Does Disease Start in the Mouth, the Gut or Both?

Many people will say it begins in the gut. The Greek physician Hippocrates – also widely known as the Father of Modern Medicine, is famous for saying: “All Disease Begins in the Gut.” But I say the mouth comes before the gut! Oral bacteria colonize the gut more frequently than previously thought.

Let’s start with the mouth. After over 35 years in the dental field, I see how health starts from the top down. I am still a bit perplexed as to why we are not talking about the nose and mouth more when it comes to overall health and wellness. We talk about diet and exercise, and both of these are billion-dollar industries.

Oral hygiene plays a critical role in whole-body health that is sadly overlooked by most doctors. For what we eat, most people have to pass through our mouth, and we need to breathe through our nose to get the proper nitric oxide co2 exchange in our body during exercise.

Modern medicine tends to think of dentistry and disease as being in two different realms. Because we separate dentistry and disease in this way, most people aren’t aware of the oral-systemic link. The oral-systemic link is the unique relationship between oral health and total body health that suggests the earliest signs of disease are evident in the mouth – what we call a mouth full of evidence.

The Oral Systemic Link

I have worked in dental finals since I was 16 years old. It has been quite the evolution of learning so many things that we were not taught in school about the body and how it functions. After seeing patterns and trends of well over 50,000 patients, I believe health starts with our mouth, nose, and tongue.

I have always known the mouth has an important function in our survival, yet I never really gave it much thought. As I saw patients for many years, I just looked at their teeth and gums for cavities, gingivitis, and gum disease taught them how to brush and floss, and sent them on their way till the next visit.

After about five years, I began to see patterns in patients’ medical histories and the condition of their teeth. I saw the mouth-body connection, especially with diabetic patients. Their sugar levels were off, and their gums were inflamed 95 % of diabetic patients have gum disease. This was when I started asking more questions and looking at Why? Why do some patients that have not been to the dentist for ten years have no dental disease? How is it that patients that go every three months to brush and floss have a rampant disease and others who rarely take care of their mouth are free from dental disease?

What is actually the cause of dental disease? We teach people they need to brush, floss, and visit their dentist at least twice a year to have a healthy mouth free from disease. Home care is merely a piece of the puzzle. The nose, mouth, gut, saliva, pH, and microbiome all play a role and are key to overall health and healthspan.

Yet the oral-systemic link remains a foreign concept to most people; it has been known, studied, and written about since the early 1900s. This uniquely intertwined relationship between the mouth and disease is highlighted best in a 2013 study that assessed patients who suffered from stroke or heart attack. It conducted DNA testing on the bacteria that caused the clots resulting in stroke and heart attack. In every case – 100% of the time – the clot-causing bacteria was proven to have come from the mouth. This is the oral-systemic link. It shows that the mouth and the rest of the body are intertwined way more than first thought. Further confirming what happens in the mouth impacts the entire body.

This leads me to ask why we are not looking at more when we do routine dental exams.

The Mouth An Ideal Incubator for Disease

The oral cavity is a perfect breeding ground for microorganisms.

Cavities and gum problems that occur early in life are just the beginning of chronic low-grade inflammation affecting the gums, known as gingivitis.

9-17% of children between the ages of 3-11 have some form of gingivitis; this number increases to 70-90% when they reach puberty. Again, why?

Gingivitis occurs when dental plaque stimulates an immune response in the soft tissues surrounding the teeth. The gums become inflamed and irritated, appearing swollen and red and bleeding easily. If gingivitis is left untreated, it may progress to periodontitis, a condition in which Gram-negative bacteria destroy the supportive structures of the teeth. Periodontitis may ultimately lead to tooth loss.

If not treated, the inflammation affecting the gums has also been implicated in the promotion of a variety of systemic disorders, such as coronary heart disease, diabetes, arthritis, and even cancer.

Oral inflammation has also been clearly linked to elevated markers of inflammation, like C-reactive protein.

In response to these warning signs, scientists have noted the growing evidence of the link between periodontal disease and several systemic diseases.

Mouth breathing, pH, bacteria, and other microorganisms are the underlying cause of dental disease.

Furthermore, a recent study by researchers at the Harvard School of Public Health tentatively concludes that periodontitis is associated with an increased risk of one of the most deadly cancers, compared with no periodontal disease. History of periodontal disease was associated with increased pancreatic cancer risk.

The American Dental Association agrees that “oral health is important for overall health” and indicates that salivary diagnosis may offer a key tool in health assessments.

Pathogens can be measured in saliva, making it an excellent candidate for rapid and early detection of biomarkers that cause disease.

Given the potentially lethal risks of poor dental hygiene, it makes sense to utilize all the science available to prevent even the smallest problems in the mouth before they turn into big ones.

Different sites inside and on the surface of the body are home to distinct ecosystems of bacteria.

Most of what we put in our body has to pass through the mouth first. We don’t put anything directly into the gut. Now let’s take a look at the process that our food goes through.

In order for our body to digest the food we eat, absorb the essential nutrients, and eliminate any waste efficiently — essential processes need to occur by specific organs that make up the digestive system, each with its own job and responsibilities. Starting with the mouth and our saliva.

Digestion starts in the mouth. Last week we talked about saliva and digestive enzymes. Last week we talked about the importance of saliva. This week we are going to break digestion down.

What is the digestive system?

The digestive system is made up of the gastrointestinal tract—also called the GI tract or digestive tract—and the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine, and anus. The liver, pancreas, and gallbladder are the solid organs that support the digestive system.

The gut is a complex system where digestion and nutrient absorption begins. Through an orchestrated process that starts in the mouth and ends in the colon, foods are first chewed, stimulating saliva, and then further broken down with stomach acid, enzymes, and bile. Most digestion takes place in the small intestine, which delivers nutrients to the liver and the conversion into glucose and protein begins.

