The Role Of Probiotics In Dental Care – Periodontal disease is the most common chronic inflammatory disease of the oral cavity, which is caused and maintained by pathogenic plaque biofilms. Central to modern periodontology is the assumption that dysbiosis of the periodontal microecology and disruption of the host’s inflammatory response lead to periodontal tissue degradation, which ultimately leads to tooth loss, severely affecting the patient’s quality of life. Probiotics were originally used to treat intestinal diseases, while in recent years extensive studies have investigated the use of probiotics in the treatment of oral diseases and maintenance of oral health. Probiotic bacteria derived from the genera Lactobacillus, Bifidobacterium, Streptococcus and Weissella play an effective role in the prevention and treatment of periodontal disease by modulating the periodontal microbiota or the host’s immune response. Here, we review the research status of periodontal health-promoting probiotic species and their regulatory implications. Finally, current issues regarding the efficacy and safety of probiotics in the management of periodontal disease are also discussed. Overall, the use of probiotics is a promising approach for the prevention and treatment of periodontal disease. However, their practical use for periodontal health needs further investigation and research.
The term “probiotic” was coined by Lilly and Stillwell in 1965, defined as “growth promoting factors produced by microorganisms” (Lilly and Stillwell, 1965). Since then, the definition of “probiotic” has changed several times, until the WHO and the Food and Agriculture Organization of the United States (FAO) made a new definition in 2002 that is generally accepted: beneficial effects on the host when administered in sufficient doses” (Hill et al ., 2014).The origin of probiotics can be traced back to ancient Roman records, and Plinius Secundus Maior stated that fermented milk products were useful for treating the stomach. In the early 20th century, Nobel laureate Eli Metchnikov noted that Bulgarians live longer than others because they drink fermented milk (Metchnikoff, 1907). By studying the human intestinal flora, he concluded that the harmful products of certain bacteria can cause aging, and he recommended Lactobacillus-fermented milk to prevent the harmful effects of bacterial products.
The Role Of Probiotics In Dental Care
Probiotics were first used to treat intestinal diseases. Studies have shown that they can help control intestinal infections, relieve constipation and diarrhea, improve lactose intolerance, etc. (Lourenshattingh and Viljoen, 2001). The beneficial effect of probiotics defined by the WHO and WHO is not only in the intestine, but also in other body systems. In fact, many probiotics have been shown to play a role in keeping the genitourinary system healthy and fighting cancer, diabetes, obesity, and allergies (Waigankar and Patel, 2011; Sunita et al., 2012; Kang et al., 2013; Takeda. Kahouli et al., 2013). In recent decades, extensive studies have also investigated the use of probiotics in the treatment of oral diseases and maintenance of oral health. Currently, probiotics that promote oral health are found to be concentrated in the genera Lactobacillus, Bifidobacterium, Streptococcus, and Weissella, as well as some widespread species such as Bacillus subtilis and Saccharomyces cerevisiae. Several strains of Lactobacillus reuteri, Lactobacillus brevis, Streptococcus salivarius, etc., have been produced commercially as oral health-promoting probiotics, all of which microorganisms are isolated from the oral cavity (Allaker and Stephen, 2017; Mahasneh, 2017). The effects of probiotics in improving oral health have been observed in common oral diseases such as dental caries, periodontal disease, oral candida infection and halitosis (Ince et al., 2015; Ohshima et al., 2016; Yoo et al., 2019).; Sivamaruti et al., 2020).
Dental Probiotics, Do They Work?
Periodontal disease is a chronic inflammatory disease that destroys the bone and gum tissue that supports the teeth, the most common being gingivitis and periodontitis. Gingivitis is a mild form of periodontal disease, but untreated gingivitis can progress to more serious periodontitis, creating deep periodontal pockets that can lead to tooth loosening or tooth loss, which has a significant impact on the patient’s life. Until 2019, it is reported that there are 1.1 billion patients with severe periodontitis worldwide, and the prevalence of severe periodontitis has increased by 8.44% from 1990 to 2019 (Chen et al., 2021). Plaque, a microbial biofilm that forms on the teeth and gums, is believed to be the initial factor in periodontal disease. The understanding of the pathogenicity of dental plaque biofilm has evolved over time, and several hypotheses have been proposed throughout history, starting from the Specific Plaque Hypothesis (1976) (Loesche, 1976), to the Non-Specific Plaque Hypothesis (1986). Theilade, 1986), to the Ecological Plate Hypothesis (1994) (Marsh, 1994). Modern periodontology, however, not only focuses on the pathogenicity of dental plaque biofilm, but also emphasizes the interaction between oral microbes and the host. In recent years, the Keystone-Pathogen Hypothesis (KPH) (2012) and the polymicrobial synergy and dysbiosis (PSD) model (2012) have received wide attention. KPH (Hajishengalis et al., 2012) suggested that some low-abundance periodontopathogens, such as Porphyromonas gingivalis, can dampen the effect of bacteria from the host’s immune system and stimulate the host’s inflammatory response, thus disrupting host-microbe homeostasis and the periodontal microecosystem. balance. finally lead to periodontal disease. The PSD model (Hajishengalis and Lamont, 2012) emphasizes that the synergistic effect between the polymicrobial community and the impaired inflammatory response of the host is caused by periodontal disease, and then, the ecological balance and the inflammatory response can reinforce each other and are real disease drivers. In fact, subversion of host immunity by dysbiotic periodontal microbiota not only causes periodontal disease but also contributes to systemic inflammation (Hajishengallis, 2015).
