|Year : 2012 | Volume
| Issue : 2 | Page : 52-55
|Role of probiotics in oral health: A review of the literature
Prashant Babaji1, Kiran Keswani2, Himani Lau3, Mayank Lau4, Nitin Sharma1, Rohit Punga5
1 Department of Pedodontics, Vyas Dental College, Jodhpur, Rajasthan, India
2 Department of Conservative Dentistry and Endodontics, Vyas Dental College, Jodhpur, Rajasthan, India
3 Department of Department of Conservative Dentistry and Endodontics, Maharana Pratap Dental College, Gwalior, Madya Pradesh, India
4 Department of Prasthodontics, Ambedkar Dental College and Hospital, Bangalore, Karnataka, India
5 Department of Oral and maxillofacial Surgery, Vyas Dental College, Jodhpur, Rajasthan, India
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|Date of Web Publication||13-Nov-2013|
| Abstract|| |
Probiotics are non-pathogenic living microorganisms used to prevent various medical conditions. They have been added in some food products because of their beneficial effect in health. They play a beneficial role in preventing common oral health problems such as dental caries, periodontal disease, fungal infections (candida) and halitosis.
Keywords: Dental caries, halitosis, oral health, periodontal disease, prebiotics, probiotics
|How to cite this article:|
Babaji P, Keswani K, Lau H, Lau M, Sharma N, Punga R. Role of probiotics in oral health: A review of the literature. J Educ Ethics Dent 2012;2:52-5
|How to cite this URL:|
Babaji P, Keswani K, Lau H, Lau M, Sharma N, Punga R. Role of probiotics in oral health: A review of the literature. J Educ Ethics Dent [serial online] 2012 [cited 2020 Mar 30];2:52-5. Available from: http://www.jeed.in/text.asp?2012/2/2/52/121256
| Introduction|| |
The oral cavity consists of more than 700 bacterial species or phylotypes, of which over 50% have not been cultivated.  For the past several decades, some of the non-pathogenic bacteria called probiotics have been added to food products because of their beneficial effect to human health, thus proving.  The Hippocrates quote "let food be thy medicine and medicine be thy food."  The promising results of probiotics in oral and general health have shown their wide spread application. Their primary use in medicine has focused on the management of the intestinal tract problems.  The term probiotics is derived from Greek, meaning "for life." Probiotics thus are microorganisms proven to exert health promoting influences in humans and animals. In 1994, the World Health Organisation (WHO) stated probiotics as the next most important immune defense system when commonly prescribed antibiotics are rendered useless by antibiotic resistance.  The Food and Agricultural Organisation of the United Nations (FAO)/WHO in 2001 defined probiotics as "live microorganisms, when administered in adequate amounts, confer a health benefit to the host." ,,
The dietary benefits of microorganism has a long history. Dairy products such as kefir, koumiss, liben and curd, were often used therapeutically before the existence of microorganism was recognized. Information regarding the importance of dairy products is found in the bible and the sacred book of Hinduism. 
The use of probiotics, such as lactic acid bacilli in health through regular ingestion was proposed by Ukrainian bacteriologist Ilya Metchnikaff in 1908. In 1950, a probiotics product was used as a drug among pigs in the treatment of scour.  Lilley and Stillwell in 1965 introduced the term probiotics as an antonym to antibiotics. In 1974 Mann and Spoering observed that the fermented yogurt reduced blood serum cholesterol.  Hull in 1984 identified the first probiotic species, the Lactobacillus biodum.  Several clinical studies have proven their beneficial effect in treatment of cancer and dental caries. 
| Characteristics of Probiotics|| |
Probiotics are living microorganisms, principally bacteria that are safe for consumption, which have a beneficial effect in health. To be called a probiotic, a bacterial strain must be fully characterized. The FAO and the WHO have recommended that probiotic bacterial strains are characterized by their spectrum of resistance to antibiotics and hemolytic activities, their capacity to produce toxins, their infectious power in immune compremised animal models and their side effects in humans. These probiotics strains should then be submitted to randomize clinical trials. The result of such studies should demonstrate an improvement of health. 
| Composition of Probiotics|| |
Probiotics can be yeast, bacteria or moulds. Most commonly they are bacteria. Some of these bacterial species are:
- Lactic acid producing bacteria (LAB): Lactobacillus, Bifidobacterium, Streptococcus.
