Dental Tribune United Kingdom Edition

February 25- March 3, 201320 Perio Tribune United Kingdom Edition P robiotics literally means ‘for life’. They are micro- organisms proven to exert health-promoting influences in humans and animals1 .Probiotics are defined by the World Health Organisation as “live microorgan- isms which when administered in adequate amounts confer a health benefit on the host”1 . A recent de- tailed definition of probiotics is “a preparation of or a product con- taining viable, defined microor- ganisms in sufficient numbers to alter the existing micro organisms in the intestine of the host and thereby exert beneficial health ef- fects”2 .These bacteria have to be the natural flora so as to be able to resist acid and bile, to survive dur- ing intestinal transit, to adhere to the intestinal mucosa, and to pro- duce antimicrobial substances in order to retain the characteristics that contribute to their beneficial health effects. Probiotics must have the abil- ity to inhibit gut pathogens, and they have to be stable during manufacture and storage which can influence both viability and functional properties. A number of bacterial strains have been iso- lated. However, all do not have the same efficacy. It is important that the potential probiotic strains are wellselectedpriortouse.Acombi- nation of strains can enhance ad- herence in a synergistic manner. Increase in antibiotic resistant in- fections due to overuse of antibi- otics by physicians has prompted the need to seek safer ways to treat infections. Recent scientific investigation has supported the important role of probiotics as a part of a healthy diet for human as well as for ani- mals and may be an avenue to provide a safe cost effective and natural approach that adds a bar- rier against microbial infection. The use of probiotics in antibiotic resistance is termed as a micro- bial interference therapy3 . This concept of microbial ecological change as a mechanism for pre- venting dental change is an im- portant one since oral infections constitute most common forms of infections in humans. Evidence is now accumulating that probiotics may also play a role in oral ecol- ogy. Researchers believe that the probiotics are beneficial for oral health in prevention and treat- ment of various dental diseases. History: 1In 1907, Elie Metchnikoff, a Nobel prize winning Russian mi- crobiologist, first proposed a hy- pothesis where he suggested that the long, healthy life of Bulgar- ian peasants resulted from their consumption of fermented milk products. He believed that when consumed, the fermenting bacil- lus positively influenced the mi- croflora of the colon, decreasing toxic microbial activities within4 . 2 In the 1950s, a probiotic product was licensed by the Unit- ed States Department of Agricul- ture as a drug for the treatment of scour among pigs5 . 3The term probiotics which is an antonym to the term antibi- otics, was introduced in 1965 by Lilley and Stillwell as ‘Substances produced by microorganisms which promote the growth of oth- er microorganisms’6 . 4 Mann and Spoerig (1974) found that people who drank yo- gurt fermented with strains of La- tobacillus sp. had very low values of blood serum cholesterol. 5The first probiotic species introduced into research were Lactobacillus acidophilus by Hull et al in 1984 and Bifidobacterium bifidum by Holcombh et al in 1991 (Tanboga et al 2003) . 6In 1994, the WHO deemed probiotics to be the next most im- portant immune defence system when commonly prescribed an- tibiotics are rendered useless by antibiotic resistance. (Kailasapa- thy and Chin 2000; Levy 2000). 7Over the last century, vari- ous microorganisms have been used to prevent and cure diseases leading to the coining of the term probiotics.7 Purported mechanisms of ac- tion: (fig 1) Several mechanisms have been suggested to contribute to the ac- tion due to probiotics. Probiotics improve colonisation resistance to gut pathogens by reinforcing the mucosal barrier and restoring normal gut micro ecology after di- arrhea8 . If the intestinal microflora is deficient, antigen transport is increased. Probiotics have been shown to normalise an increased permeability. Binding is consid- eredtobefirststepinpathogenesis, and binding of bacteria to intesti- nal mucosa or mucous may allow the colonisation9 . Probiotics com- pete with pathogens for binding sites and available substrates. The rate of progression from inflam- mation through dysplasia to colon cancer has been seen to be re- duced in experimental animals10 . Researchers have shown that the probiotics have bio-thera- peutic potential for prophylaxis against the candidiasis. The pro- biotic bacteria can protect indi- vidual from candidiasis by immu- nological and non immunological mechanisms11 . Probiotics can activate and modulate the immune system12 . They reinforce the gut defence by immune exclusion, immune elim- ination and immune regulation. Effects of probiotics on oral health: Since the mouth represents the first part of the gastrointestinal tract, there is every reason to be- lieve that at least some probiotic mechanisms may also play a role in that part of the system. Mecha- nisms of probiotics are drawn entirely from GIT studies; their applicability to oral health needs further studies. It may also antici- pate that resident probiotics could exist in the oral microflora. They may function in the complex eco- system of dental plaque and in for- mation and development of oral biofilm in general. Some hypothetical mecha- nisms of action of probiotics in the oral cavity are discussed here. Probiotics may act by direct or in- direct interaction on oral biofilm and microflora and vice versa13 . Direct interactions may in- clude13 1Involvement in binding of oral microorganisms to proteins (biofilm formation). 2Action on plaque formation and on its complex ecosystem by compromising and intervening with bacteria to bacteria attach- ments. 3Involvement in metabolism of substrate (competing with oral microorganisms of substrates available) 4Production of chemicals that inhibit oral bacteria (antimicro- Probiotics: Bactiotherapy for oral health Dr.Rahul Kale, MDS, Dr. Sonal Tambwekar, MDS, Dr. Sumanth, MDS, Dr. A. Sanjay Jain, MDS, Dr. Sharmila Baliga, BDS page 22DTà Role Outcome Strains Reference Plaque control and gingival in ammation Reduction in plaque accumulation and gingivitis. Nisin, bacteriocin extracted from L. lactis Periodontitis in smokers Improvement of plaque index and probing pocket depth from baseline within 8 weeks L. salivarius WB21 In-vivo and in-vitro study showed a de nite inhibitory e ect on produc- tion of VSC W. cibaria Kang et al 2006. Prevents re-establishment of undesirable bacterial populations and thus help limit the recurrence of oral malodor over a prolonged period Streptococcus salivarius Co-aggregated with F. nucleatum thereby forming a barrier that prevents colonization of pathogenic bacteria indicating that probiotics a ect formation of oral bio lms and modify resident micro ora W. cibaria Periodontal dressings with lactoba- cillus species diminishes the number of periodontal pathogens like Bacteroides sp. Actinomyces sp. and C. albicans Resident lactobacilli ora Lactobacillus species Inhibits the growth of P. gingivalis and P. intermedia Rapid decline in C. albicans in mice with a correlation between the highest peak of interleukin-4 and complete eradication of C. albicans L. acidophilus and L. fermentum. Signi cant reduction in the counts of S. mutans after 2 weeks. L. reuterii E ective at eradicating E. faecalis and S. gordonii within root canal. Nisin, bacteriocin extracted from L. lactis K. Noordin and S. Kamin H. Shimauchi et al 2008. Burton JP et al, 2005. Kang et al, 2005. Koll-klais et al 2006. Volozin et al 2004. Elahi et al 2005. Caglar et al 2006. Turner et al 2004. Reduction of malodor Reduction of malodor Attachment, adhesion and oral colonization Periodontal diseases Periodontal diseases Yeast infections Dental caries Root canals 23 22 21 20 19 18 17 16 15 14 s