When I first began noticing that my older patients who were in excellent health had “gums of a 16 year-old,” I knew that oral health and overall health were connected....
The Oral Microbiome: Mucosal Integrity and the Systemic Consequences of Oral Dysbiosis
“The healthy human mouth is one of the most heavily colonized parts of the body containing hundreds of different bacterial, viral, and fungal species.” Under normal conditions, the oral microbiome exists in a symbiotic relationship with the host and offers beneficial effects to the host similar to the other areas of the body such as the gastrointestinal tract. Some of these beneficial effects include: resistance to colonization by pathogens, support of host immune function, anti-inflammatory and antioxidant support and metabolic regulation and control. The oral mucosa provides a favorable niche for many microbial species, but it’s the responsibility of the host immunity to differentiate pathogenic microbes from commensal. “Other secondary and local oral immune effectors play an important supportive role in providing mucosal protection, such as the salivary antibody secretory immunoglobulin A (sIgA), which acts in non-inflammatory mediated neutralization of microbes, a phenomenon termed ‘immune exclusion’.
The Role of sIgA
Secretory IgA is the principle immunoglobulin on the mucosal surfaces of the body. “Secretory IgA serves as the first line of defense in protecting the intestinal epithelium from enteric toxins and pathogenic organisms. Through a process known as immune exclusion, sIgA promotes the clearance of antigens and pathogenic organism from the intestinal lumen by blocking their access to epithelial receptors, entrapping them in the mucus, and facilitating their removal by peristaltic and mucocilliary activity.” “From a more global immune surveillance’s point of view, the mucosal immune system, including sIgA, must constantly monitor the environment and maintain a balance between tolerance to normal microbiota and immunity to microbial pathogens while the systemic immune system is designed to vigorously react to any foreign antigen of microbe. Down modulation of sIgA associated with stress can have negative repercussions on intestinal function and integrity, as well as oral mucosal function and integrity.
“Deficiency of sIgA is the most common immunodeficiency.” Low levels of IgA allow for more susceptibility to infection, and may be the fundamental cause of asthma, autoimmune disease, candidiasis, gluten sensitivity, chronic infections, and food allergies. High levels of sIgA are found in individuals with chronic infections (e.g. CMV, EBV, and HIV) and whose immune system is overloaded. High levels of sIgA are also associated with rare medical conditions such as Berger’ nephropathy and IgA neoplasms.
Diseases Associated with Low sIgA
|Allergy||Asthma, atopy, eczema|
|Autoimmunity||Rheumatoid arthritis, ITP, hemolytic anemia, pernicious anemia, systemic lupus erythematosus, Still’s disease, transfusion reactions due to anti-IgA antibody, dermatomyositis, vitiligo, Sjogren’s syndrome,
Henoch-Schonlein syndrome, primary biliary cirrhosis, autoimmune hepatitis
|Respiratory tract||Recurrent sinopulmonary infections, sarcoidosis, pulmonary hemosiderosis|
|Gastrointestinal||Giardia, Crohn’s disease, ulcerative colitis, nodular lymphoid hyperplasia, celiac disease, lactose intolerance, malabsorption villous atrophy, achlorhydria, cholelithiasis|
|Neurological||Seizures, migraine, sensory neuropathy, myasthenia gravis, cerebral vasculitis|
|Familial history of hypogammaglobulinemia||Common variable immunodeficiency|
|Endocrinopathy||Thyroiditis, Graves disease, idiopathic Addison’s disease, diabetes mellitus, 21-hydroylase deficiency|
|Chromosomal abnormalities||Chromosome 14|
|Malignancy||Gastric carcinoma and lymphoma|
Systemic manifestations of oral diseases
An unbalanced oral microbiome has been known to be detrimental to general health in particular, systemic disease. “New studies reveal increased incidence of coronary heart disease and stroke linked to high incidence of periodontal bone loss.” Oral manifestations are encountered with higher frequency in autoimmune conditions and are often the first clinical signs or symptoms. Aside from cardiovascular disease and autoimmune disease, periodontal disease has also been linked to diabetes, adverse pregnancy outcomes and respiratory diseases.