- Non LAB species: Bacillus, Propionibacterium
- Non pathogenic yeasts: Saccharomyces
- Non spore forming and non flagellated rod or Coccobacilli
| Bacterial Strains Used|| |
The most common probiotic strains belong to the genera Lactobacillus and Bifidobacterium. L. actobacillus species from which probiotic strains have been isolated include L. acidophilus acidophillus. Lactobacillus johnsonii, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus gasseri, and Lactobacillus reuteri. Bifidobacterium strains include B. bifidum, B. longum, and B. infantis.
Most of these bacteria are intestinal strains, which helps in production of enzymes to digest and metabolize protein and carbohydrates. They helpful in the synthesis of vitamins B and K and can facilitate the breakdown of bile salts. 
A probiotic may be made out of single or multiple strains. Probiotics are available in the form of powder, liquid, gel, paste, granules, capsule or sachets. 
Commercially marketed probiotics can be available in the form of Milk, Yogurt, Straw, and Ice-cream, such as, BLIS K12 (Streptococcus salivarius), probiora3 (Streptococcus oralis strain KJ3SM; Streptococcus uberis strain KJ2SM; and Streptococcus rattus strain JH145SM), probiotcs 12 plus. 
Ideal requirements of probiotic products
- Should show the beneficial effect on host animal.
- Should be non-pathogenic, nontoxic.
- Should replace and resist the intestinal micro-flora.
- Should be capable of surviving and metabolizing in the gut environment e.g.: Resistant to low pH.
- Should remain viable under storage for duration.
Mechanism of action of probiotics
Several mechanisms have been proposed regarding action of probiotics. These bacterial strains acts by secreting various antimicrobial substances such as, organic acids, hydrogen peroxide and bacteriocines. Furthermore, they compete with pathogenic agents for adhesion sites on mucosa. Probiotics can also modify the surrounding environment by modulating the pH and/or the oxidation reduction potential, which may compromise the ability of pathogen to become established. Finally they provide beneficial effects by stimulating nonspecific immunity and modulating the humoral and cellular immune response. ,
Role of probiotics in general health
Studies have shown that probiotics are used to treat various health problems such as, inflammatory bowel disease, gasrointstinal disorders, in treating antibiotic associated and traveller's diarrhea, in delaying the onset of cancer, to treat lactose intolerance and elevated cholesterol. They are also used to treat alcoholic lever diseases, ulcerative colitis, in individuals with an allergy to milk protein, asthma, hepatic encephalopathy, juvenile chronic arthritis, hypertension, urogenital infections and to aid in calcium absorption. ,
Role of probiotics in oral health
Mechanism of action
The mechanism of action of probiotics in oral health is by direct and indirect mechanisms.
Probiotics bring about direct action by:
- Direct interaction on dental plaque,
- Preventing plaque formation by competing and involvement with bacterial attachment on the tooth surface.
Probiotics show indirect action by:
- Modulating the systemic immune system,
- Affecting local immunity,
- Regulation of mucosal permeability.
- Act as antioxidants and prevent plaque formation by neutralizing free electrons. 
Dental caries is one of the most common oral diseases that needs early prevention and intervention. Streptococus mutans is one of main causative organism for dental caries. Elevated levels of streptococcus counts are strongly associated with increased risk of dental caries.  Studies have shown that probiotics containg L. rhamnosus GG and L. casei or Bifidobacterium DN-173 010, have significantly reduced the growth of oral streptococci and dental caries risk.  Fermentation of glucose, fructose, mannitol, and trehalose by L. rhamnosus GG resulted in pH values between 5.2 and 6.8 following 24 hours of incubation, thus decreases the decalcification effect of S. mutans. It has been found that subjects without caries experience are colonized by lactobacilli that possess a significantly increased capacity to suppress the growth of S. mutans.
Certain conditions are required to remove cariogenic bacteria from the teeth surface to fight against dental caries. Firstly, probiotic bacteria must be able to stick to the tooth surface where cariogenic bacteria reside. Secondly, they must become a part of the biofilm that develops on teeth. Finally, they must compete with cariogenic bacteria. All this effects of probiotics helps in a drastic reduction of the levels of cariogenic bacterial growth. 
