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DavidPerlmutterMD · 2023-04-17 · David Perlmutter (host), Mark Burhenne

Oral Bacteria And Your Health - with Dr. Mark Burhenne | The Empowering Neurologist EP. 162

40 research-tied claims examined: 1 contradicted 8 overstated 2 context 24 supported 5 unverified

24

Supported by research

0:00:00David Perlmutter (host)supportedmoderate

Periodontal disease is linked to an increased risk for metabolic problems, coronary artery disease, and Alzheimer's disease.

"We know that there are strong relationships, for example, between having periodontal disease and risk for certain things like metabolic problems and chronic degenerative conditions like coronary artery disease and certainly Alzheimer's." (said at 0:00:00)

Substantial epidemiological evidence and meta-analyses support the link between periodontal disease and an increased risk or odds of metabolic syndrome, coronary artery disease, and Alzheimer's disease / dementia. Meta-analyses of observational and prospective cohort studies show that individuals with periodontitis have significantly elevated risks for metabolic syndrome (adjusted OR 1.46), cardiovascular events including coronary artery disease (RR ~1.34), and Alzheimer's disease (OR 1.69 to 2.98 for severe forms).

0:04:05Mark Burhennesupportedhigh

The oral microbiome is second only to the gut microbiome in both diversity and size within the human body.

"The gut microbiome, of course, is the big one, but the oral microbiome is second in diversity and in size" (said at 0:04:05)

Scientific consensus from large-scale human microbiome profiling studies establishes that the gastrointestinal tract harbors the largest and most diverse microbial community in the human body, followed by the oral cavity, which contains hundreds of distinct microbial species across various micro-niches.

0:05:23Mark Burhennesupportedmoderate

Porphyromonas gingivalis has been detected in human brain tissue and drives gum disease.

"P. gingivalis has been found in the brain and it's in the mouth and it's the driver of gum disease." (said at 0:05:23)

Porphyromonas gingivalis is widely recognized as a keystone bacterial pathogen driving chronic periodontitis (gum disease) and has been identified in human post-mortem brain tissue, along with its toxic proteases (gingipains).

0:09:45Mark Burhennesupportedlow

Having gum disease was a risk factor for severe infection or death from COVID-19.

"And for example, during COVID, if you had gum disease, that was a risk factor for getting a severe infection or even death from COVID." (said at 0:09:45)

Observational studies and meta-analyses show that pre-existing periodontitis (gum disease) is significantly associated with an increased risk of severe COVID-19 outcomes, including intensive care unit (ICU) admission, need for assisted ventilation, severe disease course, and mortality. Because the available evidence consists of observational case-control and cohort designs with potential confounding and methodological heterogeneity, the certainty of evidence is graded as low.

0:12:30Mark Burhennesupportedmoderate

Porphyromonas gingivalis excretes a substance called gingipain, which can travel to the brain.

"the P. gingivalis bug will get to the brain. It will literally—it'll excrete the substance called the gingipain." (said at 0:12:30)

The claim is supported by published literature. Porphyromonas gingivalis is an oral pathogen that secretes cysteine endopeptidases known as gingipains (such as RgpA, RgpB, and Kgp). Both P. gingivalis bacteria and their secreted gingipains have been identified in the brain tissue of humans with neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease, as well as in experimental animal models following oral infection.

0:14:50David Perlmutter (host)supportedhigh

Follow-up brain MRI scans of patients treated with anti-amyloid Alzheimer's drugs show significant brain shrinkage compared to untreated Alzheimer's controls.

"it looks as if the data that looked at the follow-up brain scans on people treated with these types of drugs shows significant shrinkage of the brain in comparison to controls who have the disease and yet were not put on that drug." (said at 0:14:50)

A systematic review and meta-analysis of 31 randomized controlled trials (encompassing over 8,000 to 10,000 Alzheimer's disease patients) evaluated brain MRI volumetric changes associated with anti-amyloid therapies compared to placebo controls. The analysis demonstrated that anti-amyloid therapies significantly accelerated brain volume loss, including increased ventricular enlargement (38.7% greater than placebo for amyloid-related imaging abnormality-inducing monoclonal antibodies) and whole-brain and hippocampal atrophy compared to untreated/placebo controls with Alzheimer's disease.

