Bacterias cromógenas: causas y tratamiento

Posibles acciones:

Eliminar el foco de origen. Es difícil de averiguar, a no ser que el foco sea la boca de otra persona. Sirve para evitar una recolonización, pero no para descolonizar una boca ya colonizada. Para esto:

1. Seguir una dieta que no favorezca a las bacterias cromógenas: baja en hierro, aunque esto no es sostenible a largo plazo.
2. Limpieza dental. La limpieza diaria habitual no es suficiente para eliminar ni las manchas, ni las bacterias cromógenas.
3. Blanqueado dental. Es un parche, ya que elimina los residuos que dejan las bacterias, pero no las propias bacterias cromógenas.
4. Usar antibióticos. Elimina las bacterias. Las manchas irán desapareciendo después. Cambia la comunidad de bacterias y no necesariamente a mejor.
5. Cambiar la dieta en un porcentaje considerable, para cambiar la microbiota y quizás que las bacterias cromógenas desaparezcan en la nueva configuración.

Acciones con efectos aparentes

Vida thru-hiker: dieta, entorno y hábitos completamente diferentes. En una semana en Picos de Europa y posterior mes en casa, vi mejoras muy evidentes, a pesar de que durante la semana de senderismo, solo hubo un cepillado diario y sin pasta dental. No veo mejoras en vida furgonetera.

Incremento del tiempo de cepillado. Reduce manchas, pero es insostenible para las encías.

Dieta alta / baja en legumbre. Al incrementar ración, aumentan las manchas. Lo tengo claro con las lentejas, no tanto con el resto de legumbres.

Dieta correcta en hierro aumentando hierro heme. Las manchas se incrementaron inicialmente, pero luego se estabilizaron.

Acciones sin efectos aparentes

Períodos con / sin pasta dental. Creo que el tiempo de cepillado es más determinante, pero quizás la pasta blanqueante ayude. No he probado pasta con flúor.

Dieta baja en hierro.

Dieta con / sin cacao.

Dieta con / sin lácteos.

Dieta con diferentes aguas.

Cambio de estropajo.

Cambio de modelo de cepillo dental.

Evitar tapas de cazuela poco higiénicas. 

Evitar sartén de acero (contiene hierro).

Acciones pendientes de probar

Dieta sin arroz durante varios meses.

Dieta alta / baja en taninos. Contenido en taninos de los alimentos: [38, 39].

Dieta alta / baja en prolina.

Dieta alta / baja en fitatos.

Dieta correcta en hierro, baja en no heme.

Dieta sin fruta, incrementando verdura.

Dieta sin talo de maíz.

Dieta baja en hidratos de carbono.

Lactoferrina.

Lactoperoxidasa.

Probióticos orales: Streptococcus salivarius M18 (SsM18).

#ideas:

Dental prophylaxis and the use of powered scalers are considered to be the standard treatments for BS; however, this is often associated with the risk of mechanical damage to enamel and tooth sensitivity. Pigments can be removed in the early stages by adequate plaque control and the use of non-invasive antimicrobial agents such as mouthwashes. Meanwhile, chlorhexidine mouthwash is also used as the gold standard for plaque removal to eliminate pigments by inhibiting chromogenic microbiota colonization. However, the use of CHX mouthwashes leads to side effects such as tooth discoloration, taste alteration, and hypersensitivity reactions. The most undesirable adverse effect following the use of CHX is the forming of brown stains on teeth, dental crowns, and tongue [30].

 

The antibacterial effect of Hypericum perforatum essential oil, coconut oil, cinnamon essential oil against bacteria, algunas cromogénicas. No implica que la opción no concentrada (no aceite esencial) funcione [31]. 

Blanqueante: huge decrease in fibroblasts viability, the main cells of both pulp and gingivae, after exposure to both product types: containing H2O2 or carbamide peroxide. 0.0001–0.0004% H2O2 es el nivel no tóxico [32].

