Effect of Probiotic Containing Ice-cream on Salivary Mutans Streptococci (SMS) Levels in Children of 6-12 Years of Age: A Randomized Controlled Double Blind Study with Six-months Follow Up

Evaluation of probiotics' efficiency on cariogenic bacteria: randomized controlled clinical study

BACKGROUND

Probiotics are live beneficial bacteria to human health and their efficiency on oral health is still being investigated. The purpose of this study was to evaluate the level of Streptococcus mutans and Lactobacillus species with and without the use of probiotics for six-months after the treatment of all dental caries under general anesthesia.

METHODS

Fifty-eight pediatric patients without any systemic diseases, whose dental treatments were completed under general anesthesia (GA), were included in the study. The patients were recruited in two-groups; Group A: Patients started using probiotics after GA and Group B: Patients did not use probiotics after GA. Saliva samples were taken from all patients on the day before GA (T0), at one-month (T1), three-month (T2) and six-month (T3) follow-up after GA. The counts of cariogenic bacteria were determined by the analysis of saliva samples using real-time polymerase chain reaction. Statistical significance level was accepted as p < 0.05.

RESULTS

There was statistically significant difference between Group A and B for T0, T1, T2 and T3 regarding S. mutans (p = 0.001, p = 0.04, p = 0.04, p = 0.03; p < 0.05). However, there was no statistically significant difference between groups regarding Lactobacillus species (p ≥ 0.05).

CONCLUSIONS

Probiotic use and treatment of all caries significantly reduced the level of S. mutans but not Lactobacillus species. Furthermore, S. mutans decreased after cessation of probiotics, but it was not statistically significant.

TRIAL REGISTRATION

Study was registered as "Effects of Probiotics on Streptococcus mutans and Lactobacillus species" with the registration number of NCT05859646 (16/05/2023) at https://www.

CLINICALTRIALS

gov Protocol Registration and Results System.

How probiotics, prebiotics, synbiotics, and postbiotics prevent dental caries: an oral microbiota perspective

Dental caries, a highly prevalent oral disease, impacts a significant portion of the global population. Conventional approaches that indiscriminately eradicate microbes disrupt the natural equilibrium of the oral microbiota. In contrast, biointervention strategies aim to restore this balance by introducing beneficial microorganisms or inhibiting cariogenic ones. Over the past three decades, microbial preparations have garnered considerable attention in dental research for the prevention and treatment of dental caries. However, unlike related pathologies in the gastrointestinal, vaginal, and respiratory tracts, dental caries occurs on hard tissues such as tooth enamel and is closely associated with localized acid overproduction facilitated by cariogenic biofilms. Therefore, it is insufficient to rely solely on previous mechanisms to delineate the role of microbial preparations in the oral cavity. A more comprehensive perspective should involve considering the concepts of cariogenic biofilms. This review elucidates the latest research progress, mechanisms of action, challenges, and future research directions regarding probiotics, prebiotics, synbiotics, and postbiotics for the prevention and treatment of dental caries, taking into account the unique pathogenic mechanisms of dental caries. With an enhanced understanding of oral microbiota, personalized microbial therapy will emerge as a critical future research trend.

A comprehensive review of the application of probiotics and postbiotics in oral health

Oral diseases are among the most common diseases around the world that people usually suffer from during their lifetime. Tooth decay is a multifactorial disease, and the composition of oral microbiota is a critical factor in its development. Also, Streptococcus mutans is considered the most important caries-causing species. It is expected that probiotics, as they adjust the intestinal microbiota and reduce the number of pathogenic bacteria in the human intestine, can exert their health-giving effects, especially the anti-pathogenic effect, in the oral cavity, which is part of the human gastrointestinal tract. Therefore, numerous in vitro and in vivo studies have been conducted on the role of probiotics in the prevention of tooth decay. In this review, while investigating the effect of different strains of probiotics Lactobacillus and Bifidobacteria on oral diseases, including dental caries, candida yeast infections, periodontal diseases, and halitosis, we have also discussed postbiotics as novel non-living biological compounds derived from probiotics.

