|Year : 2018 | Volume
| Issue : 2 | Page : 68-72
Probiotics and periodontal disease
Anjhana Asok, Rahul Bhandary, Mamatha Shetty, Nina Shenoy
Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
|Date of Web Publication||18-Dec-2018|
Department of Periodontics, 4th Floor, A B Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Probiotics are live microorganisms that when administered in adequate amounts confer health benefits to the host. Lactobacillus acidophilus was the first probiotic species. Elie Metchnikoff reported fermented dairy products to have beneficial properties. Probiotics have been used in combination with prebiotics to produce synbiotics. Probiotics have been widely used in the medical field to combat various diseases. Probiotics have been found to be helpful in periodontal tissue destruction by altering the host defense mechanism and inhibiting the secretion of proinflammatory cytokines that can mediate tissue destruction. Probiotics have been demonstrated to produce high ecological pH and have inhibitory effect on volatile sulfur compounds that help to control halitosis. The concept of guided tissue recolonization has emphasized the increased use of probiotics in periodontal management. Although probiotics also include side effects, further longitudinal studies are required to provide substantial data on the use of probiotics.
Keywords: Guided tissue recolonization, prebiotics, probiotics, synbiotics
|How to cite this article:|
Asok A, Bhandary R, Shetty M, Shenoy N. Probiotics and periodontal disease. Int J Oral Health Sci 2018;8:68-72
| Introduction|| |
Periodontitis is a chronic inflammatory disease characterized by mononuclear cell infiltration into gingival tissues, leading to connective tissue destruction and alveolar bone resorption. Many therapies have been attempted to regain the lost periodontium and control this chronic inflammatory process caused by the periodontopathic organism. The main organisms associated with periodontitis are Porphyromonas gingivalis, Treponema denticola, Tannerella forsythus, and Aggregatibacter actinomycetemcomitans. 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.
The scientific justification for the use of lactic acid bacteria for the health benefit was the emphasis of some bacterial organisms present in the large intestine as toxicants. Hence, it was suggested that the dependence of intestinal microbes on the food allows to adopt measures, to modify the flora in the bodies, and the replacement of harmful microbes by useful microbes. Probiotics conventionally used in medicine field are now used to control and treat periodontal disease by the introduction of bacterial replacement therapy. Nowadays, probiotics are widely used in the oral health perspective due to the emergence of antibiotic resistance and frequent recolonization of treated sites with pathogenic bacteria.
| History|| |
Elie Metchnikoff was the first to state that fermented dairy products have beneficial properties and that probiotics could provide a health benefit. He also proposed that Bulgarian people had longer longevity due to fermented milk containing viable bacteria.,,, During Metchnikoff's scientific demonstration of lactic acid bacteria benefits, Henry Tissier, a French pediatrician, working independently observed that children with diarrhea had a low number of bacteria characterized by a peculiar, Y-shaped morphology in their stools. On the contrary, these bifid bacteria were abundant in healthy children. Thus, he suggested that these bacteria could be administered to patients with diarrhea to help restore healthy gut flora.
In 1907, the Ukrainian-born biologist and Nobel laureate, working at the Pasteur Institute in Paris, discovered Lactobacillus bulgaricus and developed a theory that lactic acid bacteria (present in Bulgarian yoghurt) in the gastrointestinal tract could prolong life by preventing putrefaction. This was based on his observation that Bulgarians lived longer than other people., Thus, the concept of probiotics was born, and a new field of microbiology was opened.
In 1965, the term probiotics “was first used by Lilly and Stillwell, in a different context to represent ‘substances’ secreted by one organism which stimulates the growth of another.” Later in 2001, the World Health Organization defined probiotics as “Live microorganisms that, when administered in adequate amounts, confer a health benefit to the host.”
| Probiotics|| |
The term probiotic is derived from Latin (pro) and Greek (bios) meaning literally for life., It was first used by Kollath in 1953 to generically describe various organic and inorganic supplements that were believed to have the ability to restore the health of malnourished patients. In 1954, the German researcher Ferdin and Vergin proposed the term “probiotika” which described active substances that are essential for a healthy development of life. 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.,
Criteria for probiotics
To be considered for the use as probiotic, following criteria needs to be fulfilled.,,
- It should be capable of exerting a beneficial effect on the host animal, for example, increased growth or resistance to disease
- It should be of human origin
- It should have high cell viability
- It should be nonpathogenic and nontoxic
- It should be able to interact or to send signals to immune cells
- It should have the capacity to influence the local metabolic activity
- It should be capable of surviving and metabolizing in the gut environment, for example, resistance to low pH and organic acids
- It should be stable and capable of remaining viable for periods under storage and field conditions.