For oil pulling therapy, the patient is asked to take one to two tablespoons of oil in the mouth or till the mouth is half-filled, which is done on an empty stomach early in the morning. This quantity of oil is to be sipped and sucked and passes through while pulling between the teeth without swallowing for a period of 10–15 min, not longer than 20 min. Doing so allows mixing of saliva with oil promoting the extraction of toxins out of the blood flow, which turns the oil into a thin consistency while inside the mouth and makes milky white in color, indicating that it is time to be spat out. The viscous nature of coconut oil promotes lubrication, thereby inhibiting adhesion of bacteria or its by-products on the mucosal tissues.

There are a variety of edible oils such as corn oil, rice bran oil, palm oil, sesame oil, sunflower oil, and soya bean oil which have also been used for oil pulling therapy. The exact antibacterial action of coconut oil has not been clearly explained.

Coconut oil has a very effective anti-microbial action, where it stays on the tooth surface even after being washed out and cleared from saliva. On the bright side, it is a better alternative to regularly used mouthwashes containing chlorhexidine as it has no reported adverse effects. Those who suffer from loss of taste or brownish discoloration of teeth due to prolonged use of chlorhexidine can switch to oil pulling with coconut oil. All the RCTs analyzed in the review demonstrate a decrease in mean plaque scores, gingival indices, and S. mutans count with oil pulling using coconut oil within a few days of use [33].

También funciona para bacterias cromógenas [1, 2].

 

 

Oil pulling therapy can be done using edible vegetable oils such as sesame oil, sunflower oil, coconut oil, olive oil, and almond oil. Prevents decay, oral malodor, bleeding gums, and for strengthening teeth, gums, and jaws.

Aceite de sesamo son similarmente efectivos reduciendo Streptococcus mutans [34].

The oil pulling/swishing is done best before breakfast.

To accelerate the healing process, it can be repeated

3 times a day, but always before meals on an empty

stomach. This process makes oil thoroughly mixed

with saliva.

Step 1: First thing in the morning on an empty

stomach and before drinking any liquids (including

water), one should pour exactly one tablespoon of

coconut oil or sesame oil into the mouth.

Final step: Rinse out your mouth a couple of times with

warmsalt water and spit into the toilet. The oral cavity

must be thoroughly rinsed and mouth must be

washed thoroughly.

If the oil is spat into a

sink, it can clog the pipes if it solidifies.

Oil pulling therapy should be followed by brushing the

teeth and is preferably done on an empty stomach in

the morning. Do not swallow, however, inadvertently

if swallowed, there is nothing to worry [35].

Participants were instructed to use one tablespoon (5 ml)

of edible coconut oil (Patanjali’s Tejas edible coconut oil,

Haridwar, India) for mouth swishing on empty stomach in

the morning before brushing. With mouth close and chin up,

they were asked to swish oil in the mouth for 5 min. They

were asked to swish till the initially viscous oil becomes thin

and milky white. Afterward, they were asked to spit out

the swished oil and rinse their mouth thoroughly with warm

water [36].

Hierro

The mechanism of stain formation is still not understood clearly though its chemical composition is mainly iron suiphide and bacteria like actinomyces have been identified in plaque samples of these patients which have the ability to form iron sulphides. The iron content of saliva is known to increase in iron deficiency anemia and iron overload. Iron deficiency anemia is also associated with low hemoglobin levels. Pero en el estudio no vieron correlación entre manchas negras en los dientes y baja hemoglobina. El sangrado de encías supongo que también puede ser una fuente de hierro para las bacterias [28].

Dietary inhibitors such as calcium, phytates, polyphenols and enhancers such as ascorbic acid and proteins mainly influence iron bioavailability [29].

Los taninos son un tipo de polifenol que reduce la absorción del hierro no heme. La prolina de la saliva tiende a evitarlo [37].

Se asume que de una ingesta recomendada de 18mg (recommended dietary allowance (RDA)) only 10% (about 1.8 mg) from this amount is absorbed. Heme derived iron (Fe2+), contained in red meat, poultry and fish, is better assimilated (25%) than non heme iron (Fe3+) prevailing in diet (vegetable products, eggs, milk), with only 5% absorbed. [3]

Se puede observar el nivel de ferritina en analítica sanguínea, y compararlo con los valores recomendados y de analíticas previas. Síntomas de carencia de hierro pueden ser fatiga, manos y pies frios, dolor de cabeza, uñas quebradizas.