Various oral bacteria are related to periodontal and gingival diseases. The presence of S. oralis and S. uberis often associated with healthy gingiva. Mouth wash using selected strains of L. reuteri or tablets containing 6.7 × 108 colony forming units of L. salivarius and Xylitol (280 mg/tablet) has shown the reduction in gingivitis and plaque accumulation.  Studies have shown that 14-day intake of L. reuteri led to the establishment of the strain in the oral cavity and significant reduction of gingivitis and plaque in patients with moderate to severe gingivitis.  A L. salivarius WB21 containing tablet when administered to a test group compared with placebo demonstrated insignificant differences in pocket probing depth and bleeding on probing indices. L. casei 37 can reduce the number of most common periodontal pathogens and L. salivarius TI 2711 inhibit P. gingivalis when given for 4 or 8 weeks. 
Halitosis (bad breath) affects the large proportion of the population. Halitosis can be caused by sulphur containing gases (hydrogen sulfide, methyl mercaptan and dimethyl sulfide), which are derived from the bacterial degradation of sulfur containing amino acids in the oropharynx predominantly from gram negative anaerobes. Most of the pathology causing halitosis lies within the oropharynx (tongue coating, gingivitis, periodontitis, tonsillitis). There are limited study data available regarding reduction of the halitosis by decreasing bacterial count on mucosal and tongue surfaces on using probiotics containing S. salivarius. 
Candida albicans is among the most common infectious agents present in the oral cavity. Consumption of probiotic cheese containing L. rhamnosus GG and Propionibacterium freudenreichii ssp. Shermanii JS shown decrease in C albicans count [Table 1]. 
|Table 1: Studies showing the effect of probiotics strains on oral health and in reduction of microbial count|
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A prebiotic is "a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal micro-flora that confers benefits upon host well-being and health," whereas synergistic combinations of pro and prebiotics are called synbiotics.  Prebiotics aid to complement probiotics in the treatment of oral diseases. Prebiotics are non-digestible dietary supplements. Their function is to enhance the growth and activity of beneficial organisms and simultaneously suppress the growth and activity of potentially deleterious bacteria. Prebiotics can modify the balance of the intestinal micro-flora. 
The main purpose of prebiotic ingetion is mainly to change microbial population. Some of the commonly known prebiotics are lactose, inulin, fructo oligosacccharides, galacto oligosaccharides and xylo oligosaccharides. Prebiotics are naturally found in large quantity in certain fruits such as bananas, asparagus, garlic, tomato, onion and wheat. The most important characteristic feature is that prebiotics can alter the intestinal micro-flora and its activities. Basically, prebiotics selectively stimulate the growth of probiotics, which is dose and strain dependent. Studies have shown that prebiotics serve as a selective growth substrate for the probiotics strain during fermentation. 
| Safety Measures|| |
Due to increased probiotics supplementation of different food products, safety measures are a major concern. Probiotics are often regulated as dietary supplements rather than as pharmaceutical or biological products. For the safety purpose, probiotic microorganisms should not be pathogenic, should not have any growth stimulating effects on bacteria causing diarrhoea, and should not have an ability to transfer antibiotic resistance genes, and should not cause sepsis or bacteremia. The probiotic should maintain genetic stability in oral micro-flora. ,
Several results from antibiotic susceptibility tests claim that the tet- (W) and tet- (S) genes in some probitic Lactobacilli and Bifidobacteria strains are responsible for sulfamethoxazole, gentamycine, polymyxin B and tetracycline resistance. These findings show the need of minimal safety evaluation during the selection of strains for probiotic use. 
| Future Application|| |
Wider application of probiotics in general health can increase its demand. In future, probiotics application can be extended to cure many health related problems. The critical steps in wider application will be to make products available that are safer and clinically proven in a specific formulation, which should be easily accessible to physician and consumers. In India, sporolac i.e., Sporolactobacilli is commonly used probiotic. Recently Bacillus mesentricus is used as an alternate to B-complex.  Genetically modified lactic acid bacteria have been proposed as a vehicle to deliver vaccines in the gastro-intestinal tract. 
| Conclusion|| |
Probiotics are living microorganisms, are made out of single or multiple strains. They are used to treat various general and oral health problems. They act by competing with pathologic strains and by inhibiting their action. Further clinical studies is required prove their role in oral health.
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Department of Pedodontics, Vyas Dental College, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
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