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 Table of Contents  
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 140-144

Intelligent nutrition: Oral health promotion by probiotics

Department of Pedodontics, Prosthodontics, Yenepoya Dental College, Mangalore, Karnataka, India

Date of Web Publication13-Dec-2013

Correspondence Address:
Sham S Bhat
Department of Pedodontics, Yenepoya Dental College, Mangalore - 18, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2321-4848.123027

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Probiotic bacteria have been added to various foods because of their beneficial effects for human health, especially gut. Numerous studies have proved definite reliability of these viable bacteria in the treatment of gastrointestinal infections and diseases. The effect of probiotic in prevention and treatment of various oral disorders is also being studied. Although only a few clinical studies have been conducted so far, the results to date suggest that probiotics could be useful in preventing and treating oral infections, including dental caries, periodontal disease, and halitosis. This article summarizes the currently available data on the potential benefits of probiotics for oral health.

Keywords: Nutrition, oral health, probiotics

How to cite this article:
Bhat SS, Bhat VS, Hegde SK, Palit MC. Intelligent nutrition: Oral health promotion by probiotics. Arch Med Health Sci 2013;1:140-4

How to cite this URL:
Bhat SS, Bhat VS, Hegde SK, Palit MC. Intelligent nutrition: Oral health promotion by probiotics. Arch Med Health Sci [serial online] 2013 [cited 2022 Jun 27];1:140-4. Available from: https://www.amhsjournal.org/text.asp?2013/1/2/140/123027

  Introduction Top

Probiotics are defined as living microorganisms, principally bacteria, that are safe for human consumption and, when ingested in sufficient quantities, have beneficial effects on human health, beyond basic nutrition. This definition has been approved by the United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO). [1] The term "probiotics" was derived from a Greek word meaning, "for life." [2] The concept probably dates back to 1907, when Noble prize winner Eli Metchnikoff suggested that the long life of Bulgarian peasants resulted from their consumption of fermented milk products. [3] The term "probiotic" as opposed to antibiotic was initially proposed by Lilly and Stillwell in 1965. First probiotic species to be introduced in research was Lactobacillus acidophilus by Hull et al. in 1984; followed by Bifidobacterium bifidum by Holcombh et al. in 1991. [4]

The vast majority of probiotic bacteria belong to the genera Lactobacillus, Bifidobacterium, Propionibacterium, and Streptococcus. Foods of human consumption such as fermented milk, cheese, fruit juice, and sausages mainly contain lactic acid bacteria as probiotic. Single or mixed cultures of live microorganisms are used in probiotic preparations. The effectiveness of probiotics have already been demonstrated by several clinical studies in the treatment of systemic and infectious diseases as infantile diarrhea, necrotizing ulcerocolitis, Helicobacter pylori infection, inflammatory bowel disease to cancer, female uro-genital infections, and surgical infections. [2] The introduction of these beneficial species into the GI tract has also proved to be a very attractive option to establish the microbial equilibrium that has been lost due to antibiotic usage, immunosuppressive therapy, and irradiation therapy.

Properties of probiotics

Properties of an ideal probiotic preparation for oral use have been illustrated in [Figure 1]. For adequate amount of health benefit, a dose of five billion colony forming units a day (5 × 10 9 CFU/day) has been recommended, for at least five days. The microorganism, to be used clinically as a probiotic, both in vitro and in vivo studies must be conducted to demonstrate their mechanism of action, to allow prediction of its scope of applicability and its potential side-effects. [2] Importantly, they should also not carry transmissible antibiotic resistance genes.
Figure 1: Properties of an ideal probiotic preparation for oral use

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Mechanism of action of probiotics

Several mechanisms have been postulated regarding action of probiotics [Figure 2]. These bacteria produce several metabolites like free fatty acids, hydrogen peroxide, bacteriocin etc., which interfere with the growth of other pathogens. Dental caries involves the use of oral streptococci that are able to metabolize arginine or urea to ammonia. [5] A bacterium, S. oligofermentans, could be only isolated from caries-free human subjects, was found to metabolize lactic acid into hydrogen peroxide, thus inhibiting the growth of S. mutans.[6]
Figure 2: Potential mechanism of action of probiotic bacteria in the oral cavity

