Knowledge Library

by Eric Goulder, MD, and Patti DeMatteis, ASDH, RDH; Inside Dentistry 2019

Landmark research has established a connection between oral inflammatory disease and systemic inflammatory disease and has driven the establishment of collaborative dental and cardiac treatment methods to prevent or limit heart attacks and strokes.

New and active research has found that the microorganisms responsible for dental diseases also contribute to systemic inflammatory diseases, such as atherosclerosis. The discovery of this oral-systemic link is changing treatment approaches for both medical and dental professionals towards a collaborative model aimed at reducing pathogen loads that contribute to inflammation. One such collaborative model based on The BaleDoneen Method^® has been implemented at the Heart Attack and Stroke Prevention Center of Central Ohio and aims to treat or prevent heart attacks and strokes by identifying the root causes of systemic inflammation. Diagnostic methods and treatments that include close collaboration of dental and medical professions are discussed, and the success of this protocol is illustrated in a patient case report.

Oral hygiene during orthodontic treatment is difficult as fixed brackets, bands and wires trap food causing a buildup of plaque and biofilm, even with regular brushing and flossing. Oral-care probiotics, such as ProBioraPlus^® and ProBioraPro^®, help reduce this buildup of plaque and promote oral health by providing the teeth and gums with natural, healthy bacteria that crowd out the bacterial pathogens causing cavities, gingivitis, and bad breath.

Dental professionals are keeping their focus on patient care during the ADA’s current ‘emergency only’ protocol throughout the COVID-19 pandemic. Many dental professionals may consider offering oral-care probiotics to patients who need extra periodontal protection during this time. In addition to daily brushing and flossing, the use of oral-care probiotics can be an effective option to restore the natural balance of beneficial bacteria in the mouth, which can be depleted by diet, stress, medication, illness or other factors.

by Lisa Mallone, M.P.H., RDH, RD, LD; Dental Products Report 2020

Oral care probiotics support dental and systemic health by repopulating the mouth with beneficial bacteria. 

Dental patients who regularly practice good oral hygiene but continue to experience bad breath, periodontal issues, and/or cavities are left feeling frustrated by traditional preventative dentistry methods including tooth brushing and flossing. Oral care probiotics are a viable preventative dentistry alternative that can be used for the treatment of these common oral health issues by repopulating the oral cavity with natural, beneficial bacteria that crowd out unhealthy, disease causing bacteria. The benefits of oral care probiotics extend beyond the oral cavity. High-risk oral bacteria can migrate to the blood stream, causing inflammation which increases the risk of heart attacks and strokes. As oral care probiotics primarily work to crowd out these high-risk, unhealthy bacteria, they can be useful in reducing systemic disease in addition to oral disease. The benefits of oral care probiotics for both dental and systemic health have been well documented in peer-reviewed research for more than 30 years and would make a positive addition to preventative dentistry routines.

by Samuel B. Low, DDS, MS, MED; Inside Dentistry, 2020

Incorporating oral care probiotics, such as ProBioraPro^®, into existing dental hygiene routines is a proactive dentistry approach that supports tooth and gum health.

Oral care probiotics are rapidly becoming a proactive dentistry approach of choice as they are effective for maintaining tooth and gum health and are easy to incorporate into existing dental hygiene practices at home. ProBiora Health® produces the first true oral care probiotic with their patented active ingredient, ProBiora3^®, which includes three beneficial bacterial strains native to the teeth and gums. By dissolving one mint daily, ProBiora Health’s oral care probiotics help balance the oral microbiome by crowding out bacteria that cause diseases, such as caries and gingivitis, while also whitening teeth. Backed by over 30 years of clinical research, ProBiora Health probiotics are an excellent proactive choice for dental health.

Your oral health is more important than you might realize. Learn how the health of your mouth, teeth and gums can affect your general health.

