Why understanding the oral microbiome is the secret to prevention | Bethany Montoya, RDH, BAS

Dentistry historically focused on removing bacteria for cleanliness & optimal oral health. Today we know that there is a distinction between “harmful” and “helpful” bacteria, which has brought about a shift in mindset that encourages the growth of helpful microbes through the use of oral probiotics and other supportive practices.

Dentistry historically focused on removing bacteria for cleanliness & optimal oral health. Today we know that there is a distinction between “harmful” and “helpful” bacteria, which has brought about a shift in mindset that encourages the growth of helpful microbes through the use of oral probiotics and other supportive practices.

The oral microbiome is a significant factor when assessing a patient’s oral and systemic health. While the word bacteria can be scary to patients, hygienists know that to maintain oral and systemic health, you need good bacteria to fight the bad bacteria.Bethany Montoya RDH, BAS, is a practicing dental hygienist with 10 years of experience and the editorial director of the newsletter, Through the Loupes. She has advanced knowledge and training in complex cosmetic dentistry, sleep-disordered breathing, TMJ disorders, and implant dentistry. She is also the founder of Human RDH, a brand that focuses on the human aspect of dental hygienists and is a Key Opinion Leader for PacDent.

Bethany is a strong supporter of dental hygienists practicing in and out of the operatory. She mentors hygienists wanting to expand their careers into writing and speaking and is a devoted mom and wife who balances family and career daily while supporting others doing the same. We asked Bethany to break down the oral microbiome in her own words and to give a few tips and tricks to hygienists wanting to deepen their knowledge on this topic.

What is your personal definition of the oral microbiome?

To me, the oral microbiome is a complex, hidden world inside of our mouths. The average person knows very little about its effects on our dental, periodontal, and whole-body health.

What aspect of the oral microbiome should be emphasized to patients?

BALANCE. We used to think that “antibacterial” products were the best for maintaining oral health, but we have learned that we actually need bacteria in our mouths! Instead of focusing on removing harmful microbes from the mix, we need to focus on nourishing the beneficial ones. Feeding good bacteria promotes symbiosis, which leads to optimum health. When the balance is disrupted, we develop dysbiosis, which is the pathway for disease development and progression. With this in mind, the oral healthcare industry is starting to shift away from traditional concepts like antiseptic mouthwashes, antibacterial toothpaste, and harsh ingredients meant to kill microbes. Instead, research is leading us toward a focus on
oral probiotics, pH-regulating products, and lifestyle changes that encourage symbiosis.

The term “oral microbiome” is relatively new in dentistry. Where do you think it originated, and why is it crucial in dental hygiene?

Up until recently, dentistry focused its prevention efforts solely on reducing the pathogens in our patients’ mouths. We developed the standard “floss and brush twice a day” recommendation to prevent plaque biofilm accumulation. We told our patients to eat and drink less sugar because it feeds harmful bacteria. Over time, however, we saw that many of our patients who had impeccable oral hygiene habits and a low-sugar diet were still developing oral disease. How could this be? Research has shown us that there’s much more to consider, with many answers lying within the composition and surrounding environment of the patient’s unique oral microbiome. As prevention specialists, dental hygienists are tasked with the important job of helping patients discover the root cause of their issues. If we are not familiar with the oral microbiome, we are not familiar with prevention—plain and simple.

What’s one thing hygienists can do to further their understanding of the oral microbiome?

As dental hygiene students, we committed to maintaining a “lifelong learner” attitude upon transitioning into the workforce. Unfortunately, many clinicians do not make this a priority after graduation and complete continuing education courses based simply on convenience and meeting the minimum requirements established by their state dental board. Investing in quality continuing education that challenges traditional standards and inspires growth is where hygienists can learn more about topics surrounding the oral microbiome. These may be found in professional association events, study clubs, annual hygiene conferences, or clinical coaching programs.

Where can hygienists follow and support your work?

The science of the oral microbiome is evolving constantly! Don’t get left in the dark ages—seek out the information that will make you an asset to your practice and a true advocate for your patients. Knowledge really is power!

Anything else you would like to share?

Subscribe to my daily newsletter, Through the Loupes, through DentistryIQ, check out my contributions in RDH Magazine, or follow my social media brand, @humanrdh!