Recent studies have shown a correlative link between an imbalanced gut biome and the presence of chronic inflammatory conditions including periodontal disease. 70% of the immune system resides in the GI tract. Those who have a microbiome with a higher population of harmful bacterial pathogens and less bacterial diversity are more predisposed to developing systemic health conditions as well as dental diseases. Patients who have active periodontal disease are then placed at an even greater risk of developing or having difficulty controlling other inflammatory conditions such as diabetes, heart disease, and autoimmune conditions.
How can probiotics be used to treat periodontal disease?
Probiotics have successfully been used to reduce plaque accumulation, treat halitosis, improve pocket depths and alter the colonization of anaerobic bacteria.
How do they work?
Probiotics have been proven to work to improve immunity when delivered systemically and locally.
Probiotics can inhibit the growth of harmful bacterial pathogens in the way they interact with the host as well as other bacteria in the mouth. By competition for space as well as the creation of natural byproducts, probiotics can inhibit the growth of pathogenic bacteria while creating an anti-inflammatory effect. Many of the processes by which probiotics interact with pathogenic bacteria cause the inhibition of chemical mediators that are normally involved in the host inflammatory response. These chemical mediators are often related to tissue destruction as a result of chronic inflammation.
Probiotics and Periodontal Therapy
Streptococcus oralis and Streptococcus uberis are two strains of probiotics which are associated with periodontal health. These have been shown to inhibit pathogenic growth in the lab. Patients who do not have these strains of beneficial bacteria present are more likely to experience symptoms of periodontal disease.
Lactobacillus reuteri has been studied in a parallel double-blind randomized, placebo-controlled study of 59 subjects with moderate to severe gingivitis.
In this study, patients were given strains of Lactobacillus reuteri via chewing gum twice a day for two weeks (concentration was 1×108 CFU) in addition to traditional scaling and root planing. After two weeks, the subjects who used probiotic chewing gum showed improvement.
Weissella cibaria CMS1 has been shown to reduce plaque scores in a study using a mouth rinse with the strains four times a day. Plaque scores reduced by 20% in patients using the rinse.
Lactobacillus helveticus was shown to stimulate bone formation and may be useful for patients being treated for periodontitis.
Patients treated with a periodontal dressing containing the probiotic Lactobacillus casei experienced prolonged remission following treatment.
There have been multiple studies performed on many other strains of probiotics for the treatment and management of periodontal disease. Many of these studies show improvements to the periodontal condition of the patient in conjunction with traditional therapies.
Probiotics for Halitosis Treatment
Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola are bacterial species responsible for creating volatile sulfur compounds which are associated with halitosis.
Weissella cibaria is a probiotic strain that has been shown to inhibit the growth of volatile sulfur compounds by creating hydrogen peroxide. Hydrogen peroxide reduces sulfuric gases and protecting against pathogens by creating an inhospitable environment for their survival. Other strains of probiotics including Lactobacillus acidophilus, Lactobacillus casei and Streptococcus salivaris have been shown to decrease volatile sulfur compounds in patients with halitosis.
Sources of Probiotics
There are several modes of delivering probiotics. Attenuation of an infectious pathogen is the alteration of the pathogen to make it less virulent or harmful. This type of vaccine differs from traditional vaccines which are created by inactivating the virus. Attenuated pathogen vaccines use live probiotic strains and deliver direct application of immunogenic proteins from certain pathogens. Genetically altered “designer probiotics” are created to mimic naturally occurring structures within the gut. Some of these modalities have been used to help treat HIV.
Bacteriotherapy is a method in which certain strains of probiotics are applied directly to an infected area. This type of therapy results in long-term colonization of the probiotic into the natural microbiome of the patient which will help prevent or halt the pathogen from colonizing.
Traditional probiotics are usually taken as a daily oral supplement which does not have a long-term effect on the patient’s natural flora.
There are many natural foods that contain probiotics which have been shown to be beneficial and effective against pathogenic bacteria. Sources such as sourkraut, kefir, kombucha, and other fermented vegetables and dairy products.
Research is showing the significant impact probiotics can have on the oral and overall health of patients, and providers should consider using them in conjunction with traditional treatment and prevention of many health problems. Probiotics have been shown to be beneficial in a variety of applications. They have been effective in helping to treat many systemic and oral infections, allergies, chronic inflammatory conditions, and even cancers.
Unlike antibiotics, probiotics eliminate concerns about the development of resistance because of the fact that they naturally reside in the human body’s microbial flora and adapt to protect the body. Modern probiotic technology creates the opportunity to help treat a variety of medical and dental conditions with virtually no ill side-effects. Care should be taken when prescribing or recommending specific probiotics to immune-compromised individuals as there have been rare cases of bacteraeima associated with certain strains.