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Probiotic bacteria can specifically co-aggregate with the pathogenic bacteria. A recent study has demonstrated selective interaction of mutans streptococci with L. paracasei or L. rhamnosus facilitating their removal from the mouth without disruption of other oral flora. [7]

Probiotics can also use enzymatic mechanism to modify toxin receptors and block toxin-mediated pathology. Certain bacterial strains contain enzymes that prevent formation of harmful metabolites. Lactobacillus brevis could be attributed to the presence of Arginine Deiminase enzyme (AD), which prevented nitric oxide generation and hence can reduce inflammatory response of periodontal tissues. They prevent colonization of pathogens by competitive inhibition. [8] Hillman and colleagues introduced a non-acid-producing S. mutans strain that produces a bacteriocin, active against other S. mutans strains into the oral cavity to replace the naturally occurring cariogenic strains. [9]

Co-infection of rats with oral streptococci S. salivarius TOVE-R and S. mutans reduced dental caries incidence relative to the later organisms alone. This is likely due to the ability of TOVE-R to pre-empt the initial colonization of teeth surface and displace the cariogenic S. mutans that has already colonized the teeth surface. [10]

Studies have also shown that probiotic bacteria modulate immunoglobulin production (secretory IgA), which plays an important role in mucosal immunity, contributing to the barrier against pathogenic bacteria and viruses. [11],[12] The increase in certain cytokines (TNF-α, IFN-γ, IL-10) has also been observed due to stimulation with probiotic bacteria. [13]

Hence, the probiotic bacteria in oral cavity, creates a biofilm, acting as a protective lining for oral tissues against oral diseases. Such a biofilm keeps bacterial pathogens off oral tissues by filling the space pathogens would invade in the absence of the biofilm, and competing with cariogenic bacteria and periodontal pathogens growth.

Probiotic approach in the management of dental caries

Dental plaque shows higher degree of organization. Within an established dental plaque, specific bacterial species are often found located adjacent to each other or mixed together to form unique structures that may confer adherence or growth advantages. Based on our current knowledge, it is reasonable to assume that the interactions between the oral microbial residents may influence the properties of the whole community. For example, in the presence of nearby base-producing bacteria, S. mutans in dental plaque may not be pathogenic. It is now recognized that dental caries results not solely because of the presence of S. mutans, rather, it's the interaction of multiple acid-producing organisms such as S. mutans with other biofilm residents. [1] This dynamic balance of synergistic and antagonistic interactions with the neighboring bacteria has offered the probiotic strategies for dental caries treatment and prevention.

Hence, to have a beneficial effect in limiting or preventing dental caries, a probiotic must be able to adhere to dental surfaces and integrate into the bacterial communities making up the dental biofilm. It must also compete with and antagonize the cariogenic bacteria and thus prevent their proliferation. A recent study showed that some specific Lactobacillus strain has the capacity to adhere and form a biofilm on HA surface, hence replacing the more cariogenic pathogens. [15] Haukioja and colleagues investigated in vitro the effect of probiotic bacteria used in commercial products in the adherence of two oral streptococci, Streptococcus mutans and Streptococcus gordonii. The results of their research showed that probiotic bacteria that bound to saliva-coated hydroxyapatite reduced the adhesion of S. mutans, but the inhibitory effect on the adherence of S. gordonii was weaker. [16] Hence, these studies clearly suggest that commercial probiotic products competitively prevents the adhesion of the pathogenic bacteria to the dental surfaces. However, adhesion of common probiotic strains of Lactobacillus and Bifidobacterium in the oral cavity greatly varies, resulting in the difference in their survival and achieving the probiotic effect. [17]

