Oral Gut Connection Case Study with Medical Emphasis

The Challenge:

  • This apparently healthy, muscular college student was suffering from brain fog, alternating constipation and diarrhea, bloating, decreased appetite, and low energy.
  • He reports having trouble concentrating, which is interfering with his work.
  • He was referred to me by his mother, who attended my classes on Vitality.

The Background:

Age & Gender: 23-year-old Male
Medical History: Insignificant; No chronic illnesses. No pharmaceutical medications.
Family History: No significant family history.
Last Dental Exam: February 2020. He reports never having his “gums measured” or having been told that his gums were bleeding.
Home Care: Brushes morning and bedtime; flosses “occasionally.”
Chief Complaint: Brain fog, constipation, bloating, decreased appetite, low energy and burping.
Other Notes: Patient has been taking probiotics from the “big box store” for six months in an effort to “get back to feeling good and having energy to work out.”
Clinical Assessment: Head, neck, and oral exams reveal no apparent lymph node swelling, soft-tissue pathology, or dental decay. Teeth are in excellent condition and alignment; Patient had interceptive orthodontics as a teenager. He has sealants but no other dental restorations.
Periodontal Assessment: On observation, gingival tissue appears “normal” but bleeds upon exploration. Without OralDNA®’s MyPerioPath®, this could have easily been a “regular prophy” due to the patient’s age and assumed periodontal health.
Comprehensive Periodontal Exam revealed scattered 4 to 6 mm pockets with generalized bleeding. I always use Oraqix® when probing.
Medical Assessment: Patient takes no medications and reports no previous health challenges. Blood pressure and pulse were normal.

The Solution:

Date of Pre-MyPerioPath®: 6/24/2021. Surprisingly, this patient had extreme levels of ten out of the eleven pathogens measured. This is the perfect example of the incredible value of this salivary diagnostic testing for precision care. I always tell my patients “Test, don’t guess!”

Date of GI-MAP: 7/12/2021. Based on the results of the patient’s MyPerioPath® saliva test, I recommended a GI-MAP stool test. It revealed overgrowth of dysbiotic bacteria to include Pseudomonas. Additionally, he has detectable levels of four of the nine bacteria tested to be “autoimmune triggers,” including Fusobacterium nucleatum (Fn). Although Fusobacterium was not at “high” levels in his gut, I have learned that any detectable level can be significant for health and vitality when coupled with high levels of Fusobacterium orally. The stool test also revealed high Candida spp and low Secretory IgA.

Periodontal Therapy: One-visit Scaling/Root Planing with Diode Laser. Oraqix® was utilized for anesthesia. Heavy bleeding was present in all areas.

Systemic Antibiotics Used: Metronidazole (Flagyl) 500 mg/bid/10 days. Instructions to avoid all alcohol while on this medication. We will reevaluate bacterial load in June 2022.

Medical Therapy: Pharmaceutical-grade supplements to include Omega 3 Fatty Acids (for inflammation), 18-strain probiotics 350 Billion CFU stick pack on Sundays and Wednesdays, 30 Billion CFU in between (for gut dysbiosis), Vitamin K2/D3 10,000 IU (for immunity; his level was 24) and Amino Acids (to enhance metabolic regulation).

Referrals: I gave him contact information for several local physicians who are familiar with MyPerioPath®.

Home Care: Electric toothbrush, Interdental brush pics in two sizes, OraCare two-part rinse (chlorine dioxide), and extensive home care guidance. Personalized education to empower his “why” for developing this habit.

Other Notes: Interestingly the patient reported that his “problems started just one month after taking Pepsid (famotidine).” My therapy includes nutritional coaching to encourage him to enjoy more whole foods as well as “Rest and Digest” mealtime strategies.

Date of MyPerioProgress® (post-therapy test): None to date. We will retest in June 2022.

The Result:

The patient’s symptom resolution was swift, complete, and enduring. Within two weeks, his bloating resolved, his appetite and mental clarity returned, and he was full of energy. He has referred two of his colleagues. Four weeks post-therapy, he had only two bleeding points and was consistently using his home care regimen to keep the subgingival biofilm disrupted. Three months post-therapy revealed minimal bleeding and calculus on the mandibular incisor lingual area. He is now on a four-month recall. Gastrointestinal discomfort is so common that it is easily dismissed, especially in young people. MyPerioPath® gives patients an excellent visual aid, especially when combined with medical research. This objective test gives people hope. That’s exciting!

While writing this report, I texted him to see how he is feeling. He said that he “couldn’t be happier with his health” and that he often repeats my motto: “Vitality begins in the gut and the gut begins in the  mouth.” The research confirms this!

Key Takeaways:

  • Fusobacterium nucleatum (Fn) is an anaerobic, gram-negative bacterium that has been repeatedly detected at colorectal tumor sites in higher abundance than surrounding histologically normal tissue.
  • This multifaceted bacterium engages with humans and other microorganisms in a wide range – from beneficially to detrimentally.
  • Studies globally provide insight on the interplay between Fn, other gut microbiota, barrier function, host inflammatory responses and the suppression of host immunity.
    On a practical level, Fn is an oral bacterium that travels to the gut, where it generally exacerbates dysbiosis. If a patient is suffering from GI symptoms and their level of Fn is high in the gut, this bacterium must be treated in the mouth for sustained systemic health.
  • This insight has been very exciting for physicians in my area because OralDNA®’s MyPerioPath® provides the “missing link” for sustained treatment results and happy patients.
  • To date, I have yet to see high levels of Fn in the gut without significant levels in the mouth, via MyPerioPath® testing. Therefore, I encourage all physicians to administer the test themselves in conjunction with their other medical testing. My recommendation is a first thing in the morning collection. This removes the question “Was anything influencing the results?”
  • Although most studies evaluating the oral-systemic link look at more severe periodontitis, early to moderate periodontal disease has a profound impact on gut health.
  • Remember, “Vitality begins in the gut, but the gut begins in the mouth!”

The Research:

  • BMC Microbiology (2020): “Opportunistic detection of Fusobacterium nucleatum as a marker for early gut microbial dysbiosis https://bmcmicrobiol.biomedcentral.com/track/pdf/10.1186/s12866-02 0-01887-4.pdf
  • Current Opinion in Microbiology (2015): Fusobacterium nucleatum: a commensal-turned pathogen https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323942/
    Nature Reviews Microbiology (2019 – Harvard): Fusobacterium nucleatum – symbiont, opportunist and oncobacterium https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589823/
  • American Society for Microbiology (2021): Fusobacterium nucleatum Secretes Outer Membrane Vesicles and Promotes Intestinal Inflammation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092269/

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