A Review on Probiotics and their Implications in Dentistry A review on probiotics and their implications in dentistry

Abstract

The aim of this comprehensive review is to present an update about the current status of probiotics in terms of its application in the field of dentistry. The concept of administration of beneficial bacteria with a view to replace harmful microbes with useful ones has been revived by the probiotic concept. The main field of research has been in the gastrointestinal tract. However, past few years has seen investigation of probiotics from the oral health perspective. Probiotic approach has shown promising results in oral cavity with respect to control of chronic disease such as dental caries, periodontitis, and recurring problems like halitosis and candidial infections. The application of probiotic strategies may, in near future provide an end to many infections occurring in oral cavity. This article summarizes the currently available data on the potential benefits of probiotics for oral health and potential risks associated with them.

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REVIEW ARTICLE
A Review on Probiotics and their Implications
in Dentistry
Mohit Sareen*, Sayak Roy**, Siddharth Kumar Singh*** Anjali Gupta***
Abstract
The aim of this comprehensive review is to present an update about the current status of probiotics
in terms of its application in the field of dentistry. The concept of administration of beneficial bacteria
with a view to replace harmful microbes with useful ones has been revived by the probiotic concept. The
main field of research has been in the gastrointestinal tract. However, past few years has seen
investigation of probiotics from the oral health perspective. Probiotic approach has shown promising
results in oral cavity with respect to control of chronic disease such as dental caries, periodontitis, and
recurring problems like halitosis and candidial infections. The application of probiotic strategies may, in
near future provide an end to many infections occurring in oral cavity. This article summarizes the
currently available data on the potential benefits of probiotics for oral health and potential risks
associated with them.
Key words: Probiotics, oral health
(Sareen M, Roy S, Singh SK, Gupta A. A review on probiotics and their implications in dentistry.
www.journalofdentofacialsciences.com 2012; 1(2): 7-10).
Introduction
The term Probiotic, meaning “for life,” is
derived from the Greek language. This term was
first used by Lilly and Stillwell in 1965 to describe
substances secreted by one microorganism which
stimulates the growth of another.1 According to
WHO (2002), Probiotics are “live microorganisms
which, when administered in adequate amounts
confer a health benefit on the host”. Probiotics
have been used to improve gastrointestinal health
for quite some time and their popularity has
prompted increased interest for their role in
promotion of oral health. There also has been a
change in understanding of the oral disease
process because of better understanding of
ecology and microbiology of oral cavity. Very
encouraging studies have come up in recent past
exploring probiotics in fields of caries, periodontal
diseases and few other areas and the results tend
to suggest beneficial effects of probiotics on oral
health and on whole body in general.
This article summarizes currently available data on
the potential benefits of probiotics for oral health.
Historical Facts
There is a long history of health claims
concerning living microorganisms in food,
particularly lactic acid bacteria. In a Persian
version of the Old Testament it states that
“Abraham owed his longevity to the consumption
of sour milk”. In 76 BC the Roman historian
*MDS, Senior Lecturer, Department of Oral Medicine
and Radiology, Rajasthan Dental College and Hospital,
Jaipur, Rajasthan
**MDS, Senior Lecturer, Department of Oral Medicine
and Radiology, Hazaribag College of Dental Sciences
and Hospital, Jharkhand
*** MDS, Senior Lecturer, Department of Oral Medicine
and Radiology, SAIMS College of Dentistry, Indore, M.P.
Address for Correspondence:
Mohit Sareen,
C-33, Mohan Niwas, Opposite Ram gali no-8, Raja Park,
Jaipur, Rajasthan
PHONE: 09460874123
e mail: mohitsareen99@gmail.com

