Human Biofilms--Friend or Foe?

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Biofilms are very complex, interactive communities of bacteria. There are as many different kinds of biofilms as there are niches for them to grow on. Even different sides of a single tooth can have distinctly different biofilms. Nearly 1000 bacterial species can live in the mouth, although not simultaneously. A typical mouth supports about 100-200 species in different combinations on different surfaces at any given time. Biofilms on the teeth differ from those on the gums, tongue, and cheeks. Each of those surfaces is, in turn, comprised of smaller and smaller micro-ecosystems, each with its own particular microflora interacting with each other and their host.

According to David Relman of Stanford University, our personal biofilms are incredibly specialized, not only by niche but between individuals as well. Only 17% of the bacteria on your left hand, for instance, will also be on your right. Only 13% of the bacteria on one persons hands will be on someone else's as well.

Don't panic! While there are 10 bacteria living on and in us for every somatic cell, only a fraction are pathogenic. The vast majority live in harmony with us and even contribute to our well being, helping to enhance the immune system, regulating hormones and even assisting our immune systems. Resident nasal bacteria produce antibiotics that kill harmful inhaled bacteria. We'd starve without bacteria. Even with 20,000 genes, we can't digest everything we eat. We rely on our intestinal bacteria and their 3.3 million genes to digest our food. The combined human genome and the genes of our resident bacterial are really a single gene pool… a human-micro-biome.

ORAL BIOFILM FACTS:

• 1,000 Known oral bacterial species.
• 100-200 species present at any given moment.
• Composition of species varies widely by niche.
• Different sides of a single tooth can have entirely different biofilms.
• Just 17% of the bacteria on your right hand will also be on your left.
• Just 13% of the bacterial species on your hands will be on someone else's.
• 20,000 -- Human Genes
• 3,300,000 -- Intestinal bacterial genes.

The Link between Gum Disease and RA

Why do rheumatoid arthritis and gum disease often go hand in hand? Learn about the significant connection between the two.
By Regina B. Wheeler  Medically reviewed by Pat F. Bass III, MD, MPH  source: Everyday Health   

Brushing, flossing, and seeing your dentist regularly are especially important for people with rheumatoid arthritis. Research studies show a strong connection between RA and gum disease, an inflammatory condition that can lead to tooth loss.

Rheumatoid arthritis is due to an overactive immune system, says Scott Zashin, MD, clinical associate professor of medicine at the University of Texas Southwestern Medical School and attending physician at Presbyterian Hospital in Dallas. Doctors don’t know for sure how gum disease and RA are linked, but the diseases have inflammation in common, which may explain the connection.

Inflammation is a protective immune system response to substances like viruses and bacteria. In autoimmune diseases like rheumatoid arthritis, the immune system mistakenly triggers inflammation, although there are no viruses or bacteria to fight off. In RA, the inflammation causes joints to become swollen, painful, and stiff. Dr. Zashin says it’s possible that the immune system is stimulated by mouth inflammation and infection, “setting off a cascade of events where inflammation develops at the site of joints or arthritis.” He says controlling the inflammation through better dental care could play a role in reducing the incidence and severity of RA.

In fact, another study also published in the Journal of Periodontology showed that when people with a severe form of rheumatoid arthritis cleared up their gum disease, their pain and other arthritic symptoms got better. Researchers from the Case Western Reserve University School of Dental Medicine and University Hospitals of Cleveland studied 40 people with moderate to severe gum disease and severe RA. To control RA, patients either received standard RA treatment or standard treatment plus anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. Patients were then randomly selected to receive non-surgical periodontal treatments for their gum disease. Both the standard RA treatment and anti-TNF-alpha treatment patients whose gum disease was treated reported significant improvements in their RA symptoms compared to those who did not receive treatments.

Dental Care for People With Rheumatoid Arthritis
Gum disease ranges from gingivitis, a mild form that causes swollen, tender gums, to more serious forms like periodontitis, in which inflammation affects the tissue and bone supporting the teeth. Some people with RA also develop Sjogren’s syndrome, an autoimmune disease of the glands, which causes dry mouth and increased tooth decay.
If you have gingivitis, it can be reversed with twice-yearly dental cleanings and good at-home care. People with more severe gum disease need treatment from a periodontist, or gum specialist. Zashin says rheumatologists should include good dental practices in their recommendations to patients. However, people with RA sometimes have a hard time maintaining good oral hygiene because the disease can affect the joints in their hands, making brushing and flossing difficult. “Electric toothbrushes can be a great help to patients who have trouble brushing,” Zashin says.

Here are some tips from the American Dental Association to make dental care easier to manage:

• Reinvent your toothbrush. To better grip brush, add a tennis ball to end.
• Experiment with new types of floss. Try holders, picks, or threaders.
• “Pump up” paste. Toothpaste in a pump might be easier than a tube.
• Make the most of mouthwash. Buy fluoride to protect teeth from cavities.
• Don’t light up. Smoking is a big risk factor in developing gum disease.
• Speak to your dentist. Tell your dentist about your rheumatoid arthritis. Sometimes shorter appointments scheduled later in the day when joints are less stiff can make you more comfortable. Ask for a neck or leg pillow for better support in the dentist’s chair.

Remember, gum disease has been linked to other conditions like heart disease, stroke, and diabetes as well as RA. Taking care of your mouth may very well improve your overall health.
Last Updated: 02/21/2012

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