Cannon, M; Trent, B; Vorachek, A; Kramer, S; Esterly, R. 2013. Effectiveness of CRT at Measuring the Salivary Level of Bacteria in Caries Prone Children with Probiotic Therapy, The Journal of Clinical Pediatric Dentistry Cannon, M; Vorachek, A; Le, C; White, K. 2019. Retrospective Review of Oral Probiotic Therapy, The Journal of Clinical Pediatric Dentistry

Oral care probiotics significantly reduce the caries risk in children and this effect remains clinically significant after three years

An oral care probiotic regimen significantly reduced both the caries risk and the levels of cariogenic dental bacteria in caries prone children with no reported side effects. The reduction in caries risk for the pediatric study group remained clinically significant three years after the original study. Together, this data supports the use of oral care probiotics in preventative dentistry to reduce both the number of pathogenic dental bacteria and the long-term risk of caries in children. Dental professionals should adopt oral care probiotic therapy as one of the most effective caries preventive measures in children.

Laleman I, Detailleur V, Slot DE, Slomka V, Quirynen M, Teughels W.J: Clin Oral Invest (2014) 18:1539–1552 A systematic review demonstrates that probiotics have a significant role in reducing streptococci mutans and lactobacilli and thus a major component in preventing caries. Microbiological data supports that probiotic bacteria are only temporary colonizers, even in young children so the probiotic regiment must continue if the clinician desires the assurance that the dental diseases can be managed.

Yao SG, Fine JB. : Compendium October 2014 The difference between root planing alone and root planing with the application of the bacterial mixture for sites with bleeding on probing is statistically significant. This result suggests the promise of application of beneficial bacteria an adjunct to root planing Data identifies that S. sanguinis and Streptococcus uberis can inhibit the growth of periodontal pathogens. This can be based on the production of hydrogen peroxide and other factors.

Laleman I, Teughels W. Quintessence International VOLUME 46 • NUMBER 3 • MARCH 2015 Probiotics have been extensively studied in medicine and to a lesser degree in dentistry. With healthcare moving more into a holistic direction and antibiotic resistance a reality, the suggested effects of probiotics in the oral cavity can be broadly divided into three groups: 1) modulation of the host inflammatory response 2) direct effect against pathogenic bacteria and 3) indirect effect against pathogenic bacteria. For the dental practitioner, probiotics may be useful for the following conditions: caries, halitosis, periodontal disease and oral mucositis.

Seminario-Amez M, López-López J, Estrugo-Devesa A, Ayuso-Montero R, Jané- Salas E: Med Oral Patol Oral Cir Bucal. 2017 May 1;22 (3):e282-8. The literature reviewed suggests probiotics usage could be beneficial for the maintenance of oral health, due to its ability to decrease the colony forming units (CFU) counts of the oral pathogens. Decreasing the pathologic oral flora will result in continued positive management of oral disease from prevention to actual treatment.

DevkarN, ChauhanVS, VibhuteA Journal of Dental & Allied Sciences 2012;1(1):18-20 Probiotics can help prevent and treat disease through several mechanisms: a) Direct interaction with the disease-causing microbes, making it harder for them to cause the disease. b) Competitive exclusion by directly compete with the disease, developing microbes for nutrition or enterocyte adhesion sites. c) Modulation of host immune response with probiotics interacting with and strengthen the immune system and help prevent disease. Streptococcus oralis and S. uberis have been shown to inhibit the growth of pathogens both in vitro and in vivo. The presence of these organisms is an indicator of good periodontal health. Studies suggest probiotics could serve as a useful adjunct or alternative to periodontal treatment when SRP might be contraindicated due to systemic or behavioral complications.

Probiotics: A Promising Role in Dental Health MahasnehmSA and MahasnehAM Dent. J. 2017, 5, 26; doi:10.3390/dj5040026 The increase in incidence of antibiotic resistance suggests the utilization of probiotics in preventing certain oral pathologic conditions. With the development of designer probiotics, the future could be analyzing a personal oral microbiome characterized to the genus level by providing a saliva sample. This sample could be used as a biomarker to formulate a list of probiotic strains specifically targeting resident pathogenic bacteria.

Robert P. Allaker & Abish S. Stephen Curr Oral Health Rep https://doi.org/10.1007/s40496-017-0159-6 Probiotics can be useful in managing periodontal disease by disrupting microbiome colonization and this alters the microbial ecosystem. This can occur by 1) competitive inhibition of periodontal pathogens, and 2) modulating chronic inflammatory active pathways to reduce the destructive inflammation of periodontitis and lead to immune balance. However, once probiotics are eliminated, the microflora will return to the pre-administrative status.