Peristalsis is the involuntary movement of food through the digestive tract and is an essential part of the digestive process. It occurs in multiple organs during several stages of digestion. Another thing that happens in our bodies we do not give much thought to.

Here’s an overview of how the gut works:

Mouth: Digestion begins in the mouth with the act of chewing food. Saliva is a digestive juice that adds moisture to help move the food more easily, and it contains an enzyme that begins to break down the food.
Esophagus: Once you swallow, peristalsis continues to push food down the esophagus and into the stomach. The brain signals the muscles to transport food and liquid through the system.
Lower esophageal sphincter: This is a ringlike muscle/valve at the end of the esophagus. The brain sends a signal for the sphincter to relax that allows food to pass into the next area: the stomach.
Stomach: Muscles mix the food and liquid with stomach acid and enzymes to form a thick, partially digested mixture known as “chyme,” ready to move into the small intestine for the next stage.
Small intestine: This is where digestive enzymes and bile are released from the pancreas and liver to continue the digestive process. Digested nutrients and water are absorbed into the bloodstream through the small intestinal walls, and any waste products move into the large intestine.
Large intestine: This is where any waste products, including undigested food, fluid, and other cells from the digestive process, are collected. The large intestine absorbs water, changes the waste into the stool, and peristalsis moves the stool into the rectum to be eliminated during a bowel movement.

What Is Gut Health?

If Hippocrates was correct, keeping your gut healthy is the key to wellness. If you aren’t absorbing key nutrients, your body requires daily to function; you can develop deficiencies that may lead to ongoing health challenges. Your gut needs a healthy balance of friendly bacteria to protect against more harmful invaders like viruses, fungi, and unfriendly bacteria.

What Hippocrates did not mention is the mouth’s role in the balance of bacteria as the food passes through on its way to the gut. I am hoping you are connecting the dots and seeing how important the health of your mouth is in this process.

While a digestive upset is relatively common, persistent symptoms could be a sign of an underlying issue that needs further attention.

Here are some Signs your gut might not be healthy:

Abdominal pain
Bloating and gas
Constipation or loose stools
Heartburn
Bad breath
Bleeding gums
Vomiting
Nausea

Causes of Gut Challenges

If you experience persistent symptoms or more severe digestive upset, it could be a sign that you have GI distress or lifestyle patterns that can affect your gut’s ability to digest food and absorb nutrients. According to the Cleveland clinic, one or more of the following may contribute to an unbalanced gut:

Irritable bowel syndrome (IBS)
Hemorrhoids
Colon polyps
Colitis
Eating a low-fiber diet
Lack of exercise
Changes in routine
Common food sensitivities, including gluten and dairy
Stress
Overuse of laxatives
Antacids that contain aluminum or calcium
Taking antidepressants, iron, or narcotic painkillers
Pregnancy

I am going to add two more not on the list: mouth breathing and tongue thrust swallow. If you are mouth breathing, it dries out the mouth reduces the saliva, which in turn affects digestion and If you have a swallow where your tongue goes forward, you can be getting air into your stomach, which can cause gas and changes in the microbiome.

The human mouth is home to literally billions of bacteria that are constantly seeking to invade more deeply into our tissues. In order to fend off the “bad bugs,” our bodies fight back using a host of immune defenses such as white blood cells and inflammatory signaling molecules called cytokines that increase blood flow and the delivery of oxygen to help in the fight.

When the inflammatory process gets out of hand, or if the germs begin to win the battle, trouble soon follows. Our gums are so lavishly supplied with blood flow both the by-products of inflammation and even the bacteria themselves can rapidly enter the bloodstream, setting the stage for disaster and the disease process.

Oral Hygiene is not just a battle against plaque and having straight white teeth. Taking control and ownership of your health starts with knowing what is going on in your mouth and your body. We take our health for granted until we no longer have it!

You get to choose what you spend your money on. Health and prevention are not sexy and are a passing thought for many of us. We generally don’t give much thought to our body until there are symptoms that need to be addressed. We all have intuition. When we pick up something we know is not healthy, a small thought pops into our head, saying should you eat that? We shrug our shoulders, think, but it tastes so good and put it in our mouths. I am guilty, especially when it comes to donuts. I know sugar feeds cancer and makes my stomach ache, yet sometimes I just can say no.

Only you know what is right for you. Everybody is different. What affects me may not have the same effect on you. Learn to listen to your body and test early.

Finding Your Baseline

There are tests that can be done to give you a baseline before your body exhibits signs or symptoms. They tell you what bacteria you have, good or bad. What is your body lacking? What do you need to give it to not only keep you healthy but thrive?

If you are experiencing ongoing discomfort relating to your mouth and or gut, it is imperative to find the root cause.

You can do this through simple at-home lab testing, saliva, hair, and urine you can assess what bacteria are present and how well your gut is functioning by highlighting any digestion and absorption issues. Finding out what might be out of balance in the body, you will get a clear understanding of how well your body is doing from the inside out.

Once you know your body’s baseline, you can begin to make the appropriate changes to your diet and lifestyle that support optimal wellness in the most beneficial way for you.

What can you do to take action?

You can take tests to establish a baseline for you and your family. Saliva testing to see what bacteria are present in your mouth, poop testing to see what you are or are not absorbing, Hair samples to see if you have heavy metals in your system, and blood tests to see where your body is deficient.

It all starts with knowledge and sharing that knowledge; a healthy mouth is a healthy body and a longer, happier, healthier life.

I have you covered on saliva testing, and I have two friends that can help with the other testing.