Oral Care Probiotics
Understanding a critical link in the oral-systemic health connection
Hardly a television commercial break goes by in which there is not a runner, grocery store shopper, or blue-eyed Greek celebrity touting a trendy health craze: probiotics. Probiotic intake for overall health has long been used to maintain optimal gut bacteria and to prevent gas, bloating, and other unfavorable symptoms that can occur when they are out of balance.
Like the gastrointestinal tract, the oral cavity is home to hundreds of species of bacteria. When the oral ecosystem is out of equilibrium, symptoms of inflammation, caries, and bleeding will ultimately present themselves. Individuals who have integrated dietary probiotics into their health regimen may already be benefiting from the therapeutic potential and inhibition of the periodontal pathogens, specifically Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans.1
The key to maintaining oral health is to embrace the oral environment’s microbial ecosystem. By maintaining equilibrium between helpful and harmful endogenous bacteria, the oral defense system is enhanced. If we do this, we can proactively impact the oral health of our patients and minimize the need for invasive dental or pharmacologic oral care. To enhance understanding of their importance, this article will address what oral care probiotics are in comparison to other probiotics that are taken orally and how can they assist our patients in achieving optimal oral health between visits.
As oral health facilitators, we are on the front line of identifying oral risk factors specific to each patient. Collaborative efforts with patients and primary care givers, as well as specialized medical and dental teams, are imperative in creating a treatment plan that will help prophylactically maintain a healthy oral environment, with the ultimate goal of avoiding clinical signs, symptoms, and oral disease manifestations of an imbalanced oral ecosystem long term. Fortunately for us, we have a growing number of powerful tools in our toolbox, including oral care probiotics.
The word probiotic comes from Latin and Greek words literally meaning “for life.” The World Health Organization’s 2001 definition of probiotics is “the use of live microorganisms which, when administered in adequate amounts, confer a health beneﬁt on the host.”2 Oral care probiotics are probiotics intended for the oral cavity to help maintain a healthy oral flora. One of the most studied and accepted oral care probiotics is EvoraPro® from Oragenics ( www.oragenics.com). Although most probiotic products on the market are ingested orally, they are not intended to confer an oral benefit. EvoraPro’s patented blend of probiotics (ProBiora3®) consists of strains naturally found in healthy mouths and is intended to confer an oral benefit. ProBiora3 comprises Streptococcus oralis KJ3™ and S uberis KJ2™, which are both associated with gingival tissue health, as well as S rattus JH145™, which is specific to tooth health. These probiotic bacteria synergistically work as antagonists to undesirable oral bacteria associated with rampant caries, bad breath, and oral infections, challenges all dental patients face indiscriminately.
EvoraPro ideally should be taken orally every evening after normal oral hygiene routines are completed. Once activated by saliva (from chewing and swishing around mouth, sucking on until dissolved, or crushing the tablet and placing in the mouth), ProBiora3 competes with the disease-causing pathogenic microorganisms for the same nutrient layer and space that proliferates below the gum line, deep down in the base of the pocket in and around the crevices of the tooth, and on occlusal surfaces.
In a 2009 human clinical study,3 the effects of daily usage of EvoraPro oral care probiotics over 4 weeks resulted in a decrease in the levels of S mutans in 84% of the subjects tested. Across all subjects, there was an average six-fold reduction; overall risk was reduced from moderate to low according to the CAMBRA index. Also documented was a greater than 300-fold decrease in the levels of Camplylocacter rectus, a toxic gram-negative bacterium pathogenic in gum and periodontal disease. A greater than 100-fold decrease response was also noted in Porphyromonas gingivalis among other oral pathogens within a month of use.
There are other products available for the benefit of a balanced oral ecosystem that come in a variety of delivery systems. Sunstar developed GUM® PerioBalance® ( www.periobalance.com), a lozenge which contains two strains of Lactobacillus reuteri (Prodentis™) derived from dairy and the human gut. When taken daily, it helps to balance the oral environment to promote healthy teeth and gums, reduce plaque, and fight bad breath.
A product from BLIS Technologies, BLIS K12™ (https://blis.co.nz), is an advanced probiotic for oral cavity and upper respiratory tract health. It contains a specific and proprietary strain of S salivarius able to help support fresh breath naturally while supporting immune system health as it relates to the mouth and upper respiratory tract. S salivarius M18 benefits patients’ desire for fresher breath, healthy teeth, and plaque reduction.
A toothpaste from Germany called Plidenta Pro-T-Action ( www.plidenta.com) is a first-of-its-kind probiotic product. Pro-T-Action is a specific probiotic (L paracasei) that co-aggregates Mutans streptococci and reduces caries-causing bacteria in the mouth. In addition to the supplements, lozenges, and toothpaste delivery systems mentioned here, gum and mint formulations of oral health probiotics are also available.
In closing, bidirectional interactions between the mouth and the body play an important role in the maintenance of oral health and general well being. With the inclusion of probiotics as part of an oral ecosystem hygiene protocol, we can now help all patients reestablish and/or maintain the delicate balance between “good” and “bad” oral microflora to prevent the over-colonization of undesirable microorganisms. Including oral care probiotics in an oral health care regimen will assist patients in naturally and consistently improving oral health as well as maintaining a balanced ecosystem easily, effectively, and consistently between visits.
ABOUT THE AUTHOR
Debra Z. Sabatini, RDH, is a consultant, corporate executive, lecturer, and author. She can be reached by phone at 561-358-7660, or via email at email@example.com.
1. van Essche M, Loozen G, Godts C, et al. Bacterial antagonism against periodontopathogens. J Periodontol. 2013;84(6):801-811.
2. Food and Agriculture Organization of the United Nations, World Health Organization. Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria: report of a joint FAO/WHO expert consultation on evaluation of health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. October 2001. www.who.int/foodsafety/publications/fs_management/en/probiotics.pdf. Accessed May 29, 2014.
3. Zahradnik RT, Magnusson I, Walker C, et al. Preliminary assessment of safety and effectiveness in humans of ProBiora3, a probiotic mouthwash. J Appl Microbiol. 2009;107(2):682-690.
A | GUM® PerioBalance®
GUM® PerioBalance® Daily Dental Probiotic by Sunstar is a lozenge that helps to balance the oral environment to promote healthy teeth and gums, reduce plaque, and fight bad breath. The product contains a unique blend of naturally occurring probiotics called Prodentis®, which produces a beneficial, natural agent that fights bacteria responsible for poor oral health.
B | EvoraPro®
EvoraPro® supports dental and gingival health while naturally whitening teeth and fighting bacteria that causes bad breath. Each tablet contains an extra-strength blend of patented ProBiora3® probiotics. These beneficial bacteria bind to teeth and go deep under the gingival margin, crowding out undesirable bacteria to become the colonization center of a healthy, balanced oral microflora.
C | Venus Smile™ Oral Care Probiotic Mints
Heraeus Kulzer, LLC’s Venus Smile™ Oral Care Probiotic Mints are 100% natural daily mints that help keep smiles healthy, bright, and fresh. They support the health of teeth and gums, freshen breath, and release a low dose of hydrogen peroxide to provide a gradual and gentle whitening effect.
About the Author
Debra Z. Sabatini, RDH
Director, OralED Institute
Hobe Sound, Florida