Saha S, Tomaro-Duchesneau C, Tabrizian M, Prakash S.: Expert Opin. Biol. Ther. (2012) 12(9) Probiotics have shown potential for reducing the proliferation and adherence of cariogenic bacteria, suggesting their prospective use as a natural and safe oral therapeutic. Studies suggest that cocktail formulations of probiotics are able to modulate immune responses linked to periodontal disease by reducing bleeding on probing and other chronic inflammatory parameters.

Human tooth fragments transferred daily in sucrose containing cultures of Streptococcus mutans strain BHt-2 developed visible white spots, the characteristic lesion of early dental caries, within 10 days. By contrast tooth fragments exposed to an L(+) lactate dehydrogenase (LDH)-deficient derivative of BHT-2 showed no visible lesions, even after 21 days of transfer.

The plaque of 7 clinically healthy subjects was analysed for organisms inhibitory to the growth of A. acinmoycetemcomitans strain Y4 on chocolate agar medium. Ten of the 11 sites harboured such organisms which constituted a medium of 5.8 percent of the total cultivable flora.

The existence of antagonistic and commensal relationships between microorganisms was investigated. The predominant cultivable flora in 172 plaque samples from active and non-active sites in 32 human subjects with destructive periodontitis was determined.

Eleven different laboratory strains of Streptococcus mutans representing the various serogroups were found to produce an average of 6.0 + 4.8 mM acetoin when grown in glucose-containing medium under aerobic conditions. None of the strains produced detectable acetoin when grown anaerobically. A lactate dehydrogenase-deficient mutant produced acetoin both aerobically and anaerobically and in substantially greater amounts than the wild-type strains did. Substitution of mannitol for glucose resulted in decreased acetoin production by wild-type strains and the lactate dehydrogenase-deficient mutant, indicating a role for NADH2 in the regulation of the acetoin pathway. Pyruvate incorporated into the growth medium of a wild-type strain caused acetoin to be produced anaerobically and stimulated acetoin production aerobically. Cell extracts of a wild-type S. mutans strain were capable of producing acetoin from pyruvate and were (partly) dependent on thiamine PP;. Extracts prepared from aerobically grown cells had approximately twice the acetoin-producing activity as did extracts prepared from anaerobically grown cells. The results indicate that acetoin production by S. mutans may represent an auxiliary reaction of pyruvate dehydrogenase in this organism.

A number of different factors determine the composition of the bacterial flora that resides in a given ecosystem. Certainly, the minimum physical and metabolic needs of a particular organism must be satisfied if it is to grow and reproduce. In the case of bacteria colonizing a host organism, such as man, the host's defense factors may play an important role in determining the type and numbers of resident flora.

To conduct a laboratory study to evaluate the ability of a culture of a hydrogen peroxide-producing oral bacteria, Streptococcus oralis strain KJ3sm®, to whiten stained dental ceramic disks over a period of 4 weeks.

Samples of subgingival plaque were taken from 275 active and inactive sites in 35 subjects with destructive periodontal diseases. The predominant cultivable microbiota in each of the samples by characterizing 50 randomly selected isolates recovered on anaerobically incubated Trypticase soy agar supplemented with 5% sheep blood.

In vitro, Streptococcus sanguis inhibits the growth of Actinobacillus actinomycetemcomitans, a presumed aetiological agent of localized juvenile periodontitis. When provided with glucose and good aeration, a growing culture of Strep. sanguis was found to produce hydrogen peroxide at concentrations in excess of the maximum LD50 reported for strains of A. actinomycetemcomitans.

Streptococcus viridans are commensal bacteria that constitute a significant portion of resident oral microflora. The objective of the present study is to investigate adverse effects, if any, of a blend of 3 natural strains, Streptococcus uberis KJ2, Streptococcus oralis KJ3 and Streptococcus rattus JH145 (probiotics mouthwash, ProBiora3). The blend is administered to rats orally once daily (5 days per week) of each strain for 14 weeks.

To evaluate the effect of probiotic chewing tablets on early childhood caries development in preschool children living in a low socioeconomic multicultural area.