Role of Probiotics in Human Health

Certain bacteria, known as probiotics, have had a vastly beneficial effect on people's health; considering their benefits they have been mixed with a wide variety of foods for several decades now. The ability of probiotics to modify the immunological response of the host, antagonize pathogenic microbes, or compete for adhesion sites with pathogenic microorganisms is related to the action of probiotics against microorganisms. Infections of the digestive tract, irritable bowel, lactose intolerance, allergies, infections of the urogenital tract, cystic fibrosis, and various cancers can all be prevented and treated with the use of probiotics. They can reduce the side effects of various antibodies. In the field of oral health, dental caries, periodontal disease, and bad breath can be prevented and treated with the use of probiotics. The findings of several of these clinical studies indicate that probiotics may be beneficial in the treatment and prevention of various diseases and health issues. Validation of a significant number of these clinical investigations is necessary before the results can be applied to the clinical setting. Clinical studies play an important part in such investigations, and in the not-too-distant future, the outcomes of such trials will determine whether or not probiotics are effective in the treatment of disease. This article will attempt to provide a summary of the available literature on the benefits that these probiotics have with regard to health and disease. Probiotics are foods and/or supplements that contain non-pathogenic microbes such as bacteria and yeast that colonize the gut and can potentially yield a variety of health benefits. Research into the various ways in which probiotic bacteria could be used in the treatment of intestinal disorders is ongoing. Thanks to clinical studies and laboratory experiments, we now know more about how probiotics affect gut microbiome disorders. Studies can prove that probiotics can alleviate a variety of gastrointestinal ailments and improve overall health. This article concentrates on probiotics and commensal microbes, as well as their potential role in gut microbiome-related illnesses. In this section, we mark certain areas that need further work and studies so as to enhance our understanding of how probiotics help in the treatment and reduction of chances of gastrointestinal diseases.

Cultivation of Lactic Acid Bacteria and Evaluation of the Antimicrobial Potential of Partially Purified Bacteriocin-like Inhibitory Substances against Cariogenic and Food Pathogens

One of the major challenges in the pharmaceutical industry is the search for new antimicrobial compounds that can replace antibiotics. Lactic acid bacteria (LAB) can produce bacteriocin-like inhibitory substances (BLIS) that have a bacteriostatic or bactericidal effect against different bacterial genera, including those responsible for dental caries. Among the pathological processes of microbial etiology, the dental caries stands out, whose main pathogenic agent is the species Streptococcus mutans, present in about 80–90% of the oral cavity. In this context, this study aimed to produce and semi-purify BLIS from Lactobacillus plantarum ST16 Pa, Bifidobacteriumlactis BL 04, Lactococcus lactis CECT-4434 and Lactobacillus lactis 27 as well as to assess their antimicrobial potential against important dental caries causing pathogens like S. mutans UA159, Listeria innocua 2711, Carnobacterium maltaromaticum CECT 4020, Staphylococcus aureus CECT 239, and Escherichia coli ATCC 25922. While BLIS from L. plantarum ST16 Pa and L. lactis CECT-4434 were able to inhibit the growth only of S. mutans UA159, that which was produced by B. lactis BL 04 did so against all bioindicator strains; therefore, this suggests that its application could be important in the control of cariogenic microorganisms.

Efficacy of Probiotic, Chlorhexidine, and Sodium Fluoride Mouthrinses on Mutans Streptococci in 8- to 12-Year-Old Children: A Crossover Randomized Trial

INTRODUCTION

The oral cavity is home to a diverse and distinct microbiome. While the role of oral bacteria in cariogenic and other dental diseases is irrefutable, their beneficial effects in the form of probiotics (PB) has been less studied, especially pertaining to oral diseases in children. This study compares the efficacy of a PB mouthrinse with 0.12% chlorhexidine (CHX) and 0.05% sodium fluoride (NaF) mouthrinse on the colony counts of mutans streptococci (MS) in children.

METHODS

A triple-blind crossover randomized trial between interventional groups was planned. Fifty-one children between 8 to 12 years of age were divided into three groups (I, II, and III) and were exposed to all three mouthrinses (A, B, and C) by randomized allocation for a period of two weeks with an inter-phase washout period of four weeks. Pre- and post-interventional MS counts (CFU/mL) were assessed, and the mean change was analysed using the t test (intragroup) and ANOVA (intergroup and crossover).

RESULTS

The mean changes in the colony counts obtained with the use of PB, CHX, and NaF mouthrinses were -1.0223 (-1.2201 to -0.8246), -0.9564 (-1.1503 to -0.7626), and -0.9511 (-1.1554 to -0.7467), respectively, which were statistically significant (p < 0.0001). However, the intergroup comparison for the mean change in colony counts revealed no statistically significant differences (p > 0.05).

