Oral Probiotics in Everyday Dentistry

Oral Probiotics in Everyday Dentistry

Review of the November 2013 CDHA (Canadian Dental Hygienists Association) Webinar presented by Francine Gagnon, RDH

There are a 100 trillion bacteria on the human body. Over 700 species of bacteria live in the oral cavity. Most bacteria do not affect us but others make us ill (pathogens) and a few actually make us healthy (probiotics).  Stress, sickness, allergens, some medication, changes in eating habits and pollution all have an effect on the bacterial makeup in and on our bodies and can give harmful bacteria an opportunity to strike.

The word probiotic means “in favour of life”. Probioctics are live microorganisms that when administered in adequate amounts result in a health benefit for the person taking them.  They work by inhibiting growth of pathogenic bacteria and help regulate the population of bacteria on and in the body.  Probiotics modify our immune response and help improve gut function and nutritional uptake.  Interestingly, all probiotics have been shown to help promote healthy gums. Probiotics were recently characterized as a breakthrough approach for maintaining oral health.

According to the World Health Organization, 60-80% of the population in industrialized countries suffer from gingivitis (gum tissue inflammation), and 10-20% suffer from periodontitis (a more severe form of gum tissue infection).  A more recent survey by the US National Health and Nutrition Examination Survey suggest that actually 50% of the population have periodontal disease and of those, 70% are over the age of 65.  What this suggests is the need not only increased professional dental hygiene maintenance visits, but also improved home care regimens.  As part of regular brushing and flossing, probiotics can be used safely and effectively to optimize oral health.  Oral probiotics are now available in Canada.

The research supporting the use of probiotics is both extensive and compelling. To date, there have been 22 studies examining the effects of oral probiotics on gum disease.  These studies involved 971 individuals, and the results are published in 15 scientific articles and 2 doctoral theses.

In order to understand the results of these studies one needs to be familiar with a few of the basic metrics used to evaluate oral health.

 

Pocket depth – every tooth has a space between the crest of the gum tissue and the point where the gum tissue attaches to the tooth.  A measurement of  this space around the tooth and below the crest of the gum tissue is termed pocket depth.  Healthy pockets tend to be under 3mm deep.  Deeper pockets (4mm or greater) are indicative of disease.

  • The use of oral probiotics using reuteri prodentis have resulted in 22% more periodontal pocket depth reduction than with basic dental hygiene techniques alone, 54% more clinical attachment level gain in deep pockets and 53% fewer sites needing surgery with compared to placebo. (Journal of Clinical Periodontology, published online 15 August 2013).

 

Bleeding on probing – gingival bleeding is one of the hallmark signs periodontal disease and gum inflammation.

  • The use of oral probiotics has been shown to result in 85% reduction in gum bleeding after 2 weeks of treatment. (Twetman et al. 2008, Acta Odortol Scand)

 

Plaque accumulation – the more abundant the plaque build-up is around teeth (both above and below the gum line), the more likely it is that a patient will suffer from chronic gingivitis and periodontal disease.

  • Oral probiotics have been shown to reduce moderate to severe plaque build-up by 42% after 28 days. (Krasse P., et al. Swed Dent J. 2006;30-55-60). A 90% reduction in the most aggressive subgingival pathogens (bacteria below the gum line that cause disease) Prevotella intermedia, Aa- Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis occurred after 3 weeks of use.  (Vivekananda et al J Oral Microbiol 2010)

 

Points to consider when using an oral probiotic: 

  1. The dosage of Lactobacillus reuteri (the main active ingredient in oral probiotics) does not vary depending on the patients weight.
  2. A protocol of chlorhexidine (or any antibacterial rinse) and an oral probiotic like GUM PerioBalance* can work together as long as the patient rinses at least 3hours before or after using the oral probiotic.
  3. After taking an oral probiotic, you should wait 2-3hours before taking an antibiotic.
  4. Reuteri does not colonize the oral cavity or digestive tract permanently.
  5. Anyone with periodontal disease and or gingivitis would benefit from an oral probiotic. Smokers, diabetic clients and also implant clients would also benefit.
  6. The length of time a client should take an oral probiotic depends on the health of their gingiva. They should take it if they have periodontal disease and or gingivitis. If they continue to have bleeding gums, they should continue with the oral probiotic.
  7. There are no adverse side effects of taking reuteri Prodentis lozenges.
  8. You should let the reuteri lozenge dissolve in your mouth for 10minutes.
  9. The recommended daily dosage (CFU- Colony Forming Units) of reuteri is 2 X 200CFU (2 PerioBalance tablets per day).

*GUM PerioBalance L. Reuteri has been developped in collaboration with Swedish and Japanese scientists supported by an extensive science network.   Sweden- University of Lund, University of Linkoping, Karolinska Institue, University of Malmo Faculty of Odontology, University of Umea Faculty of Odontology, Swedish University of Agricultural Sciences.

USA- University of California, University of Texas, State University North Carolina, Michigan State University, University of Washington.

Germany- University of Hohenhiem

Japan- Kyorin University, Hiroshima University

South Africa- University of Pretoria

Finland- Tampere University