  • supports: Accelerated Brain Volume Loss Caused by Anti-β-Amyloid Drugs: A Systematic Review and Meta… (Neurology 2023) · cited 211x in the literature
    "A meta-analysis on the highest dose of each trial on hippocampus, ventricle, and whole brain revealed drug-induced acceleration of volume changes that varied by anti-Aβ drug class. Secretase inhibitors accelerated atrophy to the hippocampus (Δ placebo - Δ drug: -37.1 µL [19.6% more than placebo]; 95% CI -47.0 to -27.1) and whole brain (Δ placebo - Δ drug: -3.3 mL [21.8% more than placebo]; 95% CI -4.1 to 2.5). Conversely, ARIA-inducing monoclonal antibodies accelerated ventricular enlargement (Δ placebo - Δ drug: +2.1 mL [38.7% more than placebo]; 95% CI 1.5-2.8) where a striking correlation between ventricular volume and ARIA frequency was observed" (abstract, results, passage verified)
    pubmedfull study (doi)
0:21:33David Perlmutter (host)supportedvery low

Porphyromonas gingivalis secretes chemicals that cleave and activate beta-amyloid and induce tau protein phosphorylation in laboratory models.

"this organism is able to secrete various chemicals that cleave and activate beta amyloid. Everybody's talking about beta amyloid. That's the premise by which these drugs are being developed. And also causes the phosphorylation or makes tau protein more of an issue in the brain. So, we can see that. We can see that in the laboratory models of animals that are destined for Alzheimer's disease." (said at 0:21:33)

Laboratory and animal studies demonstrate that Porphyromonas gingivalis secretes toxic cysteine proteases (gingipains) that enter the brain, stimulate the generation of amyloid-beta (Aβ1-42), and induce tau protein phosphorylation and degradation in neuronal cultures and mouse models. Because these findings are derived entirely from in vitro and animal models rather than clinical human trials, the certainty of evidence is very low.

0:29:15Mark Burhennesupportedhigh

Oral bacteria on the back of the tongue convert dietary nitrates from foods like beets into nitric oxide.

"There are bacteria on the back of the tongue, part of the oral microbiome, of course, that actually when they see a uh like a beet or a high nitrate food, they will produce NO." (said at 0:29:15)

Dietary inorganic nitrate from foods such as beetroot and green leafy vegetables is concentrated in saliva and reduced by symbiotic nitrate-reducing bacteria residing predominantly on the tongue dorsum and in saliva. These oral bacteria express nitrate reductase enzymes (which humans lack) that reduce nitrate (NO3-) to nitrite (NO2-). When swallowed, salivary nitrite is converted into nitric oxide (NO) in the acidic gastric environment and systemically in tissues and blood via the enterosalivary nitrate-nitrite-nitric oxide pathway. In addition, some oral bacterial taxa can directly reduce nitrite to NO via denitrification pathways.

0:22:15David Perlmutter (host)supportedmoderate

Blood-brain barrier integrity and effectiveness decline with aging, diabetes, and cigarette smoking.

"And as we age, the effectiveness of our so-called blood-brain barrier declines. It also declines with metabolic conditions like diabetes. Cigarette smoking threatens as well as does certainly poor nutritional status." (said at 0:22:15)

Published literature confirms that blood-brain barrier integrity and effectiveness are compromised by factors including metabolic conditions such as diabetes as well as cigarette smoking, primarily through cerebral endothelial cell dysfunction and systemic vascular risk factors.

0:26:00Mark Burhennesupportedhigh

Commensal oral biofilms facilitate the remineralization of demineralized tooth enamel by processing minerals from saliva.

"one of the functions of the biofilm, and again, we're talking about plaque, that's a term that we used to use, um this is a proteoglycan layer... one of the functions of the biofilm is to help remineralize demineralizing areas of the teeth. And that essentially is reversing small cavities as they are happening." (said at 0:26:00)

Dental biofilm and its fluid phase, alongside the acquired pellicle and saliva, play a direct role in the continuous dynamic equilibrium of tooth enamel demineralization and remineralization. Under non-acidic conditions, saliva and biofilm fluid are supersaturated with calcium and phosphate ions relative to tooth hydroxyapatite, driving mineral precipitation back into early subsurface carious lesions (initial enamel demineralization). While dental plaque can drive demineralization when acidogenic bacteria ferment dietary carbohydrates, the commensal biofilm and biofilm fluid serve as reservoirs for salivary ions and fluoride that facilitate the natural remineralization and reversal of early non-cavitated lesions.