Initial periodontal tissue inflammation, which is called gingivitis, and its pathology, can be resolved by removal of dental biofilms (plaque). On the other hand, continuous existence of stable plaques, including accumulation of opportunistic bacterial species, supports long-lasting inflammation, creating a shift in the periodontal microbiome leading to periodontal disease with its associated manifestations. The proposed mechanism of systemic manifestations of oral dysbiosis is that periodontal infection leads for the production of inflammatory mediators, which can enter the blood stream along with bacteria creating an inflammatory response and tissue damage at distant sites. “However, the exact mechanisms by which oral pathobionts have effect on both cytokine network and autoimmunity remain obscure.”
It is clear that there is a link to an alteration of the oral microbiome and salivary sIgA to systemic disease. As with most chronic disease, addressing stress reduction is paramount in restoring an appropriate immune response, and therefore proper level of sIgA. It is also clear that maintaining a healthy oral microbiome by the reducing of biofilm accumulation and achieving the proper balance of microorganisms can reduce the incidence of systemic disease.
One of the tools I have used in my practice are botanical combinations that are biofilm disrupting. University studies on both sIgA and biofilms for the Dentalcidin™ combination developed at Bio-Botanical Research are compelling, with 66% increase in salivary sIgA 30 minutes post application.
Pilot studies using Phase Contrast microscopy performed after 6 weeks of use showed dramatic clearance of plaque, which included bacteria and spirochetes.
DNA analysis of Root Canal cavitations also indicated the benefit of using liposomal botanicals in the Dentalcidin™ oral care solution as an adjunct in treatment.
References and Endnotes
 Sultan AS, Kong, EF, Rizk AM, Jabra-Rizk MA. The Microbiome: A lesson in coexistence. PLoS Pathog. Jan 2018; 14(1): e1006719.
 Mantis NJ, Rol N, Corthésy B. Secretory IgA’s complex roles in immunity and mucosal homeostasis in the gut. Mucosal Immunology. November 2011; Vol. 4 (6): 603 – 611.
  Campos-Rodriguez R, Godinez-Victoria M, Abarca-Rojano E, Pacheco-Yépez J, Reyna-Garfias H, Barbosa-Cabrera RE, Drago-Serrano ME. Stress modulates intestinal secretory immunoglobulin A. Frontiers in Integrative neuroscience. December 2013; Vol.7 (86): 1 – 10.
 Lipski E. Digestive Wellness. Los Angeles: Keats Publishing; 2000. p. 123.
 Babu NC, Gomes AJ. Systemic manifestations of oral disease. J Oral Maxillofac Pathol. 2011 May-Aug; 15(2); 144-147.
 Mays JVV, Sarmadi M, Moutsopooulos NM. Oral manifestations of systemic autoimmune and inflammatory disease: diagnosis and clinical management. J Evid Baased Dent Prat. 2012 Sep;12(3 Suppl): 265-82.
 Kriebel K, Hieke C, Muller-Hilke B, Nakata M, Kreilkemeyer B. Oral Biofilms from Symbiotic to Pathogenic Interactions and Associated Disease-Connection of Periodontitis and Rheumatic Arthritis by Peptidylarginine Deiminase. Frontiers in Microbiology. Jan 2018; Vol.(9): Article 53.
Dr. Wayne Sodano is a Board Certified Chiropractic Internist, Diplomate of the American Clinical Board of Nutrition, Certified Functional Medicine Practitioner, and is Board Certified in Traditional Naturopathy. He is a former instructor of the DABCI program and currently dedicates his time to research and development in the areas of integrative and functional medicine as the Director of Medical Education at the College of Integrative Medicine (www.CollegeofIntegrativeMedicine.org). He frequently lectures live through other venues both nationwide and internationally. Dr. Sodano is also creator of iMedLogics (www.iMedLogics.com), a comprehensive health history analysis and patient management software program.