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- 1. PROBIOTICS AND ORALHEALTH SHEEJA ROSE MATHEW
- 2. Probiotics in dentistry: A boon or sham Dental research journal 2013: 10:3 Probiotics and oral health Journal of oral research 2011: 3:1 Probiotics and oral health European Journal of Dentistry 2010:4;348-355
- 3. PROBIOTICS • Probiotics aredietary supplements, which when administered in adequte amount is used for the prevention and the treatment of a wide range of diseases. • These products consist of beneficial micro organisms, ‑ which stimulate health promoting flora thus, suppressing the pathologic colonization and disease spread.
- 4. PROBIOTICS • DEFINITION : •Living microorganisms, which, when administered in adequate amounts, confer a health benefit on the host (WHO).
- 5. • Probiotics -also called friendly bacteria/good bacteria . • Probiotics are available in foods and dietary supplements (for eg; capsules, tablets, gel and powders) • Eg of foods products- • yogurt, • fermented & unfermented milk, • some juices and beverages.
- 6. HISTORY • Term probiotics= Pro (for)- Latin ‟ + Bios ( life) - Greek ‟ = for life / to promote life .
- 7. HISTORY • - Conceptof probiotics 1st introduced Metchnikoff in his book “prolongation of life” - proposed LAB in fermented milk promote longevity in human by competing with the micro organisms that are ‑ injurious to health. 1907
- 8. HISTORY • Lilley &Stillwell coined term Probiotics • • Fuller defined- live microbial food suppliment, which beneficially affect the host animal by improving its microbial balance Hull et.al introduce 1st probiotic species into research- Lactobacillus acidophilus - Holcombh et.al – Bifidobacterium bifidum 1965 1989 1984 1991
- 9. PREBIOTICS • Nondigestible foodingredients that selectively stimulate the growth and/or activity of beneficial microorganisms already in human body. • Eg, inulin fructo oligosachharides ‑
- 10. SYNBIOTIC • Product containsboth probiotics + prebiotics PROBIOTICS PREBIOTICS Live microbes Inert chemical Act on gut flora Act as a cofactor for probiotics & selectively favours probiotic compound Eg: lactobacillus Eg: Lactulose
- 11. • Probiotic microorganism – bacteria, yeast ,mould • Most of the probiotic bacteria come from two groups, Lactobacillus Bifidobacterium. Probiotic action is highly strain specific
- 12. • COMPOSITION OFPROBIOTICS • Probiotics can be made of a single bacteria strain or a group of bacterial strain • Lactic acid bacteria –L.acidophilus, L.casei, L.lactis, • L.salivarius, L. plantrum, L. rhamnosus, L.reuteri, L.fermentum, • Streptococcusthermophilus, • Enterococcus faecalis • Bifidobacterium breve,B.bifidum B. longum, • Saccharomyces boulardii
- 13. FEATURES OF PROBIOTICS Nonpathogenic, ‑ Nontoxic, Resistant to gastric acid & bile acid adhere to gut/oral epithelial tissue
- 14. Enhance specific andnon-specific immune response of the host Should persist for short periods in the GI tract influencing metabolic activities such as cholesterol assimilation, lactose activity, and vitamin production
- 16. MODE OF ACTION 1- •Directly interacting with the disease causing microbes • Competitive exclusion- competing with the disease causing microbes • Modulation of host immune response
- 17.
- 18. MECHANISMS OF PROBIOTIC/HOSTINTERACTION • IMMUNOLOGICAL BENEFITS Activate local macrophages to increase antigen presentation to B lymphocytes Increase secretory lgA production both locally and systemically Modulate cytokine profiles Induce hyporesponsiveness to food antigens
- 19. • NONIMMUNOLOGIC BENEFITS Digestionof food and compete with pathogens for nutrients Alter local pH to create an unfavourable environment for pathogens Produce bacteriocins to inhibit pathogens Produce superoxide radicals Stimulate epithelial mucin production Enhance intestinal barrier function Compete with pathogen for adhesion Modify pathogen derived toxins
- 21. . Probiotic products Culture concentrate added to beverages/f ood /fruit juices Inoculated into prebiotic fibers Concentrat ed& dried cells packed as dietry supplement s,powders, capsule, gelatin Inoculated into milk based food- yogurt, cheese , milk
- 22. INDICATIONS Sanders etal Saraf et al • PROVEN INDICATIONS Rotavirus diarrhea Reduction of antibiotic associated side effects. ‑
- 23. POSSIBLE INDICATIONS Food allergies andlactose intolerance Actopic eczema GIT/ respiratory/Ur ogenital infections Irritable bowel syndrome Inflammatory bowel syndrome Traveller’s diarrhea H. pylori infection Various cancers Improving immune response
- 24. PROBIOTICS AND ORALCAVITY • RETENTION OF PROBIOTIC IN ORAL CAVITY • Doesnot exhibit permanent colonization in oral cavity – should be used in regular basis • Horz et.al - after probiotic withdrawal from 8th day onwards- decrease in S.salivaris K12 level in saliva
- 25. Haukio et.al –bindingstrenght of 17 strains of Lactobacillus & 7 strains of bifidobacteria to saliva & oral mucous membrane are different for different strain
- 26. PROBIOTICS AND DENTALCARIES • Probiotics with anticaries effect – adhere to the enamel surface and prevent the proliferation of cariogenic bacteria. • Probiotic incorporated into dietary products like cheese – neutralize the acidic condition & promote remineralization
- 27. • Regular intakeof probitic containing cheese, yogurt or milk – decrease cariogenic streptococci in saliva and dental plaque • Nasse et.al- long term consumption of probiotic bacterium Lactobacillus rhamnosus GG in milk - decreases S.mutans level & decreases caries risk
- 28. • Probiotics &molecular genetics to replace and displace cariogenic bacteria with non cariogenic ‑ bacteria . • Various approaches for prevention of dental caries include • 1. Utilizing bacteria that expressed bacteriocins or bacteriocin like inhibitory substances to specifically ‑ prevent the growth of cariogenic bacteria. • 2. Use probiotic bacteria which have ability to colonize teeth and influence the supra gingival plaque ‑
- 29. • 3. Usingprobiotic strains which have suitable antagonistic activity against relevant oral bacteria. • 4. Using recombinant strain of S. mutans expressing urease, which reduce the cariogenicity of plaque.
