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The oral microbiome and sex hormones

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Most of us realize that germs are important contributors to the state of our health. Healthy microbiomes or bacterial colonies contribute to the valuable protection of short-chain fatty acids, vitamins and the immune system. Disordered microbiomes are reflected in oral health. Periodontal disease, gingivitis, plaque formation, and tongues covered in white candida colonies illustrate that the microbial balance in the mouth has gone awry. We have begun to study bacterial colonies that contribute to oral health and represent a disease state. In turn, sex hormones could contribute to the nature of the bacterial and fungal inhabitants of the mouth.

Saliva tests for sex hormones are offered to diagnose and monitor deficiencies and treatments. Thus, it is well established that sex hormones are easily measured in the mouth. A review “Sex Steroid Hormones as a Balancing Factor in Oral Host Microbiome Interactions” published by Pilar Cornejo Ulloa et al in Frontiers in Cellular and infection Microbiology, September 29, 2021, brings together studies with the aim of unraveling the dance between hormones and the oral microbiome.

In the absence of vitamin K, estradiol and progesterone can provide growth factors for certain bacterial species. Increased protein and polysaccharide production with estradiol may contribute to microbial biofilms. Several species demonstrate the ability to convert 4-androstenedione to testosterone and dihydrotestosterone, producing the enzymes necessary for these conversions.

One organism, Treponema denticola, present in oral biofilms can convert testosterone to dihydrotestosterone and can be inhibited by adequate plasma progesterone levels.

In cultures, Streptococcus mutans, a cavity-producing microorganism, has demonstrated the ability to metabolize progesterone and testosterone.

Candida have binding sites for estradiol and progesterone. Estradiol can promote the formation of hyphae, the form of candida that invades tissue. Progesterone can inhibit biofilm formation and colonization.

Some studies have looked at variations in the oral microbiome during female hormonal fluctuations. A greater diversity of bacteria occurs during the luteal phase of the menstrual cycle. Growth variations in some species increase during pregnancy and decrease at birth. Candida can thrive in the last two trimesters of pregnancy. This hormone-rich period has been hypothesized to contribute to the gingivitis experienced during pregnancy.

Polycystic ovary disease is associated with a high prevalence of periodontal disease. However, few studies are available to identify changes in the microbiome.

The use of oral contraceptives leads to an increased incidence of periodontal disease and the growth of candida.

The authors hypothesize that sex hormones in saliva affect changes in bacteria in the oral microbiome and that various organisms may in turn modulate hormone concentrations for their own purposes.

Their conclusion is as follows: “There is an active and bidirectional interaction between the host and its microbiome, mediated by sex steroid hormones”

We have a lot to learn to support a healthy oral microbiome, which is also dependent on the broader gastrointestinal microbiome. Hormonal balance can contribute to the diversity and health of oral microbes. But the reverse can also be true. Serious hormonal imbalances can be illustrated when you open your mouth and say “ah”.