Clinical Application of Probiotic Therapy
New adjunctive therapies offer new alternatives for treatment.
Numerous studies have researched the oral biofilm to determine the pathogenicity of specific bacteria.1-3 Now, dental researchers are looking for which bacteria, if present in large quantities, prevents the development of a pathogenic oral biofilm.4 The practitioner may then successfully modify the oral biofilm by targeting specific patients and their specific areas of concern (periodontal disease, dental caries, etc).5 By using the appropriate probiotic, there may be a method of supplementing the oral environment with beneficial bacteria to create a healthy oral biofilm and, ultimately, prevent dental disease.6
The difference between a diseased and a healthy oral condition appears not only to be related to the presence of oral pathogens but also to the level of "healthy" bacteria.4 The oral flora of young children who do not develop pathology contains a number of inhibitory bacteria. Based on this concept, Oragenics, Inc. has introduced EvoraKids™ and Evora Plus™ with a proprietary mixture (ProBiora3™) containing three GRAS (generally recognized as safe) probiotics; Streptococcus rattus JH145, Streptococcus oralis KJ3, and Streptococcus uberis KJ2. These low-acid–producing oral inhabitants quickly colonize the oral cavity to inhibit the growth of the pathogenic streptococci strains.7 Streptococcus oralis KJ3 also produces hydrogen peroxide to inhibit adjacent pathogenic bacteria by oxygenating the plaque. A probiotic mouthwash with ProBiora3, a mixture of the three previously mentioned bacteria strains, has been demonstrated as safe in the laboratory rat model.8,9
The introduction of probiotics into dentistry means that the profession should now consider the entire biofilm complex instead of just the pathogen-specific model of plaque.10 Previous considerations were to mainly focus on the specific pathogens, such as mutans streptococci and the Lactobacillus genus.11 Hence, tests were designed to measure the presence of these two "pathogens" (CRT® bacteria, Ivoclar Vivadent, www.ivoclarvivadent.com). But these bacteria are not the only causative agents; they are perhaps just markers of a pathogenic biofilm.12,13 Focusing on the genesis of the unhealthy oral biofilm will enable the practitioner to prevent or treat a host of oral pathologies and related systemic disorders.10
The patient's oral hygiene practices should be thoroughly reviewed, a complete oral prophylaxis should be performed, and Cervitec Plus™ (Ivoclar Vivadent) varnish applied to reduce the level of the oral pathogens.14-16 Then, the presence of any oral disease—either carious lesion or periodontal in nature—should be an indication for the initiation of probiotic therapy (Figure 1, Figure 2, Figure 3 and Figure 4).17-21
Conclusion
Probiotics have been extensively studied in the medical literature and dental reports are very encouraging. Indeed, current research has shown that it is the balance between beneficial and pathogenic bacteria that determines the oral health of the individual. Certain strains of specific species of naturally colonizing oral bacteria greatly inhibit pathogenic bacteria, specifically Streptococcus mutans, and results in either a caries-free condition, or a few arrested caries in caries-prone individuals dependent upon the threshold number of beneficial bacteria.22,23 Previously accepted methods of preventive dentistry may indeed only shift the strains of the more pathogenic bacteria into a greater plurality. Probiotic therapy is becoming more accepted by many in the health professions. Dental professionals should be actively pursuing this potentially very useful therapeutic measure for the benefit of their patients.
References
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About the Author
Mark L. Cannon, DDS, MS
Associate Professor
Northwestern University
Feinberg School of Medicine
Chicago, Illinois
www.carifree.com
www.carifree.com