Hypothetical actions of probiotic actions in oral cavity
Rationale for the use of probiotics
- Inability of the conventional antibiotic therapy to treat the disease completely
- Developing antibiotic resistance and the severity of disease
- Multidrug-resistant bacteria continue to emerge as the antibiotic pipeline dries up
- To raise the profile of disease prevention rather than disease management
- Short life of effectiveness of antibiotics. The arrival of new variety of bacteria
- Changing paradigms in understanding of the pathogenesis of disease
- Probiotics may prevent colonization resistance
- Probiotics prevent colonization, overgrowth, and translocation of potential pathogens.
Probiotics in general use
- Rotavirus diarrhea
- Reduction of antibiotic-associated side effect.
- Dental caries and periodontal health
- Food allergies and lactose intolerance
- Atopic eczema
- Prevention of vaginitis
- Urogenital infections
- Irritable bowel disease
- Cystic fibrosis
- Traveler's diarrhea
- Enhance oral vaccine administration
- Helicobacter pylori infection
- Various cancers.
When probiotics are living organisms used for human consumption which are beneficial to the hosts, prebiotics have been defined as nondigestible oligosaccharides that affect the proliferation of resident commensal bacteria that may then exert probiotic effects. Examples are inulin-type fructans, maltodextrin, fructooligosaccharides, and galactooligosaccharides. Prebiotics and probiotics often work in synergy and when combined in the same product, are known as synbiotics. Synbiotics contain both probiotic and prebiotic components. The rationale for such products is that the combination enhances the survival of probiotic bacteria in the passage through the proximal gastrointestinal tract, improving the colonization of the probiotic in the large intestine stimulating the effect on the growth of the endogenous flora. It is seen that synbiotics increase the survival of probiotic bacteria, stimulating their growth in the intestinal tract, and improving the balance of health-promoting bacteria.
| Probiotics and Periodontal Disease|| |
Oral probiotic bacteria adhere and colonize periodontal tissue including hard nonshedding surfaces and become part of the biofilm. They should not ferment sugars, which subsequently lower the pH, thereby resulting in caries.,
Probiotics stimulate dendritic cells resulting in expression of T-helper cell 1 or T-helper cell 2 response, which modulates immunity. Probiotics can mimic response similar to a pathogen but without periodontal destruction. Another mechanism is aggregation alteration as heterofermentative Lactobacillus is the strongest inhibitor of A. actinomycetemcomitans, P. gingivalis, and Prevotella intermedia. Lactobacillus salivarius and Lactobacillus gasseri show the strong inhibition of periopathogenic bacteria. Secretion of bacteriocins by Lactobacillus reutri, for example, reutrin and reutricyclin inhibits the growth of pathogens and has high affinity for host tissue and has anti-inflammatory effect by inhibiting the proinflammatory mediators. Similarly, Weissella cibaria releases catalase and follows the same mechanism.
Apoptosis is another mechanism in which probiotics stimulate apoptosis of tumor cells through the end-product formation. The main pathogenic agents associated with periodontitis are P. gingivalis, T. denticola, T. forsythus, and A. actinomycetemcomitans. These bacteria have a range of virulent characteristics which allow them to colonize the subgingival sites, escape the host's defense system, and thereby cause tissue damage. The persistence of the host's immune response also contributes to the progression of the disease., There is an increase in plaque mass and a shift toward obligatory anaerobic and proteolytic bacteria, many of which are Gram-negative in periodontal diseases. Grudianov et al. analyzed the effect of probiotic tablets on gingivitis and different grades of periodontitis and reported that probiotic treatment resulted in better microbiota normalization than the control group., In a recent study, the prevalence of lactobacilli, particularly L. gasseri and L. fermentum, in the oral cavity was greater among healthy participants than among patients with chronic periodontitis. There are different studies which have reported the capacity of lactobacilli to inhibit the growth of periodontopathogens including P. gingivalis, P. intermedia, and A. actinomycetemcomitans. Therefore, it has been established that lactobacilli residing in the oral cavity play a role in the oral ecological balance.
The inhibitory activity exhibited by homofermentative lactobacilli against periodontal pathogens was mainly related to their production of acid, and not to H2O2 or bacteriocin production. In a study conducted by Hojo et al., it was shown that bifidobacteria inhibit some black-pigmented anaerobes by competing for an essential growth factor, Vitamin K, although there was no significant relationship between higher bifidobacterial counts and lower black-pigmented anaerobe counts. Thus, probiotics help in making an excellent maintenance product by producing antioxidants which prevent plaque formation.