Primary causes of anemia: iron deficiency; inherited red blood cell disorders; infections, such as soil-transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. [8]

Iron status of vegetarians is compromised by the absence of highly bioavailable haem-iron in meatless diets and the inhibiting effect of certain components present in plant foods on non-haem iron bioavailability [24].

Iron absorption is impaired by dairy products, black tea, coffee, and inhibiting components in plant foods (e.g., tannins, oxalic acids, phytates, and phosphates) and enhanced by ascorbic acid [25].

Niveles de ferritina <100ng/ml podrían ser recomendables para prevenir varios tipos de cánceres [26].

Minimo 25ng/ml de ferritina [27]. 

Lactoferrina

the sequestration of Fe3+ by Lactoferrin (Lf) delays the growth of some pathogens, while it favors the duplication of commensals such as lactobacilli that do not require this element for growth.

Lf is also able to perform a bactericidal action.

The protocol included oral administration of Lf  (Forhans  Gengi-For®  orosoluble    tablets    containing 50mg  Lf  +  50mg  D-Biotin)  twice  a  day  after  proper  and accurate oral hygiene. + toothpaste Forhans Scudo Naturale contai-ning lactoferrin [11].

 

As regards lactoferrin, its anti-inflammatory action has been studied by means of in vitro periodontitis models, as well as in clinical studies: lactoferrin shows strong in vitro anti-inflammatory properties against gingival fibroblasts infected with Prevotella intermedia, whereas the topical administration to patients suffering from periodontitis is able to decrease both the levels of cytokines in crevicular fluid (e.g., IL-6), as well as edema, bleeding, pocket depth, and gingival and plaque index, with a positive variation of clinical attachment levels [9].

LTF, administered orally, normalizes iron homeostasis, not only by facilitating iron absorption, but also by inhibiting inflammatory processes responsible for anemia of chronic diseases.

Bovine lactoferrin (BLTF) is readily available on the nutritional market and generally recognized as safe for use in human diet.

warming of LTF-containing preparations above 75 °C should be avoided. Ultra-high temperature (UHT) procedure (sterilization at 130–150 °C for a few seconds) seems to affect structural as well as certain biological properties (antibacterial).

Preparations containing LTF should be preferably taken between meals (weaker activity of digestive enzymes) or as an addition to calcium-rich dairy and vegetable products, as calcium ions stabilize the structure of the LTF molecule. Although LTF alone contains little iron (about 30–40 µg/100 mg LTF powder), if added to these products it will facilitate assimilation of their non-hem iron. LTF fulfils a similar role when naturally contained in diet and added to iron-containing diet supplements [3].

Bovine milk contains 20 - 200 mg/l [4].

The ability of human milk lactoferrin to bind iron after heat treatment was also studied, remaining practically intact after treatments of 72 °C for 20 s or 135 °C for 8 s, while more severe treatments reduced markedly this ability [5].

human lactoferrin has been shown to be more resistant to proteolysis than bovine lactoferrin due to the different glycans bound to them [6].

Spray-dried lactoferrin showed significantly larger extent of denaturation, and lower iron binding capacity, when compared with fresh or freeze-dried lactoferrin [7]. 

La lactoferrina bovina es similar a la humana, aunque también se produce desde arroz transgénico.

 Aumentar lactoferrina naturalmente 

we may hypothesise that the low release of acetylcholine (ACh) and the subsequent decreased binding of ACh to M3 receptor might explain the impaired function of salivary glands. The consequence would be a reduced salivary lactoferrin secretion in Alzheimer disease patients [10].

acetylcholinesterase (AChE) mediates acetylcholine catabolism. Inhibitors suggested.

acetylcholine release is under autonomic nervous system control.

Stimulation of parasympathetic neurons leads to the release of acetylcholine, which acts upon muscarinic receptors on salivary glands [12].

Bacosides are terpenic compounds that act as acetylcholine cholinesterase inhibitors and therefore increase the levels of acetylcholine and are used as neuroprotectors [13].

