Published on March 8, 2014
Probiotics and dental caries risk Dr. Hakan Çolak DDS. PhD Department of Restorative Dentistry
Introduction • The Food and Agriculture Organization (FAO)/World Health Organization (WHO) have defined probiotics as “live micro-organisms, which when administered in adequate amounts, confer a health benefit to the host.”
Introduction • Probiotics are used in the prevention and treatment of infectious diseases and allergies. • In some countries probiotics are recommended for infants because of their long-term enhancement of the immune responses of children
Introduction • Probiotics are mainly ingested orally, and the gastrointestinal tract is thus the primary target organ for probiotic microorganisms. • However, when ingested in the form of, for example, tablets, chewing gums, cheese, and milk, the oral cavity is exposed to the probiotics.
Introduction • The probiotic species most often investigated and widely used in foods are lactobacilli and bifidobacteria. • This presentation focuses mainly on these genera even though other microorganisms are also used as probiotics
Mechanisms of Action Of Oral Probiotics PROBIOTICS DIRECT INTERACTIONS IN DENTAL PLAQUE Disrupt binding of oral microorganisms to proteins Interrupt bacteria-to-bacteria attachments Compete with oral microorganisms and their substrates Produce antimicrobial substances INDIRECT PROBIOTIC ACTIONS IN THE ORAL CAVITY Modulating systemic immune function Effect on local immunity Effect on non-immunologic defense mechanisms Regulation of mucosal permeability Colonization by less pathogenic species ORAL BIOFILM AND MICROFLORA
Caries-related mechanisms of probiotic activity • Lactobacilli and bifidobacteria are both acidogenic and aciduric. • Some lactobacilli and bifidobacteria, including L. Rhamnosus GG and B. lactisBB-12, do not ferment sucrose (Haukioja et al. 2008).
Caries-related mechanisms of probiotic activity • The low pH generated by most probiotics is also crucial for their antimicrobial actions. – Several studies have demonstrated that probiotic lactobacilli may inhibit caries-associated microorganisms via antimicrobial substances active at a low pH. • The growth inhibition of S. mutans in vitro has been attributed to the generation of a low pH either via organic acid production and/or production of bacteriocins or metabolites active at a low pH (Simark-Mattsson et al., 2009)
Caries-related mechanisms of probiotic activity • The adhesion capacity and persistence on the oral mucosa and teeth – an important property of probiotics from an oral health point of view. – In vitro studies have demonstrated that probiotic lactobacilli show varying degrees of adhesion to saliva-coated hydroxyapatite surfaces • bb
Caries-related mechanisms of probiotic activity • interactions between oral microorganisms and probiotics – Probiotics may modify the protein composition of the pellicle and specifically prevent adhesion of other bacteria
Probiotics and counts of mutans streptococci • In adults, even high counts of MS in the plaque/saliva do not necessarily mean an increased caries risk. However, decreasing MS without affecting the “normal flora” should improve the microbiological composition of the plaque and make it less virulent • In adults via straws, tablets, medical devices, milk, and chewing gums, all studies resulting in a decrease of MS counts
Probiotics and counts of mutans streptococci • In some countries probiotics are recommended for infants. Thus, a major concern is the effect the administration may have on the colonization of erupting teeth and the future dental health of the child.
Probiotics and caries occurrence • Probiotics, mostly lactobacilli or bifidobacteria, are aciduric and acidogenic microorganisms. Such bacteria are usually connected with caries occurrence, not its prevention. • So far the few studies on probiotics and caries occurrence suggest that probiotics could rather promote dental health than be a hazard to it.
• In a Finnish study, 594 children ages 1 to 6 years old attending a day-care center, received L. rhamnosusGG-containing milk for 7 months. The milk use reduced the caries risk significantly in the 3- to 4-year-old children
• Swedish study, – 248 preschool children ages 1 to 5 years -old – received either a control milk or a test milk supplemented with both fluoride and L. Rhamnosus LB21 for 21 months (Stecksen-Blicks et al. 2009). – Caries occurrence decreased significantly in the test group
Abstract: Probiotics and dental caries. ... Dental plaque is not only a caries risk factor but also associated with periodontal diseases.
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