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1. Anders Henriksson, PhD
Principal Application Specialist
July 10, 2019
A presentation with bite. Improving oral
health in an ageing population

2. A global issue
Mean percent of Community Periodontal Index (CPI)* scores in 35-44 year olds
by global World Health Organisation (WHO) offices
* CPI scores are defined by WHO protocol and is a standardized means of dental disease measurement used to compare reports
Modified from Petersen and Ogawa (2005) J Periodontol 76 (12):2187-2193
2
8 out of 10
people aged
35 years and over
suffer some kind of
gum complaint
Less than 10%
of 35-44 year olds
have healthy gums
100 %
80 %
60 %
40 %
20 %
0 %
CPI 0 - healthy periodontal
conditions
CPI 1 - gingival bleeding
CPI 2 - gingival and calculus
bleeding
CPI 3 - shallow periodontal
pockets (4-5mm)
CPI 4 - deep periodontal
pockets (≥ 6mm)
Africa Americas Eastern
Mediterranean
Europe South
East Asia
Western
Pacific

3. Gingivitis and Periodontitis
▪ The oral cavity is home to more
than 700 different bacterial
species
▪ Biofilms are formed by bacterial
communities which reside in
saliva-covered soft and hard
tissues
▪ Oral biofilms are associated
with infectious diseases such
as tooth decay (caries) and
periodontal disease
Gingivitis
Gingivitis can cause dusky red, swollen,
tender gums that bleed easily, especially
when you brush your teeth.
Healthy gums Severe periodontitis
(more than 6 mm pockets)
- Extensive bone and
tissue loss, teeth can
become loose
Gingivitis
(2-3 mm pockets)
- gums become red
and bleed easily
Moderate
periodontitis
(4-6 mm pockets)
- gum recession, bone
and tissue destruction
Periodontitis
Periodontitis is a severe gum infection
that can lead to tooth loss and other
serious health complications.
3
Untreated, can progress to

4. Increased prevalence of periodontitis in older age
FIGURE. Prevalence of total, mild, moderate, and severe periodontitis among adults aged ≥30 years, by age — National Health and Nutrition Examination Survey, United
States, 2009–2010. This figure is a line graph that presents periodontitis in adults aged ≥30 years by level of severity (i.e., total mild, moderate, and severe). This figure
demonstrates that the prevalence of mild and severe periodontitis remained relatively steady at <15% across all age groups.

5. Link between periodontal disease and
non-communicable diseases
Nazir (2017) International Journal of Health Sciences

6. Probiotic Oral Therapy
Studies
6

7. Probiotic oral therapy studies
Pre-clinical trials and important reviews in vitro and in animals
Evaluation – lactobacilli and/or bifidobacteria Authors / References
Oral adhesion and survival of probiotic and other lactobacilli and bifidobacteria in vitro Haukioja et al., Oral Microbiol Immunol. 2006
Do probiotics offer opportunities to manipulate the periodontal oral microbiota? Tueghels et al., J Clin Periodontol. 2011
Bifidobacteria inhibit the growth of Porphyromonas gingivalis but not of Streptococcus mutans
in an in vitro biofilm model
Jäsberg et al., Eur J Oral Sci. 2016
Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of
chronic periodontitis: a systematic review and meta-analysis.
Martin-Cabezas et al., J Clin Periodontol. 2016
Evaluation – Bifidobacterium lactis HN019™ Authors / References
Benefits of Bifidobacterium animalis subsp. lactis Probiotic in Experimental Periodontitis. Oliveira et al., J Periodontol. 2017
Effects of the probiotic Bifidobacterium animalis subsp. lactis on the non-surgical treatment of
periodontitis. A histomorphometric, microtomographic and immunohistochemical study in rats.
Ricoldi et al., PloS one 2017.
Effects of the probiotic Bifidobacterium animalis subsp. lactis on experimental periodontitis in
diabetic rats
Messora and Furlaneto, Conference
presentation at Vitafoods Europe, Geneva, 2017
7

8. Benefits of
B. lactis HN019™ in
experimental periodontitis
8

9. Benefits of B. lactis HN019™ in experimental periodontitis
Aim of the study
To evaluate microbiologic, histomorphometric, and
immunologic outcomes following topical administration of
B. lactis HN019™ in rats with ligature induced experimental
periodontitis in mandibular first molar (MFMs).
Study design
32 rats, divided to four groups of 8:
• control
• HN019™
• experimental periodontitis
• experimental periodontitis + HN019™
In probiotic groups each MFM were topically swabbed with 1
ml of 1.9 x 109 CFU B. lactis HN019™ on days 0, 3, and 7.
Oliveira et al., J Periodontol. 2017
9

10. Effects of B. lactis HN019™ on non-surgical treatment of
periodontitis
Aim of the study
To evaluate the effect of B. lactis HN019™ together
with scaling and root planing (SRP) on ligature
induced experimental periodontitis.
Study design
32 rats, divided to four groups of 8:
• control,
• HN019™
• experimental periodontitis + SRP
• experimental periodontitis + SPR + HN019™
Probiotic groups received B. lactis HN019™ orally
in milk 109 CFU/10 ml for 15 days.
Ricoldi et al., PloS one 2017.
10

11. Human clinical trial
Effects of probiotic therapy in the
treatment of periodontitis: a study
of clinical, microbiological and
immunological profiles of the
host response
Invernici et al. (2018) J Clin Periodontol. 45(10):1198-1210.
Aim
To evaluate the effects of the probiotic
therapy using Bifidobacterium lactis
HN019™ as an adjunct to non-surgical
periodontal treatment in patients diagnosed
with Generalized Chronic Periodontitis.
11

12. Human clinical trial – study design
7 days
Inclusion
30 days
Intervention
60 days
Follow-up
Full mouth
supragingival
scaling
Proper home care
techniques
12
Invernici et al. (2018) J Clin Periodontol. 45(10):1198-1210.
• Scaling and Root Planing (SRP) – Day 0
• Clinical Attachment Loss (CAL)
• Probing Pocking Depth (PPD)
• Gingival Recession (GR)
• Plaque Index (PI)
• Bleeding on Probing (BOP)
• Adverse Event (AE)
• Samples of Gingival Crevicular Fluid (GCF)
• Samples of plaque and saliva
• Clinical Attachment Loss (CAL)
• Probing Pocking Depth (PPD)
• Gingival Recession (GR)
• Plaque Index (PI)
• Bleeding on Probing (BOP)
• Adverse Event (AE)
• Samples of Gingival Crevicular Fluid (GCF)
• Samples of plaque and saliva

13. HN019™ induced positive changes in microbial complexes of
gingival plaque
Overall the test group
containing HN019™ indicates
significant changes in sub-
and supra- gingival plaque for
the following bacteria
compared to the control:
Red complex bacteria:
P. gingivalis and
T. denticola decreased
in probiotic group at 30
and still at 90 days
(associated with periodontal
disease)
Blue complex bacteria:
Actinomyces and
Streptococcus
increased
13
Invernici et al. (2018) J Clin Periodontol. 45(10):1198-1210.

14. Excellent stability
With the blending of different carriers, the probiotic
chewable tablets stability
Opportunity:
Probiotic chewable tablet supply well over minimum cell
count of 1.0E+09 CFU/tablet before shelf life.
1.00E+09
1.00E+10
1.00E+11
ActivityBacteria（CFU/g）
Test time
Stability of probiotics
Delivery formats
Probiotic tablet

15. Delivery formats
Probiotic dry tooth paste

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