When the topic of oral health comes up, most people think about brushing and flossing, but there’s more to oral care than that: How often do your customers think about the oral microbiome?

The mouth, according to a paper titled Oral microbiome: Unveiling the fundamentals, has the second largest and diverse microbiota in the human body, after the gut (1). It contains over 700 species of bacteria. The authors of the paper note that the mouth has plenty of places where a variety of microorganisms, ranging from fungi to protozoa, can grow: teeth, tongue, cheeks, tonsils, and the hard and soft palate. The mouth maintains a steady temperature ideal for bacterial growth, and saliva maintains a favorable pH, while serving as a medium for the transportation of nutrients to microorganisms. All surfaces are covered in a bacterial biofilm.

An imbalance in this microbiome, according to Mark Burhenne, DDS, blogger at AsktheDentist.com, can result in inflammation, illness, and disease, which occur in the forms of tooth decay, gingivitis, oral thrush, and more, although it’s also possible for an imbalance to impact gut and overall health (2). Burhenne cites a 2019 study in the Journal of Oral Microbiology that found that bacterial populations in the mouth can make their way to the gut microbiome, potentially altering immune responses and leading to systemic diseases. Caring for this microbiome is important—and yet, Burhenne notes that people are rarely taught about it: “Instead,” he writes, “we’re told to disinfect, sanitize, and ‘clean’ the mouth” (2).

Burhenne has several suggestions for the maintenance of the oral microbiome, starting with “getting rid of our sugar addiction” (2). Carb-rich diets, he says, create plaque buildup that contributes to dysbiosis on the oral microbiome, contributing to problems ranging from cavities to heart disease. Sugar intake also lowers the pH of the mouth, making it more acidic, contributing to the demineralization of teeth while selecting for certain bacteria that like acidic environments and create more acid. A more acidic environment allows S. mutans and yeast to take over, eventually causing cavities. A good diet for oral health, Burhenne suggests, includes mineral-rich foods, healthy fats, non-starchy veggies, lots of water, and sugar-free gum (2). Consumers can look for gum with xylitol, which can help remineralize the mouth (2). One option there would be Spry Dental Defense System, which sells xylitol-based gum and toothpaste.

Maintenance also involves the usual brushing and flossing: Tom’s of Maine, which lists all ingredients on the label, is a great option to provide; Spry, as mentioned, sells natural, xylitol-based products; customers with kids may appreciate an option like NOW Solution’s Kids Toothpaste Gel, a xylitol-based, SLS-free gel that comes in flavors like Orange Splash. Maintenance, for many, involves mouthwash—but there are lots of dentists who advise against that. Steven Lin, DDS, writes on DrStevenLin.com that “Many conventional mouthwashes hurt your oral flora and can actually make your breath worse” (3). The claim “kills 99.9% of germs” should be a big red flag, Lin says: “If you’re struggling with your oral health, don’t reach for [alcohol-based] mouthwash—instead, look to improve your microbiome balance.” It may be best to avoid mouthwashes containing alcohol, hydrogen peroxide, and chlorhexidine, all of which can harm the microbiome. Oral Essentials brand, Lin says, protects the microbiome; oil pulling, the practice of swishing coconut oil around in the mouth for several minutes, has been found in two studies to be just as effective as chlorhexidine at treating bad breath, without the side effects (4).