Strive-Does Probiotic Mean Anti-Dental Disease?

April, 2011 edition  

Does Probiotic Mean
Anti-Dental Disease?
By Sarah DeBowes, RDH, BS

It was not long ago that I read an article in a popular press magazine suggesting that probiotics may reduce the risk and severity of periodontal disease.[1] I began researching probiotics and oral health, and there is minimal information in dental hygiene literature about probiotics. It is hard to turn on the TV without hearing about the subject, and many food companies such as Stonyfield and Dannon are marketing their ”good bacteria.” Now popular magazines are linking probiotics with better oral health, and the dental hygiene community has little information to guide us in the right direction.

Should dental hygienists begin to focus on the relationship between probiotics and oral health? We use antibiotics for infections to kill off bad bacteria—what about using probiotics to help create a healthy oral environment? It works for the gastrointestinal tract, and the mouth is the entrance point. Are we missing out on something?

We might be. As a follow-up to reading the popular press article, I investigated and found that probiotics are being researched in the dental arena—a PubMed search shows several journals that have published articles on the relationship between probiotics and oral health. The World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations define probiotics as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host,” and they are sometimes known as the “good bacteria.”[2] Two common probiotics include Lactobacillus and Bifidobacterium, each of which has several species and strains.[2] Sources of probiotics include yogurts, select supplements, lozenges, juices, milks, cheeses and soy products.[2,3]

It has been suggested that probiotics may have a positive effect on dental caries, periodontal disease (gingivitis and periodontitis), oral yeast infections and halitosis.[3] Each of these conditions can be traced to bacteria; therefore, it seems logical that probiotics could reduce the likelihood and/or severity of one or all of these conditions. A number of studies are supporting the claim that probiotics decrease the amount of Streptococcus mutans present in the mouth, which may reduce the likelihood of decay.[3] One particular study found that consuming yogurt with Lactobacillus reuteri over a two-week time period resulted in over 90 percent reduction of viability of Streptococcus mutans in salivary content.[4] A 2007 study on oral candidiasis among the elderly population found that probiotics led to a 75 percent reduction in high yeast levels of the oral cavity.[5]

There are two sides to consider. Some researchers are suggesting probiotics can increase the likelihood of dental caries due to the lactic acid. The lactic acid can change the pH levels of the mouth, which, when exposed to cariogenic foods, could exacerbate dental caries.[4]

One question that comes to mind is whether probiotics are more like xylitol or fluoride? Xylitol is most beneficial when used topically, several times a day. Fluoride is beneficial both systemically and topically. So where does that put probiotics? Are they only beneficial when they are in the oral cavity? If so, what will it take to gain the benefit?  

There are many potential benefits probiotics can offer the dental hygiene world, and although the early research has indicated positive possibilities, we need to learn how and to what extent probiotics can be positive. We need to know if probiotics are helpful or hurtful to the oral environment. Do we want to be bystanders and let the popular media sway the opinions of our patients? It is up to the dental hygiene community to create a research agenda that distinguishes fact from fiction regarding the impact of probiotics on the oral cavity. 

References

1. Smile savers. Good Housekeeping. 2010; 250(5): 38.

2. National Center for Complementary and Alternative Medicine. An introduction to probiotics. National Institutes of Health. Available at: http://nccam.nih.gov/health/probiotics/introduction.htm. Accessed March 7, 2011.

3. Meurman J, Stamatova I. Probiotics: contributions to oral health. Oral Dis. 2007; 13: 443-51.

4. Nikawa H, Makihira S, Fukushima H, et al. Lactobacillus reuteri in bovine milk fermented decreases the oral carriage of mutans streptococci. Int J Food Microbiol. 2004; 95(2): 219-23.
5. Hatakka K, Ahola A, Yli-Knuuttila H, et al. Probiotics reduce the prevalence of oral Candida in the elderly—a randomized controlled trial. J Dent Res. 2007; 86(2): 125-30.

Additional Resources

Caglar E, Kuscu O, Cildir S, et al. A probiotics lozenge administered medical device and its effect on salivary mutans streptococci and lactobacilli. Int J Paediatr Dent. 2008; 18(1): 35-39.

Hasslof P, Hedberg M, Twetman S, et al. Growth inhibition of oral mutans streptococci and candida by commercial probiotics lactobacilli- an in vitro study. BMC Oral Health. 2010; 10(18). Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908555/. Accessed March 7, 2011.

Haukioja A, Soderling E, Tenovuo J. Acid production from sugars and sugar alcohols by probiotics lactobacilli and bifidobacteria in vitro. Caries Res. 2008; 42(6):449-453.

Iwamoto T, Suzuki N, Tanabe K, et al. Effects of probiotics Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110(2): 201-208.

Mayanagi G, Kimura M, Nakaya S, et al. Probiotic effects of orally administered Lactobacillus salivarius WB21-containing tablets on periodontopathic bacteria: a double-blinded, placebo-controlled, randomized clinical trial. J Clin Periodontol. 2009; 36(6): 506-513.

Mehanna N, Reid G. Effect of Meswak (Middle Eastern tree bark) on oral pathogens and potential for probiotics applications. J Med Food. 2010; 13(3): 729-732.

Sarah DeBowes, RDH, BS, is an adjunct clinical instructor and graduate student in the School of Dental Hygiene at Old Dominion University in Norfolk, Va. She is a graduate of Pennsylvania College of Technology and has been practicing dental hygiene full-time for over six years with experience in both pediatric and general dentistry settings.

Kelly Tanner Williams, RDH, MSDH, served as faculty mentor for this edition of Strive.