CONCLUSION

The study concluded that the PB mouthrinse was equally efficacious as compared to CHX and NaF mouthrinses against MS in 8- to 12-year-old children. However, further studies are recommended to strengthen the evidence.

Review of probiotic use in otolaryngology

OBJECTIVE

Probiotics have garnered considerable attention as an intervention for various conditions common to otolaryngology. The purpose of this review is to evaluate the current literature to offer recommendations about the safety and efficacy of probiotic management in otolaryngologic conditions.

STUDY DESIGN

Narrative review.

METHODS

PubMed and Google Scholar were queried using pertinent keywords to retrieve relevant studies with particular focus in the recent 5 years. All abstracts were assessed and studies, reviews and meta-analyses achieving evaluation of probiotic therapies or characterization of microbiome changes were included for further review. Studies were categorized by condition or anatomic region across various subspecialties. Key data parameters were extracted and evaluated across studies and treatment types.

RESULTS

Strong evidence exists for the use probiotic agents to improve symptoms for allergic rhinitis, chronic rhinosinusitis and certain dental conditions. Despite promising results, further investigation is needed to evaluate and optimize probiotic delivery for mitigating otitis media, oropharyngeal inflammation and upper respiratory tract infections. Preclinical studies suggest that probiotics may potentially offer benefit for voice prosthesis maintenance, wound healing and mitigation of oral dysplasia.

CONCLUSION

Probiotic therapies may offer clinical benefit in a variety of contexts within the field of otolaryngology, especially for short-term relief of certain inflammatory conditions of the oral cavity, auditory and nasal cavities. Further investigation is warranted for evaluation of long-term outcomes and pathogenic deterrence.

Lactobacillus Plantarum 108 Inhibits Streptococcus mutans and Candida albicans Mixed-Species Biofilm Formation

Streptococcus mutans is the principal biofilm forming oral pathogen associated with dental caries. Studies have shown that Candida albicans, a commensal oral fungus is capable of forming pathogenic mixed-species biofilms with S. mutans. The treatment of bacterial and fungal infections using conventional antimicrobial agents has become challenging due to the antimicrobial resistance of the biofilm mode of growth. The present study aimed to evaluate the efficacy of secretory components of Lactobacillus plantarum 108, a potentially promising probiotic strain, against S. mutans and C. albicans single and mixed-species biofilms. L. plantarum 108 supernatant inhibited S. mutans and C. albicans single-species biofilms as shown by XTT reduction assay, crystal violet assay, and colony forming units counting. The probiotic supernatant significantly inhibited the S. mutans and C. albicans mixed-species biofilm formation. The pre-formed mixed-species biofilms were also successfully reduced. Confocal microscopy showed poorly developed biofilm architecture in the probiotic supernatant treated biofilms. Moreover, the expression of S. mutans genes associated with glucosyltransferase activity and C. albicans hyphal specific genes (HWP1, ALS1 and ALS3) were down-regulated in the presence of the probiotic supernatant. Altogether, the data demonstrated the capacity of L. plantarum 108 supernatant to inhibit the S. mutans and C. albicans mixed-species biofilms. Herein, we provide a new insight on the potential of probiotic-based strategies to prevent bacterial-fungal mixed-species biofilms associated with dental caries.

Dietary Nitrite Drives Disease Outcomes in Oral Polymicrobial Infections

Streptococcus mutans resides in the oral polymicrobial biofilm and is a major contributor to the development of dental caries. Interestingly, high salivary nitrite concentrations have been associated with a decreased prevalence of dental caries. Moreover, the combination of hydrogen peroxide-producing oral commensal streptococci and nitrite has been shown to mediate the generation of reactive nitrogen species, which have antimicrobial activity. The goal of this study was to examine whether nitrite affects S. mutans virulence during polymicrobial infections with the commensal Streptococcus parasanguinis. Here, we report that the combination of S. parasanguinis and nitrite inhibited S. mutans growth and biofilm formation in vitro. Glucan production, which is critical for S. mutans biofilm formation, was also inhibited in 2-species biofilms with S. parasanguinis containing nitrite as compared with biofilms that contained no nitrite. In the in vivo caries model, enamel and dentin carious lesions were significantly reduced in rats that were colonized with S. parasanguinis prior to infection with S. mutans and received nitrite in the drinking water, as compared with animals that had a single S. mutans infection or were co-colonized with both bacteria and received no nitrite. Last, we report that S. mutans LiaS, a sensor kinase of the LiaFSR 3-component system, mediates resistance to nitrosative stress. In summary, our data demonstrate that commensal streptococci and nitrite provide protection against S. mutans pathogenesis. Modulating nitrite concentrations in the oral cavity could be a useful strategy to combat the prevalence of dental caries.

Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis

OBJECTIVES

To evaluate the effect of probiotic containing in dairy products on oral and salivary parameters.

MATERIAL AND METHODS

Electronic searches were performed based on the PICO criteria. Randomized controlled trials in adults/children (P) in which dairy products containing probiotics (I) were compared to controls (C) for establishment of oral health (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of probiotics on Streptococcus mutans (SM), Lactobacillus spp. (LB), and yeast counts, plaque index, and salivary pH. Random or fixed effect models were used, and heterogeneity was tested.

RESULTS

Thirty-two studies were included in the qualitative synthesis, and 24 in the meta-analysis. For dichotomous results, individuals who consumed probiotics exhibited decreased scores in SM concentrations (RD 0.15 [0.02, 0.28] p = 0.03, I² = 70%), but no change was observed for LB (RD 0.10 [- 0.03, 0.23] p = 0.13, I² = 94%), or yeast levels (RD 0.05 [- 0.02, 0.12] p = 0.7, I² = 48%). For continuous analysis, both probiotic and control groups presented similar results for SM and LB (MD - 0.55 [- 1.16, 0.07] p = 0.08, I² = 62%, and RD 0.10 [- 0.03, 0.23] p = 0.13, I² = 94%, respectively). The consumption of probiotics increased salivary pH (MD 0.20 [0.04, 0.35] p = 0.01, I² = 46%) and plaque index (MD 0.38 [0.11, 0.65] p = 0.005, I² = 0%). The probiotic milk reduced SM (MD - 0.59 [- 0.96, - 0.22] p = 0.002, I² = 0%), and the probiotic yogurt decreased LB counts (RD 0.35 [0.19, 0.51] p < 0.0001, I² = 0%).

CONCLUSIONS

In general, dairy probiotics were effective in reducing SM, increasing salivary pH, and promoting a higher plaque index. Liquid matrices, such as milk and yogurt, seem to be more effective in reducing SM and LB levels.

CLINICAL RELEVANCE

Consumption of dairy products containing probiotics could be a supporting method in caries prevention.

Effect of Short-term Consumption of Amul Probiotic Yogurt Containing Lactobacillus acidophilus La5 and Bifidobacterium Lactis Bb12 on Salivary Streptococcus mutans Count in High Caries Risk Individuals

Aim

This study aims to study the effect of short-term consumption of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on salivary Streptococcus mutans count in high caries risk individuals.

Materials and Methods

A double-blind randomized control trial was conducted, and 70 high caries risk individuals with a salivary S. mutans count of more than 10⁶ CFU/ml of saliva were followed for 4 weeks. Participants ingested 100 g yogurt containing L. acidophilus La5 and Bifidobacterium lactis Bb12 or yogurt without the two probiotic bacteria once daily at the end of meals for initial 2 weeks. Salivary S. mutans were enumerated in the laboratory by selective culture media.

Results

A statistically significant reduction (P < 0.05) of salivary S. mutans was recorded after probiotic yogurt consumption with minimal residual effect, which was in contrast to the controls.

Conclusion

L. acidophilus La5 and Bifidobacterium lactis Bb12 present in the yogurt were effective in reducing the S. mutans levels in saliva.

Effect of Probiotic Lactobacilli on the Growth of Streptococcus Mutans and Multispecies Biofilms Isolated from Children with Active Caries

BACKGROUND The purpose of this investigation was to evaluate the effect of probiotic lactobacilli on Streptococcus mutans (MS) and multispecies biofilms isolated from children with severe caries. MATERIAL AND METHODS Twenty children with active caries (DMFS ≥6) were selected as the experimental group and Streptococcus mutans (MS) were isolated from their saliva. After identification the MS strains were mixed with lactobacilli at 37°C, following which viable MS colonies were counted. At the same time dental plaques from the children were mixed with lactobacilli in vitro to form biofilms, and the population of nine common strains in the biofilms was enumerated after 24 hours of growth. RESULTS Lactobacillus casei Shirota, L. casei LC01, L. plantarum ST-III and L. paracasei LPC37 all had strong inhibitory effects on the majority the MS isolated from children with active caries, with the inhibition rate reaching approximately 70-90% (p<0.05). L. casei Shirota, L. casei LC01, L. plantarum ST-III, L. paracasei LPC37 also significantly reduced the numbers of MS, Streptococcus spp., S. sanguinis and total bacteria in mixed biofilms compared with the control group (p<0.05). CONCLUSIONS The four strains of lactobacilli were able to inhibit the growth of Streptococcus mutans and had effects on the composition of bacterial biofilms in vitro. Ingestion of probiotics may be a promising method of caries prevention.