0:30:38Mark Burhennesupportedmoderate

Swishing with disinfecting mouthwash twice a day elevates blood pressure within two to three days by compromising nitric oxide production.

"so, you you swish with mouthwash twice a day. These are studies from 2005 and and even recent ones. I just read a new one that popped out yesterday. And it actually elevates your blood pressure within two to three days. And obviously, that is because the NO production is is uh compromised." (said at 0:30:38)

Human clinical trials support the claim. Oral bacteria in the mouth reduce salivary nitrate into nitrite, which enters the bloodstream and serves as a vital substrate for systemic nitric oxide (NO) generation and vasodilation. When healthy individuals use a strong antiseptic mouthwash (such as chlorhexidine) twice daily, the oral nitrate-reducing microbiome is suppressed, reducing plasma nitrite levels and causing a measurable rise in systolic and diastolic blood pressure within 1 to 3 days.

0:31:58David Perlmutter (host)supportedlow

An in silico study analyzing over 6 million patient records found that individuals who used sildenafil (Viagra) had about a 60% reduced risk of developing Alzheimer's disease.

"One uh in silico study from last year, looking at over 6 million patient records, looking for candidates for an Alzheimer's drug, ended up out of I think 60 or 70 candidates, focusing on one. And it was a drug called sildenafil, also known as Viagra. And it looked like the you that individuals who used Viagra had about a 60% reduced risk of developing Alzheimer's." (said at 0:31:58)

A 2021 study published in Nature Aging by Fang et al. utilized an in silico network-based drug repurposing approach alongside retrospective pharmacoepidemiologic analysis of insurance claims from 7.23 million individuals. The researchers identified sildenafil (Viagra) as a lead candidate and found that its use was associated with a 69% reduced risk of Alzheimer's disease (hazard ratio 0.31, 95% CI 0.25–0.39) after adjusting for confounders. Because these findings are derived from observational claims data and in silico modeling, they represent association rather than proven causal protection.

0:32:58Mark Burhennesupportedlow

Studies demonstrate that individuals with gum disease are likely to have erectile dysfunction.

"there are a lot of good studies uh that if you have gum disease, you you are likely to have erectile dysfunction. Again, that is that is directly linked to the condition and the state of the oral microbiome." (said at 0:32:58)

Multiple systematic reviews and meta-analyses of observational studies demonstrate a statistically significant association between periodontal disease and erectile dysfunction, with affected individuals having roughly 2 to 3 times higher odds of erectile dysfunction compared to those without gum disease. Because the underlying evidence base consists primarily of observational (case-control, cross-sectional, and cohort) studies with substantial statistical heterogeneity, the GRADE certainty is rated as low.

0:40:04Mark Burhennesupportedvery low

Sodium lauryl sulfate (SLS) breaks down the lipid layer in oral mucosal cells and crosses into the blood supply, as shown in rat studies.

"And what it does though is it affects it can literally break down the lipid layer in a cell. That's bad. It can actually cross over into the blood supply uh through the oral mucosa. We've got plenty of rat studies that that show and demonstrate that." (said at 0:40:04)

Animal studies in rats demonstrate that sodium lauryl sulfate (SLS) damages the oral mucosal permeability barrier, disrupts epithelial layers (widening and separating the stratum corneum), and promotes mucosal penetration and absorption across oral tissues. Because the claim specifically refers to rat studies, the verdict is supported, though certainty is rated very low due to reliance on preclinical animal models.

0:52:17Mark Burhennesupportedvery low

Fluoride damages the myelin sheath of neurons and impairs mitochondrial integrity in the brain.

