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Lisa F. Mallonee, M.P.H., RDH, RD, LD, is a tenured professor, graduate program director, and registered dietitian at Texas A&M University College of Dentistry, Caruth School of Dental Hygiene, where she teaches public/community health and lectures on nutrition in the dental hygiene and predoctoral dental curriculum. She oversees practicum placement and thesis research as co-director in the College of Medicine’s Education for Healthcare Professionals graduate program. Mallonee received a bachelor of science in dental hygiene and a master of public health with a coordinated degree in nutrition from the University of North Carolina at Chapel Hill. Prior to becoming a registered dietitian, she practiced full time as a registered dental hygienist in both general and public health practice settings.
Strains of beneficial bacteria can help balance the oral environment and promote patients’ oral and overall health.
A frustration shared by many dentists and dental hygienists is seeing patients who, despite reporting good oral hygiene practices, present with cavities, periodontal issues and/or persistent bad breath.
Traditional methods of home care such as brushing and flossing are met with great resistance and multiple excuses for why these habits are difficult to incorporate into the daily routine. The good news is that alternatives are available, and oral care probiotics are one such option. Multiple scientific research studies conducted over the past three decades validate the efficacy of oral care probiotics as an effective means of fighting these all too common oral health issues.
With healthcare moving into a more holistic direction and antibiotic resistance becoming a reality, the suggested effects of probiotics in the oral cavity can be broadly divided into three groups: Modulation of the host inflammatory response, direct effect against pathogenic bacteria, and indirect effect against pathogenic bacteria. For the dental practitioner, oral care probiotics may be useful for the treatment of caries, halitosis, periodontal disease, and oral mucositis.
Oral care probiotics are live, healthy bacteria that are identical to the beneficial microorganisms found naturally in the mouth. They should include organisms that naturally occur in the teeth, tongue, and gingival tissue including S. oralis, S. uberis, and S. rattus. A key goal of their use is to interfere with microbial imbalance, a causal agent in caries, and periodontal diseases, by adding beneficial bacterial species.
By attaching to natural oral biofilm and forming live, active bacteria on the surface of the teeth and deep into the sulcus, probiotics reduce oral pathogens often exacerbated by processed foods and high-sugar diets. They can also reduce or prevent plaque biofilm formation and gingivitis, often associated with health problems beyond the mouth.
According to the Centers for Disease Control and Prevention, by age 34, approximately 50 percent of people will have experienced periodontal disease.1,2 Additionally, poor oral health has been linked with other chronic diseases, such as diabetes, heart disease, dementia, and Alzheimer’s disease.3
The findings linking oral and systemic bacteria are helping to shift the paradigm of dentistry from curative to preventive. This approach may offer life-changing benefits for patients, especially those with potential risk for heart disease. Collaborative treatment efforts between the Heart Attack and Stroke Prevention Center (HASPC) of Central Ohio and Complete Health Dentistry of Columbus, two practices located in the same office in Worthington, Ohio, have shown positive results in preventing heart attacks and strokes. One of their main focuses is to reduce inflammation through using oral probiotics to eliminate high-risk bacteria in the mouth, which can enter the blood stream causing an inflammatory load.4
“Our patient protocol includes testing, treating, and repopulating,” says Lora Hooper, B.S.D.H., RDH, EFDA, part of the oral care team at HASPC of Central Ohio and Complete Health Dentistry of Columbus. “I feel the most important piece is repopulating, which is centered on creating a healthy oral microbiome by repopulating with beneficial bacteria in the mouth. During my 25 years of patient care, I have seen a dramatic improvement of oral health in patients using oral care probiotics.”
An ongoing study conducted by pediatric dental expert Mark Cannon, DDS, MS, of the Feinberg School of Medicine at Northwestern University in Chicago, concludes that an oral care probiotic regimen significantly reduced both the caries risk and the levels of cariogenic dental bacteria in caries-prone children, with no reported side effects.5 The reduction in caries risk for the pediatric study group remained clinically significant three years after the original study.6,7
This data supports use of oral care probiotics in preventive dentistry to reduce both the number of pathogenic dental bacteria and the long-term caries risk in children. “Dental professionals should consider oral care probiotic therapy as one of the most effective caries preventive measures in children,” says Dr. Cannon.
The addition of oral probiotics to an oral care regimen can restore the natural balance of beneficial bacteria, which can be depleted by poor nutrition, stress, medication, illness, and other factors. The use of probiotics in patients’ daily oral care regimen following routine prophylaxis or nonsurgical periodontal therapy has the potential to alter the microflora present in the mouth.8
The introduction of beneficial bacteria strains in the oral cavity can crowd out recolonization of unhealthy bacteria, including those that can cause bad breath. Additionally, oral probiotics may support tooth and gum health as well as whiten teeth. Oral care probiotics are a promising treatment option that may offer long-term improvements in oral care-something we can all smile about.
Oral care probiotics are not a part of the majority of patients’ oral care routines, but a growing body of research shows they can be effective for many people. While more research is needed, many studies show the promise of probiotic solutions to common oral and systemic health problems. Here are some of the situations where oral care probiotics have been shown to help:
1. Centers for Disease Control and Prevention. Periodontal Disease. https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html . July 10, 2013. Accessed March 6, 2020.
2. Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J Dent Res. 2012; 91(10):914-20.
3. Oral health: A window to your overall health. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475. June 4, 2019. Accessed March 6, 2020.
4. Gould E, DeMatteis P. Collaborating to Reduce Oral-Systemic Inflammation. Inside Dentistry. 2019; 13(12):47-52, 59.
5. Cannon M, Trent B, Vorachek A, Kramer S, Esterly R. Effectiveness of CRT at Measuring the Salivary Level of Bacteria in Caries Prone Children with Probiotic Therapy. J Clin Pediatr Dent. 2013; 38 (1): 55-60.
6. Cannon M, Vorachek A, Le C, White K. Retrospective Review of Oral Probiotic Therapy. J Clin Pediatr Dent. 2019; 43(6): 367-371.
7. Cannon ML. A Review of Probiotic Therapy in Preventive Dental Practice. Probiotics Antimicrob Proteins. 2011; 3(2): 63-7
8. Naekaerts O, Jacobs R, Quirynen M et al. Replacement therapy for periodontitis: pilot radiographic evaluation in a dog model. J Clin Periodontol. 2008; 35(12): 1048-52.