Probiotics and oral health: A systematic review

Background

Probiotics are microorganisms, mainly bacteria, which benefit the host’s health. Many studies support the role of probiotics as a contributor to gastrointestinal health, and nowadays many authors are trying to prove its influence in oral health maintenance.

Objectives

To review the published literature with the purpose of knowing the importance of using probiotics as a preventive and therapeutic method for oral infectious diseases management.

Material and Methods

An electronic search in PubMed database with the keywords “oral health AND probiotics AND dentistry” was conducted. The inclusion criteria were: randomized clinical trials (RCTs) that assess the action of any probiotic strain in the treatment and / or prevention of an infectious oral disease, RCTs that assess the action of any probiotic strain on counting colony forming units (CFU) of oral pathogens, systematic reviews and meta-analysis. The Jadad scale was used to assess the high quality of RCTs.

Results

Fifteen articles were considered for this review. Of which, 12 were RCTs of good / high quality (Jadad scale), two meta-analysis and one systematic review.

Conclusions

The literature reviewed suggests probiotics usage could be beneficial for the maintenance of oral health, due to its ability to decrease the colony forming units (CFU) counts of the oral pathogens. However, randomized clinical trials with long-term follow-up periods are needed to confirm their efficacy in reducing the prevalence/incidence of oral infectious diseases. Furthermore, the recognition of specific strains with probiotic activity for each infectious oral disease is required, in order to determine exact dose, treatment time and ideal vehicles.

Key words:Probiotics, periodontal diseases, dental caries, oral health.

Mismatch between Probiotic Benefits in Trials versus Food Products

Probiotic food products contain a variety of different bacterial strains and may offer different health effects. The objective was to document the prevalence and dosage of probiotic strains in the Canadian food supply and to review the literature investigating these strains in order to understand what health benefits these products may offer. The Food Label Information Program was used to identify probiotic-containing products in the food supply. PubMed, Web of Science, and Embase were searched for randomized controlled trials that tested the health effects of these strains in humans. There were six probiotic strains/strain combinations identified in the food supply. Thirty-one studies investigated these strains and found that they are associated with decreased diarrhea and constipation, improved digestive symptoms, glycemic control, antioxidant status, blood lipids, oral health, and infant breastfeeding outcomes, as well as enhanced immunity and support for Helicobacter pylori eradication. There were a limited number of studies investigating these strains. Many studies were funded by the food industry and tested dosages that were up to twenty-five times the dosage found in most food products. Probiotic food products could have health benefits not currently reported on their labels. However, many dosages are too low to provide the benefits demonstrated in clinical trials. Further research is needed to enable more effective use of these functional foods.

Comparative Study of Probiotic Ice Cream and Probiotic Drink on Salivary Streptococcus mutans Levels in 6-12 Years Age Group Children

BACKGROUND

Dental caries is one of the most common health problems in the world. Probiotics are one the various preventive methods to reduce dental caries. The aim of this study is to compare the effectiveness of probiotic ice cream and drink on salivary Streptococcus mutans levels in children of 6-12 years age group.

MATERIALS AND METHODS

A three phase study was carried out in children (n = 50) of 6-12 years age with zero decayed missing filled teeth (dmft)/DMFT. They were randomly divided into two equal groups. Saliva samples were collected before the consumptions of probiotic ice cream and probiotic drink. Colony count obtained was recorded as baseline data. For both groups probiotic ice cream and drink was given randomly for 7 days and a washout period of 90 days were given and then the saliva samples were collected and colony counting was done.

RESULTS

Statistical analysis was performed using Student's paired t-test and multiple comparisons by Tukey's honest significant difference test which showed, there is a significant reduction in salivary S. mutans level in both groups after 7 days period. However, after washout period only probiotic ice cream showed reduction whereas drink did not. Also, there was no significant difference between probiotic ice cream and drink.

CONCLUSION

Probiotic organisms definitely have a role in reducing the salivary S. mutans level and ice cream would be a better choice than drink. However, the prolonged use of the agents and their effects on caries is still to be determined.