ANTIBIOTIC RESISTANCE AND RECOLONIZATION BY Need for new treatment PATHOGENIC BACTERIA paradigm
Probiotics = „pro‟(for) and „bios‟( life) term coined by Lilley and Stillwell(1965) Concept of probiotics by Elie Metchnikoff in his book “prolongation of life”(1907) proposed a diet containing milk fermented by lactobacilli, which produce large amounts of lactic acid that could increase the life span of humans.
Probiotic Currently adopted definition By FAO /WHO Live microorganisms which when administered in adequate amounts confer a health benefit on the host
PrebioticA non-digestible food ingredient that confers benefits on thehost by selectively stimulating the growth and/or activity ofone bacterium or a group of bacteria in the colon, and thusimprove the host health
SynbioticThe term synbiotic is used when a product contains bothprobiotics and prebiotics. Because the word alludes tosynergism, this term should be reserved for products in whichthe prebiotic compound selectively favors the probioticcompound
ANTIBIOTICS VS PROBIOTICS Antibiotics Probiotics Favours good bacteriaPathogenic bacteria Good bacteria Pathogenic Bacteria
Lactobacillus species. L acidophilus L. casei L. crispatus L. delbrueckii subsp. L. fermentum L. Gasseri L. johnsonii L. paracasei L. plantarum L. reuteri L. rhamnosus
Bifidobacterium species B. bifidum B. breve B. Infantis B. longum B. lactis B. adolescentis
Others Lactococcus lactis subsp. Cremoris Enterococcus faecalum Streptococcus salivarius subsp.thermophilus S. diacetylactis S. Intermedius Yeasts and moulds (Saccharomyces boulardii,Aspergillus niger)
Lactobacillus: enhance innate and acquired immunity inhibition of pro-inflammatory mediators production of enzymes to digest and metabolize proteins and carbohydrates. synthesis of vit. B and vit.K and facilitates breakdown of bile salts.
Bifidobacterium metabolization of lactose, generate lactic ions from lactic acid and synthesize vitamins. ferment indigestible carbohydrates and produce beneficial short chain fatty acids.
Streptococcus thermophilus and Lactobacillus bulgaricus metabolize lactose, improve lactose tolerance and antimicrobial activity
Saccharomyces boulardii: secrete proteases and other substances that breakdown bacterial enterotoxins and inhibits their binding to intestinal receptors. They also help in immune function enhancement.
1. Direct interaction2. Competitive exclusion3. Modulation of host immune response
Direct interaction: Probiotics interact directly with the disease-causing microbes, making it harder for them to cause the disease. Production of antimicrobial substances against periodonto pathogens
Competitive exclusion: Beneficial microbes directly compete with the disease developing microbes for nutrition or enterocyte adhesion sites.
Modulation of host immune response: Probiotics interact with and strengthen the immune system and help prevent disease. Modulation of host defenses including the innate as well as the acquired immune system
Modulate host immunity both systemically and locally Stimulate dendritic cells (antigen presenting cells) Expression of Th1 and Th2 Modulate pathogen induced inflammation through „toll like receptors‟ on dendritic cells. Th1 response: Phagocytose intracellular pathogens Th2 response: Extracellular pathogens
Glycoprotein-carbohydrate cell surface interaction mediate by interspecies interactions Apoptosis is yet another proposed mechanism. Probiotics stimulate apoptosis of tumor cells
Production of • Organic acidsantimicrobial • Hydrogen peroxide substances • Bacteriocins • Compete with pathogens for adhesion sitesBinding in Oral • Involvement in metabolism of Cavity substrates (competing with oral micro organisms for substrates available) • Stimulate non specific immunity Co-Immuno modulatory • Modulate humoral and cellular immune response
Produce antioxidants- neutralize free electrons that are needed for mineral formation. Break down putrescense odours by fixating the toxic gases ( volatile sulphur compounds) and change them into gases needed for metabolism
High cell viability, resistant to low pH and acids Ability to persist Adhesion to cancel the flushing agent Able to interact or to send signals to immune cells Should be of human origin Should be non pathogenic Resistance to processing Influence local metabolic activity
Plaque modification, altering anaerobic organisms colonization,altering pocket depth, improving clinical attatchment. The application of selected beneficial bacteria, as an adjunct to scaling and root planing, would also inhibit the periodonto- pathogen recolonization of periodontal pockets and thus achieve and maintain periodontal health. Probiotics can mimic response similar to a pathogen but without periodontal destruction
Protect epithelium barrier by maintaining tight junction protein expression Lactobacillus paracasei and Lactobacillus rhamnosus had a high capacity to antagonize important oral pathogens, including Streptococcus mutans and Porphyromonas gingivalis. Weissella cibaria, a gram positive facultative anaerobic lactic acid bacterium that has been isolated from humans, is present in fermented foods and is considered a potential probiotic agent. -.