- 30. • 5.Using geneticallymodified probiotics -“designer probiotics” • Eg: a recombinant strain of Lactobacillus that expressed antibodies targeting one of the major adhesins of S. mutans (antigenI/II) was able to reduce both the viable counts of S. mutans and the caries score
- 31. PROBIOTICS AND HALITOSIS •Oral malodor – multifactorial etiology in most cases – origin is from oral cavity. • Occurs due to production of volatile sulphur gases by anaerobic bacteria on food & salivary protein. • Probiotics are able to breakdown putrescence odors by fixing the toxic gases (volatile sulfur compounds) and changing them to gases needed for metabolism.
- 32. • Bacterial specieshighly beneficial in Rx oral malodor S. salivarium Weissella cibaria
- 33. • Gargling withsolution containing W.cibaria result in reduction of H2S & methanethiol produced by fusobacterium nucleatum. • Use of lozenges / chewing gum with S.salivarius K12 ↓volatile sulphur compounds • by producing bacteriocins & inhibit proliferation of bacteria causing halitosis
- 34. Kang, et al.- significant reduction of volatile sulfur compounds after gargling twice daily with 15 ml Weissella cibaria for 2 min. Burton, et al. - significant reductions in volatile sulfur compounds by using probiotic Streptococcus
- 35. PROBIOTICS AND PERIODONTALDISEASE • Treatment of periodontal diseases in recent years has moved towards an antibiotic / anti microbial model of ‑ disease management. • Probiotics decrease the pH of the oral cavity so that plaque bacteria cannot form dental plaque and calculus that causes the periodontal disease.
- 36. Probiotic lactobaclli –inhibit the growth of peridontal pathogen Porphyromonas gingivalis Prevotella intermedia Actinbacillus actinomycetumcomitan s
- 37. • Krasse et.al– ingestion of chewing gum incorporated with probiotic lactobacilli reuteri • ↓ gum bleeding • ↓ gingival inflamation • ↓ plaque index scores
- 38. • Probiotic effectof L.reuteri • - secretion of bacteriocins • - competetive inhibition of pathogenic bacteria • Inhibit production of proinflammatory cytokines
- 39. • Riccia et.al–Regular use of lozenges containing L.brevis reduce periodontitis mainly by their anti- inflammatory effect
- 40. • Probiotic speciesproduce antioxidants. • Antioxidants prevent plaque formation by neutralizing the free electrons that are needed for the mineral formation.
- 41. • Subgingival applicationof a bacterial mixture including S.sanguis, S.salivarius, and S.mitis after scaling and root planning significantly suppressed the re colonization of ‑ Porphyromona gingivalis and P. intermedia • This guided pocket re colonization approach may ‑ provide a valuable alternative to treatment options for periodontitis.
- 42. PROBIOTICS AND ORALCANDIDASIS • Candida species are normal commensal oral flora but can cause a clinically apparent lesion if the immune defenses are damaged either on the local or systemic level • Consumption of cheese containing the probiotic L. rhammnosus GG exhibited reduction in oral Candida thus confer protective effect against oral candidiasis. • Other strains of lactobacilli do not show any effect on oral Candida.
- 43. • Probiotics andvoice prosthesis • probiotics strongly reduce the occurrence of pathogenic bacteria in voice prosthetic biofilms. • consumption of buttermilk, which contains • L.cremoris, L. lactis spp. can produce antimycotics and other substances,prolongs the lifetime of indwelling voice prostheses
- 44. SIDE EFFECTS ANDRISKS • If occur- mild and digestive (such as gas or bloating). • May cause infections in immunocompromised pt that need to be treated with antibiotics • May cause unhealthy metabolic activities, too much stimulation of the immune system, or gene transfer
- 45. PRECAUTIONS AND CONTRAINDICATIONS •Since probiotics contain live micro organisms, there ‑ is a slight chance that these preparations might cause pathological infection, particularly in critically ill or severely immunocompromised patients. • Probiotic strains of Lactobacillus may cause bacteremia in patients with short bowel syndrome, ‑ due to altered gut integrity.
- 46. Lactobacillus preparations -CI persons hypersensitive to lactose or milk. S. boulardii - CI in pt with a yeast allergy. No CI are for Bifidobacteria - most species are considered nonpathogenic and non toxigenic. ‑
- 47.
- 48. • CONCLUSION • Probioticsare regulated as dietary supplements and are not subjected to the same rigorous standards as medications. • A challenge with these products involves the complexity of quality control with live micro organisms. ‑ • As a result, individuals may obtain a product that is ineffective or that contains varying quantities of bacteria or yeast. • • Probiotic therapy uses bacterial interference and immunomodulation in the control of several infectious, inflammatory, and immunologic conditions.
- 49. CONCLUSION • Dietary probioticsdo not confer a major risk for oral health. • However, the risk of transferring antibiotic resistance from probiotics to virulent micro organisms requires more evaluation. ‑ • In conclusion, probiotics have made their way into oral healthcare and are more likely to be a boon rather than sham.