, inflammatory bowel disease, atherosclerosis, cerebral aneurysm, Rheumatoid arthritis, Alzheimer’s disease, preterm birth, preeclampsia, neonatal sepsis, lemierre’s syndrome, respiratory tract infection, mastoiditis, chronic otitis, sinusitis, tonsillitis

ORANGE ASSOCIATED COMPLEX:

Campylorbacter rectus

Key concerns:

Oral signs/symptoms:

Periodontal Disease (PD)

Systemic Signs and Symptoms:

CVD, Low birth weight, pre term birth

Eubacterium nodatum

Key concerns:

Colonizes more in smokers than in non-smokers; colonizes on inanimate objects such as orthodontic appliances and implants

Oral signs/symptoms:

Periodontal Disease (PD) and peri-implantitis

Systemic Signs and Symptoms:

Infections and Pelvic inflammatory disease

GREEN COMPLEX:

Eikenella corrodens

Key concerns:

Oral signs/symptoms:

Periodontal Disease (PD)

Systemic Signs and Symptoms:

Osteomyelitis, meningitis, endocarditis, neonatal sepsis

Capnocytophaga species

Key concerns:

Oral signs/symptoms:

Periodontal Disease (PD) and root caries

Systemic Signs and Symptoms:

Bacteremia, endocarditis, pericardial abscess, coronary heart disease, lung infections, bone infections, peripartum infections or preterm birth, low birth weight, neonatal sepsis

Aa COMPLEX:

Must be treated with Laser, Antibiotics, Ozone therapy, or another adjunctive method.

Aggregatibacter actinomycetem-

comitans

Key concerns:

Oral signs/symptoms:

Periodontal Disease (PD) and Juvenile PD

Systemic Signs and Symptoms:

Aspiration pneumonia, infective endocarditis, bacterial vaginosis, rheumatoid arthritis, low birth weight

MISCELLANEOUS :

Streptococcus mutans

Notes:

OraVital® salivary test will identify, as well as a number of chair side tests (see “cavities” page)

Oral signs/symptoms:

Caries, biofilm initiator

Systemic Signs and Symptoms:

CVD, prosthetic joint infections

Candid albicans

Notes:

OraVital® Salivary test will identify

Oral signs/symptoms:

Childhood decay, peri-implantitis, soft tissue infections, angular chilitis

Systemic Signs and Symptoms:

Yeast Infections

Interleukin 6 (Il-6) Gene

Notes:

OralDNA® will identify. Clove essential oil may reduce inflammation associated with Il-6

Oral signs/symptoms:

Greater risk of PD

Systemic Signs and Symptoms:

Greater risk of heart disease, cancer and arthritis

Key concepts:

Associated: There appears to be some relationship between the oral/systemic systems, but a cause and effect relationship has not been proven.

Causal: PD causes disease (ex. Cardiovascular disease)

Bidirectional: PD causes the disease and the disease causes PD (ex. Diabetes type 2 and Rheumatoid arthritis)

Laser Therapy: the Laser is able to penetrate the soft tissue (to kill the microbes) as well as degranulate the diseased epithelium (when the tip is initiated). Check with your state’s Practice Act to determine if this is within your scope of practice. Use code D4999 (unspecified perio) with a narrative.

Ozone Therapy: Use code D4999 (unspecified perio) with a narrative.

 

A closer look at the three most common Salivary Tests available…

 

Specific Suggestions are in the “Members Only” Section

 

Print off the “Oral Bacteria” PDF under Patient Education, for a great resource that will help your patient understand the necessity of salivary testing!

Ms. Gilliam’s Perspective…

We all have different views on rinses and antibiotics, Kathryn has extensive training in Oral/systemics and the oral micro biome, and therefore a perspective worth sharing. Here are her thoughts on certain “hot topics”

Systemic Antibiotics: See “Members Only” Section

Avoid [this mouth rinse]. “The pH is very low and the alcohol content is very high. I have found it to be drying and than when my patient are faithful users of [this brand], and other over the counter rinses, they still have active periodontal infection and inflammation. The clinical evidence tells me it doesn’t work as advertised.” (See “Member’s Only for the brand name of the mouth rise she recommends avoiding)

“My favorite Rinses are the Chlorine Dioxide rinses (CloSYS®, Oxyfresh® and OraCare™). Chlorine dioxide is a strong oxidizer and it effectively kills pathogenic microorganisms such as fungi, bacteria and viruses. It also prevents and removes biofilm. When my patients use these oral rinses, I see a reduction in inflammation as evidenced by a decrease in or complete elimination of bleeding.”

Remember, when you educate your patient, use code D1330.

