Probiotics: emerging treatment for oral disease

While the main field of study on probiotics has been in the area of gastrointestinal health, research on probiotics in treating the oral flora is emerging. Because of their association with a reduction in chronic inflammation and the displacement of pathogenic bacteria through bacterial adhesion, dental researchers have begun to look at probiotics as a means to decrease oral disease. Few randomized control trials have been conducted in the oral health area, with most being short in duration, with small sample sizes. Clinical relevance continues to be problem as probiotics work only as long as they are consumed on a regular basis. Once the probiotic is stopped, colonization does not persist. Two commercial probiotic products are currently available in the United States. Sunstar Americas is marketing GUM PerioBalance, a once daily lozenge with L. reuteri Prodentis claiming a reduction in moderate to severe plaque and the promotion of healthy teeth and gums as well as fighting bad breath.(2) A recent clinical trial demonstrated that once daily lozenge of L. reuteri Prodentis in combination with scaling and root planing reduced the amount of certain periodontal pathogens as well as reduced pocket depths and increased clinical attachment level compared with scaling and root planing alone.(3)A proprietary blend of Streptococcus uberis KJ2, S. oralis KJ3, and S. rattus JH145 is called ProBiora3 and is the active ingredient in a probiotic called EvoraPlus and EvoraKids. Developed and marketed by Oragenics, this probiotic is used twice daily and claims a reduction in periopathogens within the periodontal pocket as well as a reduction in S. mutans.(4-5)Oragenics has recently announced its intention to commence a second phase 1 clinical trial of a new genetically modified strain of bacteria that will colonize in the oral cavity, displacing cariogenic bacteria from a a one-time, five minute topical treatment.(6)With the focus on oral disease prevention and optimal health for all ages, there is good potential for probiotics. Dental hygienists are in an ideal position to monitor the research and guide patients on the potential benefits that probiotics can offer.