W. cibaria secretes a significant quantity of hydrogen peroxide as well as bacteriocin that acts against gram positive bacteria. This bacterial species has the capacity to coaggregate with Fusobacterium nucleatum and to adhere to epithelial cells. These properties could enable W. cibaria to effectively colonize the oral cavity and limit the proliferation of pathogenic bacteria
The antiplaque activity of the Probiotic mouth rinse:. reduces the adhesion of bacteria to the tooth surface inhibits the growth and proliferation of microorganisms on the tooth surface inhibits the formation of the intercellular plaque matrix, modifies plaque biochemistry to reduce the formation of cytotoxic product modifies plaque ecology to a less pathogenic flora.
A decrease in gingival bleeding and reduced gingivitis has been observed by Krasse et al with the application of L. reuteri Inhibits the growth of P. gingivalis and Prevotella intermedia.
Probiotics are provided into the food items in one of four basic ways:(i) as a culture concentrate added to beverages.(e.g. fruit juice)(ii) inoculated into pre-biotic fibres which promote the growth of probiotic bacteria(iii) inoculated into milk and milk-based foods (e.g. milk drinks, yoghurt, cheese, kefir, bio-drinks)
As lyophilized, dried cells packaged as dietary supplements (tablets, chewing gums, straws). The archetypical probiotic food is yoghurt and daily consumption of dairy products seems to be the most natural way to ingest probiotic bacteria
Probiotic MintsChewing gums
Sepsis Lactobacillus species are a rare but well-recognized cause of endocarditis in adults (and other forms of sepsis in children) in the absence of probiotic supplementation. Several reports have directly linked cases of Lactobacillus and other bacterial sepsis to the ingestion of probiotic supplements.Deleterious metabolic activitiesImmune deviation or excessive immune stimulation
Major risk factors1) Immune compromise, including a debilitated state or malignancy2) Premature infantsMinor risk factors1) CVC2) Impaired intestinal epithelial barrier, eg, diarrheal illness, intestinal inflammation3) Administration of probiotic by jejunostomy4)Probiotics with properties of high mucosal adhesion or knownpathogenicity5) Cardiac valvular disease (Lactobacillus probiotics only)
Probiotics represent an upcoming field of research, the examination of the close relationships between oral health and our daily diet. It is a natural way of maintaining health and protecting oral tissues from disease, and datas suggest that the potential benefits increase with an early childhood start.
It still remains to be seen, the extent to which probiotics are applicable to promoting oral health. Although the results of past studies are encouraging, still much needs to be done for identification of the probiotics that are best suited to oral use, as well as the most appropriate vehicles for its delivery. The application of probiotic strategies may, in near future provide an end to many infections occurring in oral cavity.
Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria (October 2001) Retrieved 2009-11-04 Jürgen Schrezenmeir and Michael de Vrese Am J Clin Nutr February 2001 vol. 73 no. 2 361S-364S Deepa D,D.S.Mehta Is the role of probiotics friendly in the treatment of periodontal diseases? JISP Vol 13 Issue 1 Jan-Apr 2009 30-31 Anirban Chatterjee,Hirak Bhattacharya,Abhishek Kandwal Probiotics in periodontal health and disease JISP Vol 15 2011 23-24 Gupta G Probiotics and periodontal health Journal of medicine and life Kedar Saraf, MC Shashikanth, Tulasi Priya, Nishat Sultana, Nallan CSK Chaitanya JAPI • august 2010 • VOL. 58 488-492 Robert J Boyle, Roy M Robins-Browne, and Mimi LK Tang The American Journal of Clinical Nutrition V Shivakumar, S Pavithrapriyadharshoni, V Gopinath n Journal of Multidisciplinary Dentistry, Vol. 1, Issue 6, September-October 2011 316-320
PRESENTED BYAYSHA JABEEN.M.2007-2012 BATCHVIVEKANANDHA DENTAL COLLEGE FOR WO