To study the ability of daily applications of Streptococcus rattus strain JH145 to affect the numbers of an implanted Streptococcus mutans strain in a rat model

The release this year of “Oral Health in America: A Report of the Surgeon General”—the first such report on this topic in U.S. history—gives national visibility to the scope and breadth of oral health and disease in America. The report emphasizes oral health’s inextricable link to general health and well-being. Although the country has seen major improvements in oral health, some population groups have yet to benefit from these improvements. To address health disparities and improve quality of life for all Americans, the surgeon general’s report calls for the development of a National Oral Health Plan.

Are probiotics the future of medicine? Theoretically, beneficial microorganisms could be used to treat a range of clinical conditions that have been linked to pathogens, including gastrointestinal problems like irritable bowel syndrome and inflammatory bowel disease (e.g., ulcerative colitis and Crohn’s disease), oral diseases like tooth decay and periodontal disease, and various other infections, including vaginal infections and possibly skin infections. Probiotics could also conceivably be put to use in preventing disease or thwarting autoimmune disorders. A number of these possibilities are being explored in research laboratories and hospitals around the world.

Probiotics have been extensively studied for their health promoting effects. The main field of research has been in the gastrointestinal tract. However, in the past few years probiotics have also been investigated in the oral health perspective, which is the topic of the present review. We discuss the mechanisms of bacterial adhesion, potential of probiotics in oral cavity colonization, interspecies interactions, and possible effects on immunomodulation, and means of probiotic administration. We suggest that probiotic treatment of diseases other than dental caries and periodontal disease should also be systematically investigated. In general, hardly any randomized controlled trials have been conducted in this area and the studies on probiotics vs oral health are still in their cradle. Hence, much more investigations are called for before any evidence-based conclusions can be drawn: if or not probiotic therapy can be recommended for oral health purposes.

The complexity of the periodontal microbiota resembles that of the gastro-intestinal tract, where infectious diseases are treatable via probiotics. In the oro-pharyngeal region, probiotic or replacement therapies have shown some benefit in the prevention of dental caries, otitis media, and pharyngitis, but their effectiveness in the treatment of periodontitis is unknown. Therefore, this study addressed the hypothesis that the application of selected beneficial bacteria, as an adjunct to scaling and root planing, would inhibit the periodontopathogen recolonization of periodontal pockets. Analysis of the data showed, in a beagle dog model, that when beneficial bacteria were applied in periodontal pockets adjunctively after root planing, subgingival recolonization of periodontopathogens was delayed and reduced, as was the degree of inflammation, at a clinically significant level. The study confirmed the hypothesis and provides a proof of concept for a guided pocket recolonization (GPR) approach in the treatment of periodontitis.

Bacteriotherapy in the form of probiotics seems to be a natural way to maintain health and protect oral tissues from disease, and data suggest that the potential benefits increase with an early childhood start. The research is still in its infancy but a daily intake of probiotic lactobacilli with an inhibitory effect on other bacteria is currently most promising. Milk, milk drinks, or yoghurt containing one or more probiotic strains could be a treatment option in the long-term prevention of childhood caries. However, further double-blind, randomized, placebo-controlled trials that assess carefully selected and defined strains of probiotics using standardized outcomes are needed before any clinical recommendations can be made.

A 2009 published human clinical study evaluated the effect of 4 week daily u age of IO CF ProBiora3 oral probiotic on the reduction in level of key pathogenic micro-organism in the oral cavity. The original analysis was completed using group mean values and large decreases and encouraging trend were found. Some of the finding of the original study included:

Aims: To conduct a pilot human clinical trial to assess the safety and to test the ability of a probiotic mouthwash, ProBiora3, to affect the levels of Streptococcus mutans and certain known periodontal pathogens in the mouth when administered twice daily over a period of 4 weeks.

Dental caries is the most common chronic disease of childhood, with its prevalence largely surpassing asthma.1-2 It is a transmissible disease typically passed on vertically by caregiver to child through salivary contact. Horizontal transmission can also occur between siblings or children in the same daycare. The main microorganisms involved have been shown to be a group of phenotypically similar, but genetically different streptococcal species known as mutans streptococci.

Oral care probiotics that incorporate hydrogen peroxide-producing strains of Streptococcus oralis may represent an effective means of naturally whitening teeth, when whitening is indicated. The purpose of this study was to evaluate the cosmetic benefit (“whitening effect”) of a laboratory culture of S. oralis strain KJ3® and further investigate its mechanism of action.