| Probiotics and Halitosis|| |
Halitosis or oral malodor refers to the foul and unpleasant odor originating from the oral cavity caused by volatile sulfur compounds (VSC). Bacteria responsible for VSC production are Fusobacterium nucleatum, P. gingivalis, P. intermedia, and T. denticola. The regular use of probiotics helps to control halitosis. The W. cibaria isolates resulted in a higher ecological pH than that which would normally be observed in conjunction with lactobacilli encouraging with regard to the utility of this species within the context of probiotic use. After taking W. cibaria, reduced levels of volatile sulfide components produced by F. nucleatum were observed by Kang et al., in which, he concluded that the effect could be due to hydrogen peroxide production by W. cibaria, causing F. nucleatum inhibition. Streptococcus salivarius, also a potential candidate for an oral probiotic, has demonstrated the inhibitory effect on VSC by competing for colonization sites with species causing an increase in levels of VSC.
| Commercially Available Probiotics for Periodontal Disease Management|| |
Probiotics are commercially available in the form of lozenges, toothpaste, chewing gums, or mouthwash.
This is probably the first probiotic specifically formulated to fight against periodontal disease. It contains a patented combination of two strains of L. reuteri specially selected for their synergistic properties in fighting cariogenic bacteria and periodontopathogens.
This toothpaste is an all-natural, fluoride-free oral hygiene supplement containing Dental-Lac, a functional Lactobacillus paracasei probiotics not found in any other toothpaste.
Bifidumbacterin, Acilact, Vitanar
This probiotics preparation of a complex of five live lyophilized lactic acid bacteria is claimed to improve both clinical and microbiologic parameters in gingivitis and mild periodontitis patients.
This probiotic tablet contains 6.5 × 108 CFU per tablet of L. salivarius WB21, and xylitol (280 mg/tablet) was originally prepared to contribute for the intestinal microbial balance by providing acid-tolerant L. salivarius WB21.
This probiotic lozenge is a blend of two Lactobacillus reuteri containing a minimum of 1 × 108 CFU for each of the strains DSM 17938 and ATCC PTA 5289.
| Probiotics as Guided Tissue Recolonization|| |
The concept of replacing the pathogenic bacteria in the gingival sulcus with beneficial bacteria is called guided periodontal pocket recolonization. Teughels et al. conducted a study on guiding periodontal pocket and hypothesized that the application of selected beneficial bacteria, as an adjunct to scaling and root planing, would inhibit the periodontopathogen recolonization of periodontal pockets. However, the evolving problem of antibiotic resistance has led to renewed interest in bacterial replacement. When Streptococcus sangius, S. salivarius, and S. mitis were applied subgingivally in dog models delay in recolonization by periodontal pathogens, reduction in inflammation, and improvement in bone level; and bone density was observed by Nackaerts in acid-deficient variant of Streptococcus rattus, strain JH145.
| Risks and Side Effects|| |
It is essential that the various strains should be carefully studied and selected before their use as a probiotic as all strains of a species do not exhibit similar properties. Side effects caused by probiotics are mild and digestive. L. bulgaricus, was shown to be incapable of degrading some host tissue components. Probiotics are contraindicated in immunocompromised patients. Bacteremia and fungemia have been reported following the use of probiotics in immunocompromised individuals, infants, patients with chronic disease, short-gut syndrome, and individuals with a prior history of prolonged hospitalization and surgical intervention. Lactobacillus endocarditis was reported after dental treatment in a patient with mitral regurgitation who was taking a probiotic preparation containing Lactobacillus rhamnosus. The liver abscess was reported following the use of probiotic-containing L. rhamnosus GG. It has been shown that a probiotic strain of L. salivarius is cariogenic in a rat model. A number of probiotic lactobacilli and bifidobacteria produce acid from fermentation of dietary sugars in vitro.
| Safety of Probiotics|| |
Before marketing probiotics, the safety factor is of prime importance and has to be inspected.
- Properly tested and prepared probiotic strains are, for the most part, extremely safe for human oral and vaginal use
- New strains and products wishing to be designated as probiotics, should be proven in human studies to be safe
- Clear labeling is recommended when a strain, for example, Saccharomyces boulardii (Saccharomyces cerevisiae), has some limitations in its use such as for patients with a leaky gut or at risk of blood-borne infection.
| Conclusion|| |
The concept of probiotics prompts a new horizon on the link between diet and oral health. The use of probiotics for use in oral care applications is gaining importance. Increasing evidence has shown that the use of existing probiotic strains can deliver oral health benefits. More studies are required to support and quantify the extent of this benefit. Furthermore, the potential of prebiotics to maintain and enhance the benefits provided by the resident oral microbiota has to be investigated. Further studies to understand the ability of probiotic bacteria to survive, grow, and have a therapeutic effect when used for the treatment or when added to foods, to fix the doses and schedules of administration of probiotics are required. In addition, well-designed, long-term follow-up studies have to be conducted to interpret the oral health risk of long-term use of probiotics. The role of probiotics in various fields has to be emphasized and practiced accordingly.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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