"Eat what you like and let the food fight it out inside." According to Mark Twain, this is one of life's secrets to success, and he said this without ever reading a study about probiotics. These living microorganisms provide health benefits by adding "good" microbes to fight against "bad" microbes. When effective, the good microbes reduce the bacterial threat of the bad microbes associated with caries, periodontal diseases and halitosis.
Probiotics are classified by the United States Food and Drug Administration as dietary supplements or foods, and can be extracted from plant or animal tissue.1 The majority of microorganisms found in probiotics, often delivered in noninvasive capsules, tablets or powder form, are bacteria-based, but can also include molds and yeasts.1 There are at least six known strains from bacteria and one known strain from yeast. Each strain can have multiple species, such as bacteria-based Lactobacillus, which has at least 11 species.2 The effects of probiotics are benefit-specific, and two strains from the same species may not provide the same outcome in a patient.
"The rationale for using probiotics involves restoring microbial balance," reports Nancy Toedter Williams, PharmD, BCPS, BCNSP, in a recent study.2 Williams, associate professor of pharmacy practice in the College of Pharmacy at Southwestern Oklahoma State University in Weatherford, reviewed the pharmacology of probiotics, including dosages, drug interactions, contraindications, and safety concerns associated with their use. "Although probiotics' exact mechanisms of action are not known, several have been proposed," Williams writes. For example, certain types of probiotics produce lactic acid, which is capable of suppressing the growth of different pathogenic microbes.
Battling Caries, Periodontal Diseases and Halitosis
In oral health research, probiotics have been closely examined for their ability to combat caries, periodontal diseases and halitosis. Two studies that investigated the effects of probiotics on dental caries showed treatment with probiotics yielded positive results. In the first study, Lactobacillus reuteri performed well in reducing Streptococcus mutans. A second study tested a probiotic against chlorhexidine and a placebo. This study revealed that probiotics not only significantly reduced plaque accumulation compared to the study's placebo treatment, but also outperformed chlorhexidine in measures of the gingival index.3
Investigators have been curious about the effectiveness of probiotics in periodontal treatment, and have designed studies to gauge how probiotic microbes might reduce the body's inflammatory response to periodontal diseases. One study found L. casei Shirota effectively lowered elastase activity and shrunk the production of an agent associated with the inflammatory response.4 A second study confirmed that one pair of probiotic strains reduced the presence of cytokines in gingival crevicular fluid and also decreased bleeding on probing.5 Unpublished research performed by Noel Kelsch, RDHAP, and Gregori Kurtzman, DDS, found that the use of a dental probiotic (GUM® PerioBalance® by Sunstar Americas Inc) had a profound effect on the oral health of patients studied. A 49% reduction in oral bacteria, 47% reduction in plaque accumulation, and 43% improvement in periodontal classification scores were noted after patients used the dental probiotic for 60 days.
Halitosis is another oral condition in which probiotics can aid treatment. One study showed that subjects who took probiotics in the form of chewing gum, lozenges, and mouthrinses lowered the production of sulfur, which causes bad breath. A subsequent study confirmed these finding by testing a different strain of probiotic against halitosis and found significant decreases in the condition.6
A Boost to Systemic Health
Probiotics that can help treat harmful conditions in the oral cavity may be beneficial in treating certain systemic conditions. The gastrointestinal tract, for example, is one area where probiotics are well studied. Research concludes that probiotics can successfully treat viral diarrhea and several inflammatory bowel conditions. Probiotics can also benefit dental patients who have comorbidities such as type 1 diabetes, rheumatoid arthritis or high cholesterol.
Taken orally, probiotics are considered generally safe to use. Many probiotics appear on the market in the US, but only products that have been tested in controlled human studies should be recommended, according to Williams. "It is important to remember that the overall risk of developing an infection from ingested probiotics is very low," Williams advises, "particularly when used by generally healthy individuals."
Strength in Numbers
The great variety of probiotics makes it difficult to isolate which strain is effective in treating a particular health problem. Still, their expansive numbers seem a key benefit behind their use. "Products containing more than one organism are particularly appealing for two reasons," reports Williams. "Colonization in some patients may occur with one strain and not in another, and probiotic mixtures may be synergistic in suppressing pathogens."
Good oral flora is key to maintaining oral health, as it actively reduces the risk of caries, periodontal diseases and halitosis. For these reasons, oral health researchers generally agree the mechanisms of probiotics deserve greater illumination. A number of studies investigating the function of probiotics in oral health have been published in the past year, which underscores the interest in expanding the clinical implications of probiotic treatment. Though health care's understanding of probiotics may yet be in the cradle, the proof of their potential is clear. And, as dentistry warms to the idea of prevention over drill-and-fill for the provision of care, probiotics offer dental hygienists an option for preserving oral health that, when used correctly, is safe, effective and noninvasive.
References
1. Deepak TA, Manjunath M, Shubha P. Antibiotics are passe: take a look at probiotics. World Journal of Dentistry. 2010;1(2):109-111.
2. Williams NT. Probiotics. Am J Health-Syst Pharm. 2010;67:449-458.
3. Harini PM, Anegundi RT. Efficacy of a probiotic and chlorhexidine mouth rinses: a short-term clinical study. J Indian Soc Pedod Prev Dent. 2010;28:179-182.
4. Staab B, Eick S, Knöfler G, Jentsch H. The influence of a probiotic milk drink on the development of gingivitis: a pilot study. J Clin Periodontol. 2009;36:850-856.
5. Twetman S, Derawi B, Keller M, Ekstrand K, Yucel-Lindberg T, Stecksén-Blicks C. Short-term effect of chewing gums containing probiotic Lactobacillus reuteri on the levels of inflammatory mediators in gingival crevicular fluid. Acta Odontol Scand. 2009;67:19-24.
6. Iwamoto T, Suzuki N, Tanabe K, Takeshita T, Hirofuji T. Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110:201-208.
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