"It does have some direct effects on the brain. Uh, it can uh, affect the myelin sheath of a neuron in the brain. It can affect the uh, the integrity of the mitochondria in the brain. We we have this data." (said at 0:52:17)

Preclinical evidence in rodent models and in vitro neural cell lines supports the claim that fluoride exposure can cause myelin sheath damage and mitochondrial dysfunction in brain tissue. Studies in mice demonstrate that high-dose sodium fluoride exposure leads to hippocampal myelin damage—marked by decreased proteolipid protein (PLP) expression and increased myelin-associated glycoprotein (MAG)—as well as altered synaptic ultrastructure. Similarly, animal and cellular studies show that fluoride impairs mitochondrial integrity and function via mechanisms such as SIRT3 downregulation, altered mitochondrial dynamics, decreased mitochondrial DNA transcription, and elevated mitochondrial oxidative stress. However, certainty is very low because these findings derive entirely from experimental animal and cell culture models, often utilizing high concentrations, rather than direct human clinical trials or human neuroimaging studies.

0:36:27Mark Burhennesupportedmoderate

Hydroxyapatite dental remineralization technology was developed by NASA and has been used in commercial oral care products in Japan for 40 years.

"Japan's been using wonderful uh products developed by NASA uh coincidentally for 40 years. And and that stuff now is slowly becoming available in the US." (said at 0:36:27)

Hydroxyapatite oral care technology was originally conceived and patented by NASA in the 1970s to help repair astronauts' bone and tooth mineral loss in zero gravity environments. In 1978, the Japanese company Sangi Co., Ltd. acquired the patent rights from NASA and subsequently launched the world's first hydroxyapatite remineralizing toothpaste (Apagard / Apadent) in Japan in 1980, followed by Japanese government approval as an anti-caries agent in 1993. This represents roughly four decades of commercial use in Japan before gaining wider availability and regulatory adoption in North America and Europe.

0:46:00Mark Burhennesupportedmoderate

Essential oils in toothpastes act as bactericides and disrupt the oral microbiome.

"And no essential oils. Essential oils actually are bactericidal. They have an effect on the oral microbiome." (said at 0:46:00)

The claim that essential oils are bactericidal and affect the oral microbiome is supported by published literature. Reviews evaluating plant-derived essential oils demonstrate that they possess direct bactericidal and bacteriostatic properties against key oral bacteria, including pathogenic species involved in dental plaque and gingivitis, thereby modulating oral microbial populations when incorporated into oral hygiene products.

0:41:47Mark Burhennesupportedmoderate

Charcoal in toothpaste has no intrinsic whitening effect and functions only through adsorption of tannins from the tooth pellicle.

"First of all, charcoal does not have a whitening effect. It is good at perhaps and not as good as another ingredient which we can talk about later at adsorption, not absorption, but adsorption of pulling uh tannins off a tooth off the pellicle." (said at 0:41:47)

Charcoal in toothpastes does not possess intrinsic chemical bleaching or whitening properties (unlike peroxide-based bleaching agents). Systematic reviews indicate that charcoal-based dentifrices produce no true chemical whitening effect and primarily interact with the tooth surface via mechanical abrasiveness and the physical adsorption of extrinsic chromogens (such as tannins from food and beverages) from the enamel pellicle.

1:01:54Mark Burhennesupportedmoderate

Sleeping with an open mouth causes dry mouth that disrupts the oral microbiome, which requires saliva and a neutral pH.

"If you're falling asleep with your mouth open at night, that is a oral microbiome a buster. I mean, it really is hard for the oral microbiome to recover the next day. It needs a lot of saliva. It needs a neutral pH." (said at 1:01:54)

Published physiologic and dental research supports the claim that mouth breathing during sleep alters the intraoral environment by lowering pH and contributing to dry mouth, which facilitates shifts toward acid-tolerant, cariogenic bacteria. A crossover study measuring continuous intraoral pH during sleep in healthy adults found that simulated mouth breathing significantly decreased intraoral pH to an acidic average of 6.6 (compared to 7.0 during normal nasal sleep and 7.3 during the daytime), with extended drops during nocturnal hours. Furthermore, reduced salivary flow and lower salivary pH are well-documented to impair the buffering capacity needed to maintain a balanced oral microbiome, leading to elevated counts of acidogenic taxa such as Streptococcus mutans and Lactobacillus species.

1:02:31Mark Burhennesupportedmoderate

Studies demonstrate that pulsating water flossers (such as Waterpik), when used correctly, are more effective than traditional dental floss at cleaning periodontal pockets.

