How dysbiotic oral microbiome drives systemic histamine symptoms

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By Carolina Brooks, BA, IFMCP

Six months ago, I started working with a young male patient in his thirties presenting with anxiety and laryngopharyngeal reflux (LPR), which he said had experienced for the past four years with little respite. He had recently had a root canal replaced, as it had been causing him severe pain, and since its replacement, had experienced sinusitis, migraines, and post-prandial burning mouth syndrome every time he ate, which was impacting his quality of life.

This patient had an unremarkable medical history except his history of poor nutrition and poor dental health, resulting in numerous fillings over the years. Since childhood, he had eaten a standard British diet, which involved a high volume of refined carbohydrates, red meat, tuna, or prawns twice a day, and a low intake of phytonutrients, as he did not enjoy eating vegetables. He had switched from sugary snacks to large amounts of nuts as an adult, as he said he had lost his sweet tooth.

When I asked about stress management, he answered that he had never had any stress in his life, and as such, had no idea how to manage his anxiety, which he believed was driven by food as he had read up about histamine intolerance. The patient’s diet had become more restricted since the symptoms started as he became concerned about high histamine foods, and he felt he was reacting to salicylates, so he had removed nuts and all remaining vegetables in the diet to minimize reactivity, and was living on chicken, veal, white rice, and potatoes.

Although the patient’s dentist had examined him and determined that the burning mouth syndrome he was experiencing had nothing to do with his dental health or the dental materials used, a  2014 review in Journal of Medicine and Life considered the role of contact allergies of metals such as cobalt, mercury, gold. or food allergens in burning mouth syndrome, so I immediately took a targeted interest.

While we waited for the results of this patient’s tests, limited to an oral microbiome panel and an allergy panel for budgetary reasons, I worked on addressing the underlying inflammation and regulate the immune response driving his health concerns by improving digestive assimilation, increasing diversity in the diet while maintaining a lower histamine diet, and reintroducing anti-inflammatory phytonutrient-rich plant foods.

I brought in supplements such as digestive enzymes, vitamins A and D, immunoglobulins and histamine support, fish oil, as well as prebiotic fibers and magnesium. I also asked him to switch out shellfish and tuna due to their high arsenic and mercury content for smaller, oily fish. Part of this patient’s protocol was to start flossing consistently and introduce a probiotic mouthwash.

Within a few weeks of following these dietary adjustments, including introducing a variety of vegetables and taking his supplements, the patient’s anxiety, LPR, and sinusitis had completely resolved. The burning mouth syndrome had reduced significantly but had not completely disappeared. The patient’s allergy results indicated an allergy to cobalt, a material widely used in dentistry.

According to a 2019 paper in Journal of Oral and Maxillofacial Pathology, the oral microbiome is the second largest after the gut, containing a diverse range of microorganisms, which colonize the soft tissues of the oral mucosa and the hard surfaces of teeth, including over seven hundred species of bacteria, as well as fungi, viruses, and protozoa. Contiguous structures with the oral cavity include the sinuses, nasal passages, lungs, and esophagus. Although each structure and tissue will have its own distinct microbial community, there is the possibility of microorganisms spreading via epithelial surfaces.

A 2010 article in Journal of Bacteriology discussed the role of microorganisms from the oral cavity not only contributing to periodontal and endodontic disease, but also dental caries and systemic disease, including cardiovascular disease, stroke, diabetes, pneumonia, and pre-term birth. The oral microbiome has also been implicated in the pathogenesis of Alzheimer’s disease and Parkinson’s disease.

My patient’s oral microbiome results indicated high levels of many bacteria species associated with periodontal gingivitis, gum erosion and disease, dental caries, and systemic disease risk, including oral, gastrointestinal, and esophageal cancer, osteoarthritis, and cardiovascular disease. A 2019 paper in Frontiers of Microbiology discussed the role of commensal streptococci Streptococcus sanguinis and Streptococcus gordonii in providing some protection against cariogenic species, such as Streptococcus mutans. My patient not only had high levels of S. mutans present, but high levels of other major periodontitis associated pathogens, such as Preponema denticola, Aggregatibacter actinomycetemcomitans, Campylobacter rectus, and Tannerella forsythia.

The test also measured interleukin 1-beta (IL-1b), an inflammatory cytokine produced in response to inflammatory stimuli such as pathogens, poor diet, or toxic exposures. My patient’s IL-1b result was extremely high, indicating a significant histamine response exacerbating his burning mouth symptoms, which coupled with the pathogens present, were having a significant impact on dental, oral, and systemic health.

After we went through his results, I advised my patient to get a second opinion from a holistic dentist who used ozone therapy to address dysbiotic oral bacteria and removed his problematic replacement root canal. He continued with the probiotic mouthwash in the morning and started using an antimicrobial natural toothpaste at night. Additionally, as he was fearful of using essential oils in his mouth due to the risk of experiencing the burning mouth symptoms, we used fresh, decocted antimicrobial herbs grown locally and organically, such as oregano, thyme, and rosemary, during the day. His wife and daughter also followed the same protocol because they had also experienced dental concerns.

Within three months of my patient’s initial appointment, the burning mouth symptoms had stopped, he experienced complete resolution of symptoms, and he has now implemented lifelong dietary and dental hygiene practices he is adamant to stick to for fear of ever experiencing a recurrence. I have kept him on herbs as well as oral microbiome and digestive support for an additional three months and suggest that we re-test at the six-month mark to assess how much the microbiome picture has changed.

References

Baker, J. L., and Edlund, A. (2019) Exploiting the Oral Microbiome to Prevent Tooth Decay: Has Evolution Already Provided the Best Tools?. Frontiers in Microbiology.  Retrieved from: https://www.frontiersin.org/articles/10.3389/fmicb.2018.03323/full

Coculescu, E. C., Radu, A., and Coculescu, B. I. (2014) Burning mouth syndrome: a review on diagnosis and treatment. Journal of medicine and life. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316128/

Deo, P.N. and Deshmukh, R. (2019) Oral microbiome: Unveiling the fundamentals. Journal of Oral and Maxillofacial Pathology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503789/

Dewhirst, F.E., Chen, T., Izard, J., Paster, B.J., Tanner, A.C.R., Yu, W., Lakshmanan, A., and Wade, W.G. (2010) The Human Oral Microbiome. Journal of Bacteriology. Retrieved from: https://jb.asm.org/content/192/19/5002

Dill-McFarland, K.A., Tang, Z.Z., Kemis, J.H., Kerby, L.K., Chen, G., Pallonia, A., Sorenson, T., Rey, F.E., and Herd, P. (2019) Close social relationships correlate with human gut microbiota composition. Scientific Reports. Retrieved from: https://www.nature.com/articles/s41598-018-37298-9