Several studies have also shown that consumption of products containing probiotics bacteria could reduce the number of mutans streptococci in saliva, hence providing protection against dental caries. [18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28] However, these results are highly inconclusive as the same strain of probiotic has shown dissimilar effects [29],[30] [Table 1]. Importantly, these clinical trials are also of short duration, and number of individuals participating in the study is also less. Lodi and colleagues (2010) in their study has presented that fermented milk containing probiotic decreased the pH of dental biofilm and promoted demineralization of the enamel. [31] Whereas others have suggested in their in vitro studies that, final pH in the medium is an important factor for growth inhibition, either directly or due to the production of bacteriocins at low pH. The antimicrobial activity of Lactobacillus spp. against S. mutans is pH-dependent and lower the final pH, higher the inhibition. [32]
Table 1: Summary of studies showing interference of probiotic bacteria with S. mutans growth

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Other bacteria have also shown probiotic effect against dental caries. ProBiora3, an oral probiotic mouthwash product consisting of a mixture of Strep. uberis strain KJ2smTM, Strep. oralis strain KJ3smTM, and Strep. rattus strain JH145TM, has been shown to be safe and effective in reducing salivary levels of mutans streptococci, preserving dental health in young orally healthy adults. [33]

Probiotic approach in the management of periodontal disease

The main pathogenic agents associated with periodontitis are P. gingivalis, Treponema denticola, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans. Studies have reported the capacity of lactobacillus to inhibit the growth of these pathogens. Probiotic strains used include L. reuteri strains, L. brevis [CD2], L. casei Shirota, L. salivarius B21, and Bacillus subtilis. [34] Effect of probiotic tablets on gingivitis and different grades of periodontitis has been studied where probiotic treatment resulted in better normalization than control groups. Krasse and colleague assessed the beneficial effects of L. reuteri against gingivitis. After 14 days of ingestion of probiotic-incorporated chewing gum, there was a reduction in plaque index, and concluded that this probiotic was effective to reduce gingivitis and bacterial plaque deposition in patients with moderate to severe gingivitis. [33] Riccia and colleagues studied the anti-inflammatory effect of lactobacillus brevis in a group of patients with chronic periodontitis. Sucking lozenges with L. brevis for 4 days improved plaque index, gingival index, and bleeding on probing with also a significant reduction in salivary levels of prostaglandin E 2 and matrix metalloproteinases. [35] Although promising results has been obtained by all these studies, most studies are of very short duration, small sample size, and the difference in results being very small though statistically significant.


Halitosis results from the action of anaerobic bacteria that degrade salivary and food proteins to generate amino acids, which are in turn transformed into volatile sulfur compounds, including hydrogen sulfide and methanethiol. In a pilot study, Streptococcus salivarius K12, a pioneering colonizer of oral surface and excellent numerically predominant non-disease-associated member of the oral microbiota of healthy humans, have been effectively used as a probiotic to replace bacteria implicated in halitosis. Decrease in volatile sulfurcompounds was seen after administration, but it was used after the use of an antimicrbial mouthwash. Weissella cibaria has also shown to reduce the levels of volatile sulfur compounds produced by Fusobacterium nucleate.[36]

  Conclusion Top

Probiotic represents a new area of research in dentistry to combat oral diseases in a model approach. The preliminary data obtained from numerous studies have shown promising results; however, the effects of individual strains have to be studied in detail. The long-term effects as well as colonization of the probiotic species in the oral cavity also has to be explored. The mode of use or the vehicle of delivery of these probiotic, to be effective for oral use, also needs further research. Hence, continued expansion of such information in the future may enable an exogenous modulation of the interactions between oral biofilm constituents, and thereby result in novel approaches for controlling biofilm activities and oral diseases.