8 Sareen et al.
www.journalofdentofacialsciences.com Vol. 1 Issue 2
Plinius recommended the administration of
fermented milk products for treating
gastroenteritis.2 Elie Metchnikoff was perhaps the
first researcher to propose that fermented dairy
products have beneficial properties.3 In 1894, he
showed that cholera could be prevented by the
presence of antagonistic organisms in the
intestine.4 In 1907 the Ukrainian-born biologist
and Nobel laureate, working at the Pasteur
Institute in Paris, discovered Lactobacillus
bulgaricus. He developed a theory that lactic acid
bacteria (present in Bulgarian yoghurt) in the
gastrointestinal tract could, by preventing
putrefaction, prolong life. This was based on his
observation that Bulgarians lived longer than other
people. He devoted the last decade of his life to
the study of lactic acid-producing bacteria as a
means of increasing human longevity. The concept
of probiotics was thus born and a new field of
microbiology was opened.5
Ideal Requirement of a Probiotic
It should be:
• Non toxic and non pathogenic
• Having beneficial effects
• Able to withstand gastrointestinal juices
• Replace and reinstate the flora
Therapeutic Actions of Probiotics6
The major areas of their therapeutic clinical action
include:
• Prevention of diarrhoea caused by
clostridium difficile
• Prevention of colon cancer.
• Reduces progression of AIDS.
• Enhancement of calcium absorption.
• Regulation of Immunity.
• Compete against harmful microorganisms,
preventing colonization of pathogens.
• Reduction of blood cholesterol levels.
• Reduction of liver toxicities.
• Enhancement of vitamin status (B, K).
• Increases the lifetime of voice prosthesis.
Probiotic Products
Probiotics are provided in products in one of
the four basic ways:
1. A culture concentrate added to a beverage or
food (such as a fruit juice).
2. Inoculated into prebiotic fibers.
3. Inoculants into a milk-based food (dairy
products such as milk, milk drink, yoghurt).
4. As concentrated and dried cells packaged as
dietary supplements (non-dairy products).
Probiotic Species for Oral Health
Probiotics can be varied. They can be yeast,
bacteria or moulds. But most commonly, bacterial
species are predominant. Some of the species are:
1. Lactic acid producing bacteria (LAB):
Lactobacillus, bifidobacterium,
streptococcus
2. Non lactic acid producing bacterial species:
Bacillus, propionibacterium
3. Non pathogenic yeasts: Saccharomyces
4. Non spore forming and non flagellated rod
or coccobacilli
Mechanism of Probiotics in Oral Health
The suggested mechanisms of probiotic action
on oral health are drawn entirely from
gastrointestinal studies. Several mechanisms have
been suggested to contribute to the probiotic
action in systemic health.5 They relate to immune
modulation, modulation of gut immunological
mechanisms, mucin production, down regulation
of inflammatory responses, secretion of
antimicrobial substances, competition with other
flora, including potential pathogens by competitive
blocking of adhesion sites at epithelial and
mucosal surfaces, and inhibition of epithelial
invasion by regulation of intestinal permeability,
inhibition of pathogens mucosal adherence and
stimulation of immunoglobin A production.7,8
There is also evidence of production of anti-
microbial substances, such as organic acids,
hydrogen peroxide and bacteriocins.9 Their
applicability to oral health needs further studies.
Nevertheless, since the mouth represents the first
part of the gastrointestinal tract, there is every
reason to believe that at least some probiotic
mechanisms may also play a role in that part of
the system. It may also be anticipated that resident
probiotics could exist in the oral microflora, and
that they may function in the complex ecosystem
of dental plaque and in the formation and
development of oral biofilms in general.