"And the studies on Waterpiks, in some cases, do a better job. Again, this is not a continuous stream of water. This is a pulsation of water that literally, if pointed in the right direction and used correctly, is better than floss. It literally cleans out the pocket and it's safe and it's easier." (said at 1:02:31)

Multiple randomized controlled trials support the claim that pulsating oral irrigators (such as Waterpik dental water jets) are as effective as or more effective than traditional dental floss for reducing gingival inflammation, bleeding on probing, and plaque in interdental and subgingival areas. For example, a 4-week randomized controlled trial comparing a water flosser to dental floss found significantly greater reductions in bleeding on probing, gingival index scores, and plaque index scores with the water flosser. Another 4-week trial demonstrated that oral irrigation was significantly more effective than traditional flossing at reducing bleeding indices.

1:06:15Mark Burhennesupportedmoderate

Periodontal disease and diabetes share a bidirectional relationship where gum disease impairs blood glucose control and fluctuating blood glucose exacerbates gum disease.

"And of course, periodontal disease is intimately connected to and fires up diabetes. And I mean, this is cycle of of, you know, do you if you have gum disease, it's going to be more difficult to control your blood sugar levels. If your blood sugar levels are all over the place and it's more difficult to keep them steady glucose levels, then obviously your gum disease is going to suffer" (said at 1:06:15)

A bidirectional relationship between periodontitis (gum disease) and diabetes is well-established in systematic reviews and international consensus guidelines. Poor glycemic control in diabetes increases the risk, severity, and progression of periodontitis due to heightened systemic inflammation and impaired immune response. Conversely, active periodontal inflammation promotes systemic inflammation and insulin resistance, worsening glycemic control; treatment of periodontitis has been shown in randomized controlled trials to lead to modest but clinically meaningful reductions in HbA1c (around 0.3% to 0.5% at 3 to 4 months).

1:07:03David Perlmutter (host)supportedmoderate

Inflammatory bowel disease is strongly linked to an increased risk of developing multiple sclerosis.

"we've known about inflammatory bowel disease being so strongly related to risk for MS, for example." (said at 1:07:03)

Systematic reviews and meta-analyses of observational and cohort studies demonstrate a significant association between inflammatory bowel disease (IBD, including Crohn's disease and ulcerative colitis) and an increased risk of multiple sclerosis (MS). A 2022 meta-analysis found that patients with IBD have approximately a 1.9-fold higher prevalence/risk of MS compared to controls (RR 1.91, 95% CI 1.06–3.45). Other meta-analyses consistently confirm elevated risk estimates (ranging from RR 1.66 to HR 2.89) for MS development among individuals with IBD.

1:09:45David Perlmutter (host)supportedmoderate

Porphyromonas gingivalis in the oral cavity is directly linked to an increased risk of Alzheimer's disease.

"and especially the part of our discussion today that dealt with the relationship of P. gingivalis, Porphyromonas gingivalis, an organism that clearly links things going on in the mouth to risk for Alzheimer's disease." (said at 1:09:45)

Published systematic reviews, meta-analyses, and longitudinal cohort studies demonstrate that the periodontal pathogen Porphyromonas gingivalis and chronic periodontal infection are linked to an increased risk of Alzheimer's disease. A 2023 meta-analysis of clinical studies reported a significant association between P. gingivalis and Alzheimer's disease (OR = 6.84, 95% CI: 2.70–17.31), with observational evidence supporting periodontal pathobionts as potential risk factors.

1:09:40David Perlmutter (host)supportedhigh

Oral bacteria can gain direct access to the bloodstream through the oral cavity without needing to cross the intestinal gut barrier.

"The direct access to the bloodstream, for example, that bacteria have in the mouth, not having to be dependent upon, you know, this gut barrier that we've been talking about for so long." (said at 1:09:40)

The claim is fully supported. Oral bacteria routinely enter the systemic circulation directly via micro-trauma or lesions in the oral mucosa and gingiva (such as during tooth brushing, chewing, or dental procedures), bypassing the intestinal mucosal barrier. This process, known as transient oral bacteremia, allows oral micro-organisms to disseminate directly into the bloodstream.

Unverified means no publication matching the claim was located; it does not prove the claim false. Spotted an error? See the corrections policy - disputes from the people quoted are prioritized.