  References Top

1.Food and Health Agricultural Organization of the United Nations and World Health Organization. Guidelines for the evaluation of probiotics in food. Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food. 2002. Available from: http://ftp.fao.org/es/esn/food/wgreport2.pdf. Last acessed in Nov. 2012.  Back to cited text no. 1
2.Reid G, Jass J, Sebulsky MT, McCormick JK. Potential use of probiotics inclinical practice. Clin Microbiol Rev 2003; 16:658-72.  Back to cited text no. 2
3.Metchnikoff E. The prolongation of life. In: Heinemann W, editor. Optimistic studies. London: G. P. Putnam & Sons; 1907. p. 1-100.  Back to cited text no. 3
4.Tanboga I, Çaglar E, Kargul B. Campaign of probiotic food consumption in Turkish children, oral perspectives "Probiotics for your child". Int J Pediatr Dent 2003;13:59-64.  Back to cited text no. 4
5.Marquis RE, Burne RA, Parsonsons DT, Casiano-Colon AE. Arginine deiminase and alkaline generation in plaque. In: Bowen WH, Tabak LA, editors. Cariology for the nineties. Rochester, N.Y.: University of Rochester Press; 1993. p. 309-17.  Back to cited text no. 5
6.Tong H, Chen W, Merritt J, Qi F, Shi W, Dong X. Streptococcus oligofermentans inhibits Streptococcus mutans through conversion of lactic acid into inhibitory H2O2: A possible counteroffensive strategy for interspecies competition. Mol Microbiol 2007;63:872-80.  Back to cited text no. 6
7.Pothoulakis C, Kelly CP, Joshi MA, Gao N, O'Keane CJ, Castagliuolo I, et al. Saccharomyces boulardii inhibits clostridium difficile toxin A binding and enterotoxicity in rat ileum. Gastroenterology 1993;104:1108-15.  Back to cited text no. 7
8.Della Riccia DN, Bizzini F, Perilli MG, Polimeni A, Trinchieri V, Amicosante G, et al. Anti-inflammatory effects of Lactobacillus brevis (CD2) on periodontal disease. Oral Dis 2007;13:376-85.  Back to cited text no. 8
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10.Tanzer JM, Kurasz AB, Clive J. Inhibition of ecological emergence of mutans streptococci naturally transmitted between rats and consequent caries inhibition by Streptococcus salivarius TOVE-R infection. Infect Immun 1985;49:76-83.  Back to cited text no. 10
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13.Arvola T, Laiho K, Torkkeli S, Mykkanen H, Salminen S, Maunula L, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: A randomized study. Pediatrics 1999; 104:e64.  Back to cited text no. 13
14.Kleinberg I. A mixed-bacterial ecological approach to understanding the role of oral bacteria in dental caries causation: An alternate to Streptococcus mutans and the specific-plaque hypothesis. Crit Rev Oral Biol Med 2002; 13:108-25.  Back to cited text no. 14
15.Samot J, Lebreton J, Badet C. Adherence capacities of oral lactobacilli for potential probiotic purposes. Anaerobe 2011; 17:69-72.  Back to cited text no. 15
16.Haukioja A, Loimaranta V, Tenovuo J. Probiotic bacteria affect the composition of salivary pellicle and streptococcal adhesion in vitro. Oral Microbiol Immunol 2008; 4:336-43.  Back to cited text no. 16
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18.Näse L, Hatakka K, Savilahti E, Saxelin M, Ponka A, Poussa T, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res 2001; 35:412-20.  Back to cited text no. 18
19.Ahola AJ, Yli-Knuuttila H, Suomalainen T, Poussa T, Ahlstrom A, Meurman JH, et al. Short-term consumption of probiotic-containing cheese and its effect on dental caries risk factors. Arch Oral Biol 2002; 47:799-804.  Back to cited text no. 19
20.Nikawa H, Makihira S, Fukushima H, Nishimura H, Ozaki Y, Ishida K, et al. Lactobacillus reuteri in bovine milk fermented decreases the oral carriage of mutans streptococci. Int J Food Microbiol 2004; 95:219-23.  Back to cited text no. 20
