Do probiotics offer opportunities to manipulate the periodontal oral microbiota?

Abstract

Background: As in other fields of healthcare, probiotics have been introduced for prevention and treatment of periodontal diseases. Objective: This review was initiated to explore whether the use of probiotics can influence the periodontal microbiota and periodontal health. Materials and Methods: Literature on the mode of action of oral probiotics was reviewed and a systematic review was performed on the microbiological and clinical effects of oral probiotics on periodontal health. Results: Three animal and 11 in vivo human studies were retrieved. Six studies reported on microbiological effects whereas eight studies report on clinical effects. Seven studies were performed on healthy or gingivitis patients and four studies on periodontitis patients. Many of the retrieved studies are pilot in nature and with low quality. The high degree of heterogeneity between studies hampered analysis. Conclusion: Taking into consideration all limitations, the currently available data indicate an effect of probiotics on the oral microbiota and a more limited effect on clinical periodontal outcome measures. However, there is an urgent need for properly conducted clinical trials where probiotics are used as adjuncts to standard periodontal care, similar to antibiotics, using probiotic strains with, at least at an in vitro level, proven periodontal probiotic effects.

Microbiota, cirrhosis, and the emerging oral-gut-liver axis

“…Matsuoka and colleagues noted a significant reduction in total plaque bacteria and Porphyromonas gingivalis after administration of Lactobacillus salivarius; however, bacterial levels returned to baseline after the treatment was stopped (102). Similarly, Teughels and colleagues found that probiotic treatment in patients with chronic periodontitis reduced plaque score, bleeding, gingival scores, and markers of inflammation during the period of probiotic administration (65). Gingivitis-associated inflammation was studied by Twetman and colleagues, who found that 2 weeks of oral probiotics significantly reduced the levels of IL-8 and TNF-α in the crevicular fluid during therapy; however, these changes were reversed after probiotic administration was stopped (103).…”

“…While most of the gut microbiota is extracellular, several oral pathogens such as Porphyromonas gingivalis (a key stone periodontal bacterium) can be intracellular and more pathogenic. Oral pathogens can be beneficial, exacerbate disease processes (64), or be modulated for beneficial purposes (65).…”

The role of probiotic bacteria in managing periodontal disease: a systematic review

“…As per the ecological plaque hypothesis [48], the ability of probiotics to tip the overall composition of the periodontal biofilm in favor of commensals and eliminate the dysbiosis caused by periodontopathogens (the so called `red complex bacteria`) could be one reason for such observations. Other possible mechanisms of probiotic action may include the competitive inhibition of adhesion sites, and nutrient depletion [49,50]; modulation of the immune system [22,51]; modulation of cell proliferation and apoptosis [52]; production of antimicrobial substances, such as lactic acid, hydrogen peroxide and reuterin [49,53]; and modulation of the pH and/or the oxidation-reduction potential of the plaque biofilm [9] (Figure 2). Some examples of the above could be gleaned from the evaluated studies.…”

Ex vivo anti-inflammatory effects of probiotics for periodontal health

“…In many cases, clinical investigations of probiotics for oral health are performed without any preclinical evidence of their beneficial potential in the oral cavity and the rationale for their use is based on their mechanisms of action in the gut [18]. The use of a screening strategy for probiotic strains, such as the one employed here, enables the rational selection of candidates with optimal activity for evaluation in clinical trials, wherein their therapeutic effects can be determined and safety assessed.…”