HTMEA0114

hygiene tribune Dental Tribune Middle East & Africa Edition | November-December 20142B Oral Probiotics – Overview < Page 1B > Page 4B By Dr. JJ Smith, John Nosti, Shirley Gutkowski O ral probiotics are live bacteria that are similar (or identical) to the ben- eficial microorganisms found naturally in the oral cavity. The addition of oral probiotics to an oral care regimen can restore the natural balance of beneficial bacteria, which can be depleted by diet, stress, medication, ill- ness or other factors. Oral pro- biotics support tooth and gum health, whiten teeth and freshen breath. How on earth did the words “brush” and “floss” come to de- fine our entire profession? Did we spend almost 3,000 grueling hours learning only how to teach people to brush ‘n’ floss? I don’t think so. What we learned is how to bring the mouth to health. What we learned is more accurately achieved today by health promoting products such as oral probiotics, making die- tary changes, and neurogenesis. The brain is plastic in that it’s moldable and new pathways can be built, which is a process called neurogenesis. Providing the brain opportunities for neu- rogenesis is important to brain health. It turns out that playing Sudoku doesn’t stimulate brain fitness; it helps a person become really good at Sudoku. It is kind of like telling patients to brush ‘n’ floss the same way over and over -- you become really great at explaining the mechanical re- moval of plaque. To start your own neurogenesis mission, stop the brush ‘n’ floss default story. Focus on the term biofilm management instead. Learn about and then talk to your patients about biofilm. Then talk about how oral pro- biotics can reduce oral biofilm, particularly in the secret spots where a brush and floss cannot reach. All probiotics work in the digestive system, but only a few can function in the first six inch- es of the mouth. Oral probiotics are a little differ- ent than their counterparts. Pro- biotics for the gut must make it past the hostile environment of the stomach. For example, yo- gurt is teeming with excessive numbers of live bacteria. This is so an appropriate number of live bacteria can make it to the intestines where they can do their work. Probiotic tablets are specially coated to help them stay together until they get to the right part of the digestive sys- tem, where the friendly bacte- ria are released. Oral probiotics must be activated in the mouth. Most people immediately think that the tablets or capsules are teeming with motile bacteria. Not so. The bacteria are freeze- shown to be significantly higher when manual brushes are used. What’s the bottom line? Oscillating-rotating power toothbrushes were not shown to have a greater safety risk when compared head-to-head with manual brushes. The review au- thors concluded that, “This sys- tematic review of a large body of published research in the pre- ceding two decades consistent- ly showed oscillating-rotating toothbrushes to be safe when compared with manual brushes, and collectively indicated that they do not pose a clinically rel- evant concern to either hard or soft tissues.” References 1. Power brush sales whirring as prices drop. Chain Drug Review. Available at: http://findarticles. com/p/articles/mi_hb3007/ is_3_31/ai_n31357545/. Ac- cessed 15 April 2011. 2. “Toothbrush effect” helps Brits smile through the reces- sion. PR Newswire Europe Ltd. Available at: http://www. prnewswire.co.uk/cgi/news/ release?id=257225 Accessed 15 April 2011. 3. Warren PR, Landmann H, Chater BV. Electric toothbrush use. Attitudes and experi- ence among dental practition- ers in Germany. Am J Dent 1998:Sep;11(Spec No):S3-6. 4. Warren PR, Ray TS, Cugini M, Chater BV. A practice-based study of a power toothbrush: as- sessment of effectiveness and acceptance. J Am Dent Assoc 2000;Mar;131(3):389-94. 5. Van der Weijden GA, Tim- merman MF, Danser MM, van der Velden U. The role of elec- tric toothbrushes – advantages and limitations of electric tooth- brushes. In: Lang NP, Attström R, Löe H, eds, Proceedings Euro- pean Workshop on Mechanical Plaque Control, Berlin: Quintes- sence Publishing; 1998a.: pgs. 138-155. 6. Sicilia A, Arregui I, Gallego M, etal.Asystematicreviewofpow- ered vs manual toothbrushes in periodontal cause-related ther- apy. J Clin Periodontol 2002;29 Suppl 3:39-54; discussion 90-1. Shelley L. Campbell, RDH, MPH, of Teneriffe Research Associates, has worked in the oral health clinic research field for over 20 years. She writes from her home in Lee’s Summit, Mo., and occa- sionally does medical writing for Procter & Gamble. About the Author Systematic analysis in a nut- shell •Whatisit?Asystematicreview asks a research question(s), and then scours the literature to identify all relevant, well-con- ducted research that speaks to the question. The resulting data are combined when possible, and analyzed (statistically and/ or with a qualitative method) to give a summary conclusion. • Why do it? While well-con- trolled, individual clinical stud- ies give important insight, syn- thesizing the combined results of multiple, high-quality investi- gations will deliver the most de- finitive answer to the question. • How rigorous is it? If done correctly, it is very rigorous. All procedures are explicit and pre- determined so that the process can be replicated. The literature search is exhaustive. Multiple, independent data screeners/an- alysts are used to prevent bias. • What is a meta-analysis? When different studies with similar designs have common clinical measures, the data (re- sults) can sometimes be com- bined and statistically analyzed for a more powerful estimate of the effect. • Why aren’t more systematic reviews done? These reviews can be quite time-intensive, re- quiring dedicated manpower to design and execute searches of the literature and appraise the results. • What does it mean to me? If you’ve read a well-conducted systematic review, then you can feel confident you’re up to speed on the bottom line of the highest quality research currently avail- able, and your patient product recommendations can be evi- dence-based. 