The expression of choline acetyltransferase, which is necessary for acetylcholine synthesis, is downregulated in the parotid glands of liquid diet-fed growing rats, suggesting suppression of the parasympathetic nerve system that is needed to maintain parotid gland structure. Thus, the parotid glands may exhibit degeneration [14].

salivary glands atrophied by low mastication may be able to restore its secretory function by recovering the size of PGs through masticatory stimulation [15].

In aging SAMP1 kl -/- mice, supplementation with ascorbic acid (100mg/kg/day) significantly increased saliva secretion compared with the control. Ascorbic acid also importantly induced the expression of acetylcholine and/or beta-adrenergic receptors (M1AchR, M3AchR, and Adrb1) and salivary gland functional markers (α-amylase, ZO-1, and Aqua5) in vitro and in vivo. These results confirmed that ascorbic acid can improve aging-induced salivary gland dysfunction [16].

exercise activates neutrophils, potentially causing the release of lysozyme and lactoferrin into the saliva.

lactoferrin concentration in saliva decreased over a competitive training season. On the other hand, acute running increases lactoferrin and lysozyme expression in both men and women [17].

The non-enzymatic salivary antioxidants are: uric acid, glutathione, albumin, lactoferrin, ascorbic acid (vitamin C), and vitamins A and E. The most crucial representants of this group are uric acid, ascorbic acid, and reduced glutathione [52,56]. The correlation between the level of uric acid in saliva and the level in the plasma proves that uric acid comes from plasma [65]. Uric acid (UA) represents more than 85% of the total antioxidant capacity of unstimulated and stimulated human saliva [18].

Lactoferrin (Lf), a multiple functional natural immune protein, is widely distributed in mammalian milk and glandular secretions (bile, saliva, tears and nasal mucosal secretions, etc.).

Expression levels of Lf were significantly increased when the organism was infected by Gram-negative bacteria. In mice [19].

Oral Lf is digested in the stomach by gastric juices with only 1% utilization rate, and only trace amounts of intact Lf reach the small intestine [20].

reduced salivary Lf levels seem to be specific to Alzheimer Disease. La dirección de la causalidad no está clara.

reduced levels of salivary Lf could reflect compromised immunity [22].

Lactoferrin is raised in stimulated whole saliva in subjects with chronic periodontitis [23].

Microbiota

Black teeth stains (BTS) group contained increased numbers of Actinomyces naeslundii and reduced numbers of Lactobacillus spp. and Fusobacterium nucleatum.

abundance of Pseudopropionibacterium, Actinomyces, Rothia, and Cardiobacterium was higher and that of Porphyromonas was lower in the BTS group.


lower incidence of dental caries. The improved oral health of the participants with BTS may be attributed to more attention in maintaining the oral hygiene to relieve or control the expansion of BTS.


higher numbers of Rothia aeria were found in black-stained plaques in the present study. Rothia belongs to the Actinomycetaceae family.


Aggregatibacter sp._HMT_898 was highly abundant in black plaque group.


Aggregatibacter actinomycetemcomitans was reported to be significantly higher in BTS plaque samples. En algunos estudios sí, en otros no había diferencia con el grupo control.

According to microbiota functions analysis, pathways related to glycolysis/gluconeogenesis, cysteine and methionine metabolism, pyruvate metabolism, serine, glycine, and threonine metabolism were highly abundant in the BP group. These findings are similar to those of previous studies, suggesting the existence of a hyperactive metabolic state in teeth surfaces with BTS plaques [21].

Aloe Vera

Focusing on Aloe Barbadensis Leaf Juice Powder, several clinical studies have demonstrated that Aloe mouthwash and gel are effective in the prevention and treatment of gingivitis and periodontitis by reducing gingival index, plaque index, and probing depth and by increasing bone fill and regeneration. Additionally, Aloe vera has proven to be as effective as the other usual treatments, such as chlorhexidine, alendronate, and chlorine dioxide [9].

Más

Hierro

Referencias

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35. Oil Pulling-A Blessing in Disguise.

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