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Effect of Probiotics on Oral Health
Probiotics and Dental Caries10,11
Streptococcus mutans is the main micro
organism involved in causation of dental caries.
Probiotics can reduce the risk for a high
Streptococcus mutans (S. mutans) level
occurrence. Bacteria administered as probiotics
compete with cariogenic microbes for adhesion
sites as well as for nutrients and growth factors
leading to reduced level of S. mutans in oral
cavity. Çaglar et al. in a comparative study of S.
mutans reduction effects by several probiotic
administration forms, showed a reduced S. mutans
level in patients receiving fluid or tablet probiotic
forms. Nikawa et al. reported that consumption of
yoghurt containing Lactobacillus reuteri (L.
reuteri) over a period of 2 weeks reduced the
concentration of S. mutans in the saliva by up to
80%. Comparable results were obtained by
incorporating probiotics into chewing gum or
lozenges. These promising results suggest a
potentially beneficial application of probiotics for
the prevention of dental caries.
Probiotics and Halitosis11,12
Halitosis or bad breadth is a condition
affecting comparatively large section of population.
Bad breadth in oral cavity is mainly ascribed to the
production of volatile sulfur compounds (VSC)
predominantly by gram negative anaerobes
residing in periodontal pockets and on the dorsal
surface of tongue. The replacement of bacteria
implicated in halitosis by colonization with
probiotic bacterial stains may have potential
application as adjuncts for the prevention and
treatment of halitosis.
A definite inhibitory effect on the production of
volatile sulfur compounds (VSC) by F. nucleatum
was observed after ingestion of Weissella cibaria
both in vitro and in vivo. In children, a marked
reduction in the levels of H2S and CH3SH was
registered after gargling with W. cibaria containing
rinse. The possible mechanism in the VSC
reduction is the hydrogen peroxide generated by
W. cibaria that inhibits the proliferation of F.
nucleatum. Streptococcus salivarius, also a
possible candidate for an oral probiotic, has
demonstrated inhibitory effect on VSC by
competing for colonization sites with species
causing an increase in levels of VSC.
Although various probiotic products are marketed
for both mouth and gut associated halitosis, their
efficacy demands more clinical studies.
Probiotics and Periodontal Disease:12, 13
Mucosal immune responses may be invoked
by probiotic immunization. Studies of adhesion
molecules have shown that superficial cell layers of
the gingiva can be affected and can be stimulated
to enhance the presence of immune potent cells.
Regulation of microflora composition (e.g. by
probiotics and prebiotics) may offer the possibility
to influence the development of mucosal and
systemic immunity, but it can also play a role in
the prevention and treatment of diseases such as
periodontitis. In a Russian study using probiotic
tablets in complex treatment of gingivitis and
different degrees of periodontitis, the effect of
probiotics to the normalization of microflora was
found to be higher in comparison to the controls,
particularly in the cases of gingivitis and
periodontitis. A decrease in gum bleeding and
reduced gingivitis has been observed with the
application of L. reuteri. Probiotic strains included
in periodontal dressings at optimal concentration
were shown to diminish the number of most
frequently isolated periodontal pathogens:
Bacteroides sp., Actinomyces sp. and S.
intermedius, and also C. albicans. Nevertheless,
similar to the case with dental caries, however,
there is not yet any true evidence on the effect of
probiotic therapy on periodontal disease.
Probiotics and Candidiasis12,14
A reduction in the prevalence of Candida
Albicans in the elderly after consumption of
probiotic cheese containing L. rhamnosus and
propionibacterium has been demonstrated.
This is the only study that has been published
in human population and the authors didn’t have
any explanation to this and further investigations
are needed.
Future Directions
Recently, oral lactic acid bacteria and
bifidobacteria have been isolated and
characterized for various oral health purposes,
including caries, periodontal diseases, and

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halitosis. The new probiotic products targeted for
oral health purposes do not necessarily comprise
the same species as products now in market.
Genetically modified microbes bring a new
dimension to the concept of probiotics. Their main
thrush is on reducing the harmful properties of
pathogenic strains naturally colonizing the oral
cavity. The modified strain could then be used to
replace the original pathogen. Also they could be
used to enhance the properties of a potentially
beneficial strain. In field of oral immunology,
probiotics are being used as passive local
immunization vehicles against dental caries.
Bacteriophages, viruses that kill bacteria, have
been detected in oral pathogens, such as
Actinobacillus actinomycetemcomitans, and they
may play a role in the pathogenicity.
Subsequently, future studies should be conducted
to investigate if phage therapy might be applied for
oral and dental diseases in the same way as has
been attempted for systemic infections. The
selection of the best probiotic for oral health is also
an issue that calls for further study.5
Conclusion
Probiotics are emerging as a fascinating field in
oral medicine. This concept prompts a new
horizon on the relationship between diet and oral
health.
Clinical trials should be directed to assess the
method of probiotic administration in oral cavity
and dosages or different therapeutic uses.
Research should be directed towards the action of
probiotics on oral cavity and also on its
pathological conditions.
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