Up Your Oral Health Game with Salivary Testing: Part 2

The Path of Pathogen Destruction

Cardiovascular Disease

We know that the oral pathogens Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), and Fusobacterium nucleatum (Fn) are directly connected to atherosclerosis.1  We know cardiovascular disease is the number one cause of death and disability in the United States.  Gastrointestinal and colorectal cancers, as well as adverse pregnancy outcomes and aspiration pneumonia all can connect back to oral pathogens.  Pg is common to all these diseases.2 Oral pathogens are swallowed, inhaled and/or transported via the bloodstream.  Oral bacteremia occurs from brushing, chewing, flossing, dental prophylaxis, and dental surgeries – things our patients do daily.  These bacteria and their endotoxins create systemic inflammation throughout the entire body.

“Fifty percent of heart attacks and strokes occur in people with normal cholesterol levels. Inflammation is the key contributor to heart disease and cardiac events.”3

Oral bacteria of endodontic and periodontal origin have been found in coronary artery thrombus aspirates and cerebral aneurysm walls.4 Further research is looking onto the connection between oral pathogens and lower limb vascular events.5

Alzheimer’s Disease

We also have new research connecting Alzheimer’s Disease (AD) to a spirochete infection.6,7 Dental spirochetes have been found in 93.7% of Alzheimer’s patient’s brains.8

“Long-term exposure to periodontal disease bacteria causes inflammation and degeneration of brain neurons in mice that is similar to the effects of Alzheimer’s disease in humans. Periodontal disease may be an initiator of Alzheimer’s.”9

Spirochetes take many years to divide, multiply, and form biofilms.  We also know, AD symptoms show up slowly over a long time period.  We must be aggressive in changing the oral microbiome and eliminate the spirochete population before it infects the brain.  I have taken plaque samples in very young children and viewed aggressive spirochetes on their phase contrast microscope slides.  These spirochete pathogens create a biofilm in the brain and as we well know, biofilms are impenetrable. The hippocampus is only four centimeters from the posterior oral cavity and a favored area of AD involvement.  These same periodontal disease bacteria are present in gingivitis.10

Research is also connecting the pathogen Pg to inflammation in the brain and the cause of amyloid plaque buildup in healthy mice.11

Caries Pathogens are not Benign

Further research also connects caries pathogens to facial cellulitis.  Dental caries can lead to brain abscesses and death, so testing for caries pathogens is also vital.12,13 Early childhood caries is destructive and painful for our youngest clients.  We know early childhood caries pathogens become more aggressive and virulent when candida albicans combine with the Streptococcus mutans.14 Testing for these pathogens should be part of our dental protocols along with diet and risk assessments.  OralDNA® salivary testing allows for early intervention and enhanced preventive care for these susceptible little people. Having the right tools makes the difference.

Viral Connections

In addition to bacteria, we must address the viral component of periodontal infections as well. Herpes simplex viruses, Epstein-Barr virus, and Cytomegalovirus all contribute to the pathogenicity of the perio pathogens.15,16 The combination of bacterial pathogens and viruses makes the pathogens that much more virulent. Viruses don’t show up on the microscope.

Your Genes are Not Your Destiny

Genetics play a role in our susceptibility to periodontal pathogens.  Our unique genes may be the root of all chronic illnesses within us.  Folks that are genetically susceptible are called hyper-responders.  By being aware of your own genetic risk level you can hopefully prevent not only gum disease but also its connection to cardiovascular disease, diabetes and atherosclerosis17 by guiding your lifestyle to emphasize prevention for you and the entire family.  We can certainly override our genes with unhealthy lifestyle choices such as smoking, vaping, cannabis,18 and sugar19 intake.


Bleeding gums are not okay.  Period.  These same pathogens exist in both gingivitis and periodontal infections.10 Before we can treat, we must diagnose so we know exactly what we are treating and what our end point should be.  Then we treat and retest until these bad, destructive, inflammation-causing pathogens are reduced and a healthy plaque biofilm is present.  Prevention is vital for even our youngest clients.  It is time to treat both gingivitis and periodontitis infections as well as caries pathogens aggressively.

An important point to emphasize – our patients can mask infection by their excellent oral hygiene yet still harbor these pathogens within the periodontal pockets.  Spirochetes are hard to kill, going into hiding in spore form not only in the oral cavity but elsewhere in the body.  We cannot tell just by looking if someone is indeed infected with these viruses and bacteria.  We must look, and we must test. Absence of bleeding is not an endpoint.

The Time is Now for Salivary Diagnostics

Dentistry’s time has come to do preventive dental care. We can be better practitioners than the drill’em fill’em days.  We should be the principle healers of the body.  We need to test for the keystone pathogens, viruses, and the genes that cause oral infections and systemic disease, and to truly up our game.  Let’s take advantage of all the tools at our disposal. Because of this new research connecting perio pathogens and dementia, we at Green City Dental are now testing every new patient for these pathogens and viruses as well as genetic risk level.  The microscope cannot distinguish between all the different rods, cocci, and spirochetes. In other words, the microscope isn’t sensitive, or specific but salivary diagnostics can provide you results that are sensitive and specific, so we know exactly which pathogens are present and their actual bacterial level. We want to know where our patients are starting and then how they are progressing.  Eventually, all of our patients will do a salivary test as a baseline; then, just like yearly checkups and other preventive medical testing, saliva testing will be added to our lineup of preventive protocols.  With current research connecting oral pathogens to systemic illnesses it is important to use all the tools at our disposal, so we can best direct and customize their treatment and care.

Testing in Action

By using testing, we were able to diagnose and treat a patient with a heavy bleeding situation.  No periodontal pathogens were present, so we referred the patient for additional testing with his medical practitioner.  He was found to be in a dire diabetic condition.  Same with a patient that was found to have leukemia-caused bleeding rather than just “poor oral hygiene.”  Testing reveals root causes.  Medical offices test, then treat.  If we want to move from the shadows of healthcare to true health and prevention specialists, we must join their ranks.

21st Century Preventive Oral Wellness

Bottom line – we must help our patients kill these pathogens BEFORE they get to the brain, to the arteries, and elsewhere in the body.  My mantra is test, treat, and retest until the pathogens are gone, or at minimum reduced, and the mouth is healthy.  We can no longer say things look healthy when we have no true idea what is lurking below the gumline.  It’s dishonest.  Patients trust us to be educated and proactive.  They expect us to KNOW the research.  They love when we use technology.  They want our expertise.  Salivary diagnostic tests are the cutting edge of non-cutting dental care.  Use them on every single patient for preventive 21st century dental healthcare at its very best.



  1. https://pmj.bmj.com/content/postgradmedj/early/2016/11/29/postgradmedj-2016-134279.full.pdf
  2. https://www.researchgate.net/publication/331466973_Association_between_periodontal_pathogens_and_systemic_disease
  3. https://www.dentaleconomics.com/science-tech/article/16392172/oral-inflammation-the-tipping-point-of-health-care
  4. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.112.001254
  5. https://www.ejves.com/article/S1078-5884(19)31308-5/pdf
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981904/
  7. https://www.sciencedaily.com/releases/2018/10/181004100009.htm
  8. https://www.oravital.com//wp-content/uploads/2017/12/Dementia-Miklossy-J-Neuroinflammation-Spirochetes-and-Alzhiemers.pdf
  9. https://www.sciencedaily.com/releases/2018/10/181004100009.htm
  10. http://queenofdentalhygiene.net/2016/10/say-no-to-ginger-vitis-and-her-friend-perry-o/

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Barbara Tritz RDH
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