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Inside Dental Hygiene
October 2021
Volume 0, Issue 0

What's in Your Probiotic?

Comparing Oral Care and Digestive Probiotics

Samuel B. Low, DDS, MS, MEd

What is the difference between digestive and oral care probiotics? While the science behind both is similar—utilizing naturally occurring positive bacteria to improve health—the bacterial strains and purpose of each is vastly different. Digestive or "gut" probiotics have been embraced by the medical and healthcare industries for certain applications, yet many dental professionals are just beginning to understand how oral care probiotics can help patients dramatically improve their oral health.

Oral care probiotics are formulated with three naturally occurring strains of bacteria (Streptococcus oralis KJ3®, Streptococcus uberis KJ2®, and Streptococcus rattus JH145®) to specifically support tooth and gum health. These positive bacteria colonize on tooth surfaces and along the gum line, effectively "crowding out" the pathogenic bacteria that lead to caries and periodontal disease. The scientific basis for the oral health benefits provided by these three strains of bacteria has been documented in numerous peer-reviewed publications over the last 30 years.1

Digestive probiotics work by balancing the levels of microorganisms in the intestines. Similar to oral care probiotics, they drive down the numbers of harmful bacteria.

"Oral-care probiotics are designed specifically to balance the bacteria in the mouth, similarly to how traditional probiotics work in the gut," says Barbara L. McClatchie, DDS. "Oral-care probiotics can be one of the easiest and most effective ways to maintain good dental hygiene for patients of all ages. Since the mouth is the gateway to the body, excellent oral hygiene can contribute to overall health in so many ways. Science is rapidly advancing in the field of oral-care probiotics, and we are just at the tip of the iceberg now."

Digestive probiotics are common, as more than 3.9 million Americans having taken some form of probiotics in their lifetimes, according to 2020 guidelines from the American Gastroenterological Association (AGA). As gut probiotic science has become more established, researchers are now focused on several conditions that are favorable for traditional probiotics.

Gut probiotics are thought to be useful in treating symptoms of Crohn's, ulcerative colitis, or irritable bowel syndrome, and helping to maintain overall health. Similarly, some leading researchers in the field of oral care probiotics are reporting some exciting findings. While more research is continuing, some recent reports are encouraging.

Dental researchers continue to emphasize the systemic health benefits of repopulating beneficial oral bacteria and crowding out the pathogenic bacteria that can lead to inflammation, caries, plaque, gingivitis, and periodontal disease. Oral inflammation is also associated with heart attack, stroke, diabetes, and Alzheimer's Disease, among other chronic conditions. The health benefits of oral care probiotics can be seen in patients of all ages and levels of health.

In a retrospective review of oral probiotic therapy, 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.2 The reduction in caries risk for the pediatric study group remained clinically significant 3 years after the original study. Together, this data supports the use of oral care probiotics in preventive dentistry to reduce both the number of pathogenic dental bacteria and the long-term risk of caries in children. "Our study concluded that the dental profession should adopt oral care probiotic therapy as it is the most effective caries preventative for children," stated Mark Cannon, DDS, MS, Professor, Feinberg School of Medicine, Northwestern University.

Another population which may benefit from oral-care probiotic therapy is bariatric surgery patients. According to the Bariatric Surgical Practice and Patient Care, research has shown an increased risk of periodontal disease post-bariatric surgery.3Oral care probiotics could help these patients maintain a healthy microbiome.

Oral care probiotics may also be useful in avoiding severe symptoms of serious diseases such as COVID-19, although this topic has yet to be studied in depth. British researchers have proposed a link between poor oral hygiene and severity of COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Researchers who collaborated to find the connection published in a recent issue of the British Dental Journal and stated in conclusion: "The four main comorbidities associated with an increased risk of complications and death from COVID-19 are also associated with altered oral biofilms and periodontal disease, hence why the link between poor oral health and COVID-19 complications is suggested."4

Many factors can lead to the imbalance of bacteria in the mouth. "The natural balance of beneficial bacteria can be depleted by diet, stress, medication, illness or other factors," reports Lisa. F. Mallonee, MPH, RDH, RD, LD, Professor and Graduate Program Director at the Caruth School of Dental Hygiene, Texas A&M College of Dentistry in Dallas. "The healthy balance can be restored by the addition of oral-care probiotics to an oral hygiene regimen."5

As doctors and dentists increasingly collaborate to ensure optimal health outcomes for patients, probiotics may be one of the important tools that help bridge the oral-systemic gap. Dentists serve as the gatekeepers of the healthy mouth, and medical doctors will appreciate having patients with a healthy oral microbiome before starting treatments or surgeries. Regular use of oral care probiotics may help make this goal possible. 

About the Author

Samuel B. Low, DDS, MS, MEd
Associate Faculty Member
L.D. Pankey Institute
Professor Emeritus
University of Florida, College of Dentistry

References

1. Knowledge Library. ProBiora Health Web site. https://probiorahealth.com/knowledge-library/. Accessed August 20, 2021.

2. Cannon M, Trent B, Vorachek A, et al. 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.

3. Centrella LM, Boyd LD. Oral health of postbariatric surgery recipients. Bariatric Surgical Practice and Patient Care. 2017;15(2). doi.org/10.1089/bari.2017.0046.

4. Sampson V, Kamona N, Sampson A. Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? Br Dent J. 2020;228(12):971-975.

5. ProBiora Healthᵀᴹ reports that probiotics aren’t just for the gut anymore. June 28, 2020. https://probiorahealth.com/probiotics-not-just-for-the-gut/. Accessed August 19, 2021.

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