Studies on oral microorganisms indicate that there are more than 700 species of bacteria that colonize the mouth (Kumar et al., 2005). However, only a few bacteria have been proven to initiate and cause periodontal disease, such as P. gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Prevotella intermedia and Fusobacterium nucleatum (Hajishengallis et al., 2012). In a review of studies focused on the effects of probiotics in the management of periodontal disease, we observed that the majority involved four periodontopathogens: P. gingivalis (chronic periodontitis), A. actinomycetemcomitans (aggressive periodontitis), P. intermedia (pregnancy gingivitis, moderate to severe gingivitis, necrotizing gingivitis acute and chronic periodontitis) and F. nucleatum (chronic periodontitis and acute necrotizing ulcerative gingivitis), indicating that periodontal probiotics are often linked or used for specific periodontal diseases caused by them. With the help of several virulence factors that directly destroy periodontal tissue or stimulate host cells to activate various inflammatory responses (Figure 1), this pathogen destroys host-microbe homeostasis and causes or contributes to the onset and development of many periodontal diseases. disease (Zhao et al., 2012; Jaffar et al., 2016; Zhao et al., 2019; Ishikawa et al., 2020; Moman et al., 2020; Ding et al., 2021; Jansen et al., 2020 ;
Figure 1 How probiotics and periodontal pathogens play a role in the regulation of periodontal health and disease. The diagram illustrates the primary mechanisms of periodontal pathogens and probiotics in modulating periodontal microbiota and host immune responses, respectively.
There is increasing interest in the use of probiotics in periodontal therapy and periodontal care. Published studies have shown that probiotics can effectively inhibit periodontopathogens and improve various clinical indicators related to periodontal health, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), periodontal pocket depth ( PPD), clinical. attachment loss (CAL) and gingival crevicular fluid volume (GCF), as well as biochemical markers associated with inflammation, such as interleukin (IL)-1β, matrix metalloproteinase (MMP)-8, and tissue inhibitor of metalloproteinase (TIMP)-1 different forms of probiotics are used in the treatment of periodontal disease such as tablets, mouthwash and toothpaste, commercial probiotics and embedded in periodontal therapy are usually prepared in tablets, while probiotics in the form of mouthwash and toothpaste are often used for periodontal. health. maintain
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Several studies have focused on the role of probiotics in periodontal care. Amizic et al It was found that probiotic toothpaste can prevent caries and periodontal disease more effectively than non-probiotic toothpaste, and the ability of toothpaste to inhibit bacteria is better than mouthwash. It is considered that toothpaste can be in contact with the tooth surface for a long time, and it will be easy to enter the gingival crevice with the help of a toothbrush (Amizic et al., 2017). However, a study by Alkaya et al. (2016) had a different conclusion. 40 patients with gingivitis were recruited and divided into 2 groups using a placebo or an experimental probiotic B. subtilis-, Bacillus megaterium-, and Bacillus pumulus-containing toothpaste, mouthwash, and toothbrush cleaner for 8 weeks. After the assessment of PI, GI, PPD and BOP at the base of 8 weeks, it was reported that no intergroup differences were found, suggesting that different genetic probiotics may have different effects on periodontal health.
Several researchers have evaluated the short-term and long-term effects of probiotics as an adjunctive therapy to non-surgical periodontal treatment. For example, in a study by Kuru et al. (2017), 51 periodontally healthy volunteers were first given non-surgical periodontal therapy and after 7 days (baseline) they were randomly divided into two groups to receive placebo or yogurt containing Bifidobacterium animalis subsp. lactis DN-173010 for 28 days followed by a 5-day washout period. PI, GI, BOP, PPD, GCF volume, and the total amount and concentration of IL-1β in GCF were measured on days 0 (baseline), 28, and 33. It has been reported that there