7. Robinson P, Deacon SA, Deery C, et al. Manual versus pow- ered toothbrushing for oral health. Cochrane Database of Systematic Reviews 2005, Is- sue 2. Art. No.: CD002281. DOI: 10.1002/14651858.CD002281. pub2. 8. Walters PA, Cugini M, Bies- brock AR, Warren PR. A nov- el oscillatingrotating power toothbrush with SmartGuide: designed for enhanced perfor- mance and compliance. J Con- temp Dent Pract 2007;8:1-9. 9. Stålnacke K, Söderfeldt B, Sjö- din B. Compliance in use of elec- tric toothbrushes. Acta Odontol Scand 1995;53:17-19. 10. Van der Weijden FA, Tim- merman MF, Piscaer M, et al. A comparison of the efficacy of a novel electric toothbrush and a manual toothbrush in the treat- ment of gingivitis. Am J Dent 1998;11(Spec No):S23-28. 11. Hellstadius K, Asman B, Gustafsson A. Improved main- tenance of plaque control by electrical toothbrushing in periodontitis patients with low compliance. J Clin Periodontol 1993;20:235-237. 12. Heasman PA, McCracken GI. Clinical evidence for the ef- ficacy and safety of powered toothbrushes. Adv Dent Res 2002;16:9-15. 13. Addy M, Hunter ML. Can tooth brushing damage your health? Effects on oral and den- tal tissues. Int Dent J 2003;53 Suppl 3:177-86. 14. Rajapakse PS, McCracken GI, Gwynnett E, et al. Does tooth brushing influence the develop- ment and progression of nonin- flammatory gingival recession? A systematic review. J Clin Peri- odontol 2007;34:1046-1061. 15. Slim L. Power brushing and recession. RDH. Avail- able at: http://www.rdhmag. com/index/display/articledis- play/2574033117/articles/rdh/ volume-30/issue-6/columns/ poweredbrushing_and.html) Accessed 15 April 2011. 16. Van der Weijden FA, Camp- bell SL, Dörfer CE, et al. Safety of oscillating-rotating pow- ered brushes compared to manual toothbrushes: a sys- tematic review. J Periodontol 2011;82(1):5.24. Epub 2010 Sep 10. Originally published in RDH Magazine, January 2012. Reprinted with permission from PennWell. dried so that they can reanimate under moist conditions. When using products contain- ing freezed dried oral probiotics in the mouth, saliva causes their activation with the release of live, active bacteria that attaches themselves both on the surface of the teeth and deep beneath the gum line. These colonies be- come a basecamp of beneficial bacteria to support oral health. With daily replenishment, these probiotic bacteria re-establish the natural microbial balance in the mouth and create whiter teeth, fresher breath and health- ier teeth and gums. In the oral cavity, harmful bac- teria convert sugar and carbo- hydrates into lactic acid. Lactic acid is the bacterial byproduct which is responsible for dental caries and the erosion of tooth enamel. Without requiring life- style changes, the addition of oral probiotics can positively affect the long-term health and wellness of the mouth and the other health systems dependent on oral health. Some oral probiotic strains are beneficial in promoting healthy teeth due to their lactic-acid de- ficiency. A byproduct of other probiotic strains are natural low doses of hydrogen peroxide, which safely supports healthy gums, fresher breath and whiter teeth. Use of oral probiotics Caries The ecological plaque hypoth- esis states that caries and peri- odontitis, the 2 most common bi- ofilm- associated diseases in the world, originate from a distur- bance in the balance and diver- sity in the biofilm. Contributing causes may be inadequate oral hygiene, incorrect diet, stress and/or other factors which de- termine the micro-ecology. Car- ies is caused by the presence of acidogenic and aciduric bacteria (mainly mutans streptococci) metabolizing dietary sugars to create a low local pH environ- ment which can de-mineralize enamel. Oral probiotics are able to naturally alter the oral ph lev- els. Oral probiotics and gut probiot- ics share a common health goal. To achieve that goal they use health-promoting bacteria to crowd out the disease-promot- ing bacteria. That’s how the oral probiotics, such as ProBiora3 and Blis K12/M18 work. The ProBiora3 complex is a grouping of early biofilm colonizers that build a much smaller biofilm because they are not aciduric (don’t make acid). Pathogenic biofilm has a couple of requisites, and one is a low pH. So a biofilm with early colo- nizers that doesn’t make acid has a harder time harboring the bacteria that we associate with dental disease. Harnessing this pH characteristic of biofilm goes right up into the face of tradi- tional methods -- brush ‘n’ floss. Adjusting the pH allows your pa- tients a way to manage their bio- film without having the dexterity and laser-focused education of a dental hygienist. This pH alteration is energized by one particular friendly bac- teria in the ProBiora3 fam- ily. Streptococcus oralis KJ3 and Streptococcus uberis KJ2 give off hydrogen peroxide. Take a shade guide picture before start- ing your patients on these probi- otics and see if you notice a dif- ference. Are the teeth lighter? In the early days of caries bacte- rial studies, it was learned that when Streptococcus mutans were fed sucrose, they would excrete massive amounts of the sticky goo called glycomatrix or mucopolysaccharide. This goo of the biofilm protects the popu- lation in order to survive unmo- lested by such things as antibi- otics, toothbrushes, and floss. Supplying the mouth with the ProBiora3 complex populates the niche previously inhabited by Streptococcus mutans faster than Strep. mutans can.

HTMEA0114

Pages Overview