Oral health refers to the health of your mouth, including your teeth, gums, tongue, and the rest of your oral cavity. Good oral health is not only crucial for maintaining a bright smile but also plays a significant role in supporting overall health and quality of life. Oral diseases are very common worldwide, affecting about half of the population at some point in their lives, according to the World Health Organization. However, there's promising research showing that probiotics, which help balance the good and bad bacteria in our guts, can also have positive effects on oral health by reducing harmful bacteria in our mouths.
It has been observed that probiotics can adjust the intestinal microbiota, reduce the number of pathogenic bacteria in the human intestine, and can also exert their health-giving effects, especially the anti-pathogenic effect, in the oral cavity. Both, in-vitro studies and in-vivo studies show the advantageous effects of different strains of probiotics against oral pathogens and mention the effect of probiotics in the prevention or cure of periodontal diseases and tooth decay. This is because probiotics produce substances like bacteriocins, organic acids, fatty acids, and hydrogen peroxide, which have antimicrobial properties that fight off harmful bacteria. In simpler terms, probiotics can help keep our mouths healthy by fighting the bad bacteria that cause oral problems like cavities and gum diseases. They do this by producing substances that kill these harmful bacteria.
What Are Probiotics?
The World Health Organization defines probiotics as “living microorganisms which when administered in adequate amounts confer a health benefit on the host”. These "good" bacteria are naturally present in the body, particularly in the digestive system, where they help maintain a healthy balance of microflora. Probiotics are commonly found in fermented foods like curd, buttermilk, idli, dosa batter, dhokla, and kanji as well as in dietary supplements.Various probiotics are present. However, the seven main microbial organisms used in probiotic-based products are Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Escherichia, and Bacillus. The most commonly used probiotic bacterial strains are Lactobacillus and Bifidobacterium which are regarded as a part of the normal human microbiota. Probiotics are often taken as dietary supplements to help improve our health, especially in our digestive system. They promote well-being in the intestinal microbiome by keeping out harmful germs, helping the immune system, and producing neurotransmitters.
The Oral Microbiome: Understanding the Balance
Our mouth is home to billions of bacteria, some of which are beneficial and some of which are harmful. These bacteria form a complex ecosystem called the oral microbiome, which plays a crucial role in your oral health and overall well-being. There are four main locales of microbial colonization in the body: the oral, intestines, skin, and vagina. Among all, the oral cavity is one of the largest microbial sites where the microbiome is stored on the teeth, tongue, soft and hard palates, gingival sulcus, and tonsils, and is an important factor in health and diseases related to the oral and teeth. The mouth is home to a diverse community of bacteria, fungi, and other microorganisms, collectively known as the oral microbiome. When the oral homeostasis is disturbed, and the dominance of good bacteria is lost, the conditions for dysbiosis and the growth of a diverse population of pathogenic bacteria increase. Factors such as poor diet, inadequate oral hygiene, stress, and certain medications can disrupt this delicate balance, leading to dental problems such as cavities, gum disease, and bad breath. Studies show that probiotics have a role in maintaining oral health through interaction with the oral microbiome, thus contributing to healthy microbial equilibrium. Probiotics can outcompete pathogenic bacteria and increase the proportion of beneficial bacteria in the mouth.Probiotics and Oral Health
Potential mechanisms of action of probiotics in oral health and disease:- Direct interaction with pathogens to prevent pathogen colonization
- Antagonistic activity on pathogens cytotoxic metabolites, oral biofilm, and extracellular matrix
- Synthesis of antibacterial agents (e.g., bacteriocins)
Research suggests that certain strains of probiotics can positively influence the oral microbiome and contribute to improved oral health in several ways such as:
• Preventing Cavities: Dental caries, commonly known as cavities or tooth decay, are defined as a localized chemical dissolution of tooth surface resulting from metabolic events in a biofilm (dental plaque) covering the affected area. The damage is associated with the dental hard tissue which progresses to inflammation and death of the vital pulp tissue. This can lead to problems like toothaches, sensitivity, and discoloration. Streptococcus mutans is the main bacterium that causes cavities. However, certain good bacteria, like Lactobacillus reuteri and Lactobacillus casei, can fight against Streptococcus mutans and help prevent cavities. Some studies found that drinking milk with specific probiotics like rhamnosous GG and L. reuteri can lower the risk of cavities caused by Streptococcus mutans and even stop cavities from forming in the first place. For instance, one study discovered that when preschool children drank milk with L. rhamnosus SP1 (107 CFU/mL) for ten months, the number of children with cavities decreased from 65.8% to 54.4%. This shows that probiotics can help keep teeth healthy and prevent cavities, especially in young children.