SOME BACTERIA ENTER DIRECTLY INTO THE BLOODSTREAM, (THROUGH A BLEEDING POCKET) REACHING EVERY PART OF OUR BODY

EXAMPLES OF BACTERIA THAT ENTER OUR BLOODSTREAM DIRECTLY:

  • Porphyromonas gingivalis 
  • Fusobacterium nucleatum
  • Tanerella forsythia 
  • Treponema denticola 
  • Prevotella intermedia
  • Aggregatibacter actinomycetemcomitans 

BACTERIA MAY CAUSE

  • CAUSAL FOR CARDIOVASCULAR DISEASE (Stroke, heart attack, etc)
  • Preterm birth
  • Adverse Pregnancy Outcomes (preterm birth, pre-eclampsia, etc)
  • Diabetes type 2
  • Chronic obstructive pulmonary disease
  • Osteoporosis
  • Kidney Disease
  • Rheumatoid Arthritis
  • Increased rates of Cancer and more aggressive forms (Prostate, kidney, Colon, esophageal, etc)
  • Prostatitis
  • Brain Abscess
  • Inflammatory Bowel disease

 

Remember from Statistics, Association does not mean Causation (research is ongoing).

ORAL BACTERIA TRIGGERS INFLAMMATION

EXAMPLES OF BACTERIA THAT TRIGGER THE INFLAMMATORY PROCESS

  • Porphyromonas gingivalis
  • Fusobacterium nucleatum
  • Tanerella forsythia
  • Treponema denticola
  • Aggregatibacter actinomycetemcomitan

* Red Complex bacteria

There is a lot of overlap between the bacteria that trigger inflammation and the bacteria that enter our bloodstream directly.

CHRONIC INFLAMMATION MAY CAUSE

  • Cardiovascular disease
  • Type 2 Diabetes
  • Rheumatoid Arthritis
  • Alzheimers
  • Autoimmune Diseases
  • Pulmonary Diseases

The link between CVD/Diabetes with Periodontal Disease is so strong, that in some cases medical insurance will pay for Perio therapy in the dental office (though you need to know how to bill). See the Coding page for more info.

ORAL BACTERIA IS SWALLOWED

EXAMPLES OF BACTERIA MAY TRIGGER DISEASE IN OTHER PARTS OF THE GI TRACT

  • Klebsiella pneumoniae
  • Klebsiella aeromobils

BACTERIA THAT IS SWALLOWED MAY CAUSE

  • Crohn’s Disease (in susceptible individuals)

BACTERIA ENTERS THROUGH CAVITIES

EXAMPLES OF BACTERIA THAT MAY CAUSE AN INFECTION THROUGH THE TOOTH

  • Streptococcus mutans
  • Prevotella nigrescens

BACTERIA THAT ENTERS OUR BODY THROUGH OUR TEETH, MAY CAUSE

  • Painful, localized infection at the root of the tooth
  • An infection that spreads and may become life-threatening (every so often the news reports a child that had died from such an infection)
  • S mutans is Causative of Heart Attack and maybe stroke!

BACTERIA ENTERS THROUGH OUR RESPIRATORY SYSTEM

EXAMPLES OF ORAL BACTERIA THAT MAY CAUSE AN INFECTION IN OUR RESPIRATORY SYSTEM​

  • Aggregatibacter actinomycetemcomitans
  • Streptococcus sobrinus
  • Porphyromonas gingivalis

BACTERIA THAT ENTERS OUR BODY THROUGH OUR RESPIRATORY SYSTEM MAY CAUSE

  • Recurring Pneumonia (especially common in the elderly, or immunocompromised or on ventilators).

PROBIOTICS FOR THE ORAL CAVITY

PROBIOTICS MAY MINIMIZE THE BAD BACTERIA

  • Streptococcus salivarius (Strains DSM 14675, BLIS K12, BLIS M18, DSM13084)
  • ​Lactobacillus acidophilus may help, depending on the strain (this is more research based and not commercially marketed yet)

Probiotics available specific to oral health:

EvoraPro

Zymogen (currently reformulating)

PlaqueHD

And many more…

 

The specific strain of probiotics matters!

Read this study (“Streptococcus salivarius MS-oral-D6 promotes gingival re-epithelialization in vitro through a secreted serine protease“) to see how different strains of the same bacteria had different results in gingival re-epithelialization. The more reputable brand of probiotics will inform you what stain of bacteria their product contains.

Interested in more information?

Check out the American Academy of Oral Systemic Health, www.AAOSH.org.

“Beat the Heart Attack Gene” Bradley Bale, MD, and Amy Doneen,ARNP, or visit  their website www.baledoneen.com.

“The Dental Diet” Dr Steven Lin, or visit his website at www.stevenlin.com

Tailored Treatment: Evaluation of Salivary Diagnostics” Rebecca Comstedt, article in RDH Mag (10/18)

 

Tools for the office?

Salivary testing. See the Patient Education page for a printable PDF that compares the two most common tests available.