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Probiotic Concept for Dental/ Oral Care
.. New Opportunities for Dental/ Oral Prevention and Disease Control?
Probiotics and the Future What will happen in the next 15 years? In today’s -omics era, it is obvious that the general awareness concerning the co- evolvement and symbiosis between the human host and bacteria is increasing along with a demand for “health-by-nature” instead of an overuse of chemicals and antibiotics. Hopefully, probiotic administration to combat biofilm mediated diseases will help to reduce the need for antibiotics in the future. Furthermore, the common risk factor approach with close links between oral and general diseases (diabetes, metabolic syndrome, obesity), which calls for a patient-centered holistic view, will unite the efforts of dental and medical professionals in health promotion. In fact, due to evidence supporting the role of probiotics for the prevention of eczema in infants, management of side effects related to antibiotics and alleviation of functional bowel symptoms, fi ve states within the European Union have recognized probiotics in their national dietary guidelines. The interest for prebiotic substances that induce the growth or activity of benefi cial microorganisms is also emerging. Recently, arginine was described as a genuine oral prebiotic because of its ability to promote a healthy oral ecology from a caries point of view. It is therefore likely that an increasing number of consumer oral care products with prebiotics and/ or orally optimized probiotic strains will be developed and available over the counter in the coming years.
The next probiotic area to investigate in clinical dentistry could very well be oral wound healing and control of post operative pain and discomfort, for example after third molar surgery. Research has indicated that lactobacilli-derived probiotics may enhance chronic wound healing, which could also be applicable in the oral cavity. In this context, our research group has recently shown that bacterial products secreted from L. reuteri are noncytotoxic for human gingival fibroblasts and may stimulate the production of prostaglandin E2. Thus, probiotic bacteria may play a role in the resolution of inflammation in human gingival fibroblasts, which is an important first step in accelerated oral wound healing.
Numerous antiplaque (e.g. surfactants) and antimicrobial agents (e.g. bisbiguanides, metal ions, phenols, quaternary ammonium compounds, etc.) have been successfully formulated into toothpastes and mouthrinses to control plaque biofilms. At high concentrations, these agents can remove biofilm and/or kill disease-associated bacteria, while even at sub-lethal levels they can inhibit the expression of pathogenic traits. Successful antimicrobial agents are able to meet the apparently contradictory requirements of maintaining the oral biofilm at levels compatible with oral health but without disrupting the natural and beneficial properties of the resident oral microflora.
The oral microbiome delivers important benefits to the host (symbiosis). Changes to the oral environment drive deleterious shifts in this microbiome (dysbiosis). Low biofilm pH from dietary sugar catabolism selects for acidogenic/acid-tolerating species and promotes dental caries, while inflammation following biofilm accumulation enriches for the proteolytic and anaerobic microbial communities associated with periodontal disease. Prevention depends not only on biofilm control but also on eliminating drivers of dysbiosis, i.e., an ecological approach to disease prevention.
Probiotic treatment to restore and maintain normal function of human associated biofilm microbiota has been employed as a therapeutic approach for intestinal ailments for more than a century. Its debut in the oral cavity was only 15 years ago, when a first clinical study showed that the probiotic Lactobacillus rhamnosus GG exhibited promising reduction of selected caries risk factors in preschool age children. Svante Twetman, DDS, with co-authors Mette Rose Jørgensen, PhD, and Mette Kirstine Keller, PhD, point out in their research that these findings led to a rapid expansion of probiotic applications to a number of different biofilm-associated oral diseases. Probiotic treatment aims to shift the microbial biofilm communities from a dysbiotic “diseased” state back to a beneficial biofilm via introduction of “good” bacteria, which are safe to use. However, more detailed longitudinal studies are still needed to elucidate the underlying mechanisms and long-term benefits.
Beneficial commensals within oral biofilms have the ability to antagonize pathogenic species and thus prevent disease development. In their research, Robert Burne, PhD, and co-authors Brinta Chakraborty, PhD, and Kyulim Lee, BS, focus on examples of antagonisms against the major cariogenic species Streptococcus mutans by commensal streptococci and other beneficial species. Antagonistic actions including alkali generation or hydrogen peroxide production among others are represented by a number of different mechanisms and pathways. This natural anti-S. mutans potential of beneficial biofilm species can be enhanced by prebiotic compounds such as arginine, which promote alkali production for plaque pH neutralization.
Caries prevention remains a major oral health challenge. Currently available therapies such as fluoride treatment can be effective but do not remove the etiological disease agent. In their research, Anna Edlund, PhD, and Lihong Guo, DDS, PhD, review an innovative approach to specifically remove the prominent cariogenic species Streptococcus mutans. The application of “specifically targeted antimicrobial peptides” (STAMPs) eliminates S. mutans from oral biofilms. S. mutans removal reduces acid production and alters overall biofilm composition toward a community that is more resistant to S. mutans invasion. This novel technology is safe for host cells and comprises a promising future therapeutic. A signiﬁcant challenge for the future will be to develop even more effective dental/ oral care products that are able to improve clinical efﬁcacy while still preserving the beneﬁts of the normal, resident oral microﬂora.