21.Caglar E, Sandalli N, Twetman S, Kavaloglu S, Ergeneli S, Selvi S. Effect of yoghurt with Bifidobacterium DN-173 010 on salivary mutans streptococci and lactobacilli in young adults. Acta Odontol Scand 2005;63:317-20.  Back to cited text no. 21
22.Caglar E, Cildir SK, Ergeneli S, Sandalli N, Twetman S. Salivary mutans streptococci and lactobacilli levels after ingestion of the probiotic bacterium Lactobacillus reuteri ATCC 55730 by straws or tablets. Acta Odontol Scand 2006;64:314-8.  Back to cited text no. 22
23.Caglar E, Kavaloglu SC, Kuscu OO, Sandalli N, Holgerson PL, Twetman S. Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli. Clin Oral Investig 2007;11:425-9.  Back to cited text no. 23
24.Caglar E, Kuscu OO, Selvi Kuvvetli S, Kavaloglu Cildir S, Sandalli N, Twetman S. Short-term effect of ice-cream containing Bifidobacterium lactis Bb-12 on the number of salivary mutans streptococci and lactobacilli. Acta Odontol Scand 2008;66:154-8.  Back to cited text no. 24
25.Caglar E, Kuscu OO, Cildir SK, Kuvvetli SS, Sandalli N. A probiotic lozenge administered medical device and its effect on salivary mutans streptococci and lactobacilli. Int J Paediatr Dent 2008;18:35-9.  Back to cited text no. 25
26.Taipale T, Pienihakkinen K, Alanen P, Jokela J, Söderling E. Dissolution of xylitol from a food supplement administered with a novel slow-release pacifier: Preliminary results. Eur Arch Paediatr Dent 2007;8:123-5.  Back to cited text no. 26
27.Cildir SK, Germec D, Sandalli N, Ozdemir FI, Arun T, Twetman S, et al. Reduction of salivary mutans streptococci in orthodontic patients during daily consumption of yoghurt containing probiotic bacteria. Eur J Orthod 2009;31:407-11.  Back to cited text no. 27
28.Stecksén-Blicks C, Sjöström I, Twetman S. Effect of long-term consumption of milk supplemented with probiotic lactobacilli and fluoride on dental caries and general health in preschool children: A cluster-randomized study. Caries Res 2009;43:374-81.  Back to cited text no. 28
29.Montalto M, Vastola M, Marigo L, Covino M, Graziosetto R, Curigliano V, et al. Probiotic treatment increases salivary counts of lactobacilli: A double-blind, randomized, controlled study. Digestion 2004;69:53-6.  Back to cited text no. 29
30.Lexner MO, Blomqvist S, Dahlén G, Twetman S. Microbiological profiles in saliva and supragingival plaque from caries-active adolescents before and after a short-term daily intake of milk supplemented with probiotic bacteria - a pilot study. Oral Health Prev Dent 2010;8:383-8.  Back to cited text no. 30
31.Lodi CS, Manarelli MM, Sassaki KT, Fraiz FC, Delbem AC, Martinhon CC. Evaluation of fermented milk containing probiotic on dental enamel and biofilm: In Situ study. Arch Oral Biol 2010;55:29-33.  Back to cited text no. 31
32.Söderling EM, Marttinen AM, Haukioja AL. Probiotic lactobacilli interfere with Streptococcus mutans biofilm formation in vitro. Curr Microbiol 2011;62:618-22.  Back to cited text no. 32
33.Zahradnik RT, Magnusson I, Walker C, McDonell E, Hillman CH, Hillman JD. Preliminary assessment of safety and effectiveness in humans of ProBiora3, a probiotic mouthwash. J Appl Microbiol 2009;107:682-90.  Back to cited text no. 33
34.Krasse P, Carlsson B, Dahl C, Paulsson A, Nilsson A, Sinkiewicz G. Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri. Swed Dent J 2006;30:55-60.  Back to cited text no. 34
35.Riccia DN, Bizzini F, Perilli MG, Polimeni A, Trinchieri V, Amicosante G, et al. Anti-inflammatory effects of Lactobacillus brevis (CD2) on periodontal disease. Oral Dis 2007;13:376-85.  Back to cited text no. 35
36.Kang MS, Kim BG, Chung J, Lee HC, Oh JS. Inhibitory effect of Weissella cibaria isolates on the production of volatile sulphur compounds. J Clin Periodontol 2006;33:226-32.  Back to cited text no. 36


  [Figure 1], [Figure 2]

  [Table 1]


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