• Reducing Plaque: Dental plaque is recognized as the single most important cause of dental caries. It is a result of several microorganisms involved in a wide range of physical, metabolic, and molecular interactions. The plaque provides the pathogenic micro-organisms with a favourable niche for growth and protection from antimicrobial agents. If not cleaned regularly, plaque can cause damage leading to gum problems, tooth decay, and even tooth loss. A dietary study conducted on 942 adults showed a direct relationship between periodontal health and the consumption of lactic acid foods such as yogurt. Another study, lasting 42 days and involving 30 people, showed that a type of probiotic called Lactobacillus reuteri could reduce plaque, and inflammation, and fight off harmful bacteria in the mouth.
• Preventing Periodontal disease: Periodontal disease is a common problem in oral health that involves inflammation and infection of both the soft and hard tissues in the mouth. It usually starts with the buildup of plaque, a sticky film of bacteria, on the surfaces of teeth close to the gums. Symptoms of periodontal disease can include bleeding gums, changes in gum color, swelling, pain, and in severe cases, loose teeth. Probiotics help prevent plaque buildup by changing the pH level of saliva and producing substances that stop the formation of harmful substances in plaque. Some types of bacteria called Lactobacillus, found in probiotics, can also limit the growth of bacteria that cause periodontal disease. Research that combines the results of many studies, known as a meta-analysis, supports the idea that taking probiotics can be beneficial in managing periodontal disease.
• Managing Gingivitis: Gingivitis is caused by to accumulation of bacterial plaque and tartar leading to the inflammation of the gingiva or gums. The most common causative organism is Porphyromonas gingivalis, which colonizes gingival sites and causes tissue damage by invading gingival epithelial cells leading to the progression of chronic inflammatory diseases. GI (Gingival Index) and BOP (Bleeding on probing) are the markers of inflammation and represent parameters of gingivitis. Studies indicate that the probiotic strains help in managing gingivitis by stabilizing the flora of the oral cavity. Acidogenic probiotic bacteria such as Lactobacilli, Streptococci, and Bifidobacterium release antimicrobial substances that show inhibitory effects against pathogens through coaggregation, production of toxic byproducts, and competing for substrates.
• Combatting Bad Breath: Bad breath, or halitosis, can result from the proliferation of odor-causing bacteria in the mouth. Probiotics can help restore bacterial balance, reducing the prevalence of malodorous compounds and freshening breath. In children, after gargling the rinsing solution containing Weissella cibaria, a significant decrease in H2S (48.2%) and CH3SH (59.4%) levels is seen. Also, chewing gum with probiotics helps cut down levels of non-sulphur odour-producing bacteria.
• Supporting Oral Wound Healing: Probiotics may aid in the healing of oral wounds, such as those resulting from tooth extraction or oral surgery, by promoting tissue regeneration and reducing the risk of infection.
How to integrate probiotics into oral care routine?
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Probiotic-Rich Foods: Incorporate probiotic-rich foods like curd, buttermilk, lassi, fermented rice foods such as idli, dosa, kefir, fermented vegetables, pickles, chutney into your diet.
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Probiotic Supplements: Consider taking oral probiotic supplements containing specific strains beneficial for oral health.
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Probiotic Toothpaste and Mouthwash: Some oral care products contain probiotics that help restore microbial balance in the mouth.
As we continue to uncover the intricate world of the human microbiome, the role of probiotics in oral care becomes increasingly evident. From combating harmful bacteria to supporting immune function and maintaining a balanced oral microbiome, these microscopic superheroes have the potential to revolutionize the way we approach oral health. As research in this field advances, incorporating probiotics into our oral care routine may well become a key strategy for promoting a healthy and radiant smile.
References:
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Haukioja A. Probiotics and oral health. Eur J Dent. 2010 Jul;4(3):348-55
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Homayouni Rad A, Pourjafar H and Mirzakhani E (2023) A comprehensive review of the application of probiotics and postbiotics in oral health. Front. Infect. Microbiol.13:1120995.
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Mahasneh SA, Mahasneh AM. Probiotics: A Promising Role in Dental Health. Dent J (Basel). 2017 Sep 27;5(4):26.
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Mohd Fuad, A.S., Amran, N.A., Nasruddin, N.S. et al.The Mechanisms of Probiotics, Prebiotics, Synbiotics, and Postbiotics in Oral Cancer Management. Probiotics & Antimicro. Prot. 15, 1298–1311 (2023).
