ECOHEART – BIOTICS
The application of probiotics
and postbiotics in oral health
The changing food habits and lifestyle has resulted in deterioration of oral health in the people of all ages. The increasing global problems with the traditional disease management strategies have prompted the investigators to hunt for the new and better alternatives to deal with health issues. The global demand for chemical free, less harmful and easier solutions to health problems has increased in past few years. Probiotics or the foods with ‘live cultures’ have come up as one of the most promising alternate to traditional disease management. Probiotics are those viable microorganisms which are constituents of natural microflora of human body. Probiotic therapy decreases the risk of colonization by oral pathogens without depleting the friendly microflora. Probiotics resembles the human body microbiota and are readily incorporated in the natural microflora of human body.
PHILOSOPHY
Lactobacillus bacteria and oral health
Tooth decay is a local demineralization of the hard tissues of the crown and root surface of the tooth, which happens in a bacterial accumulation that adheres to the tooth surfaces, called dental plaque, which is made of a gelatinous substance (Gupta and Gupta, 2015). S. mutans has been introduced as the main species of caries-causing bacteria due to its strong acid production and high tolerance to acidic conditions (Sales-Campos et al., 2019; Hasslöf and Stecksén-Blicks, 2020). Research has shown that the number of S. mutans in the saliva of people without caries is normally between 104 and 105 CFU/mL (Deepti et al., 2008), But at 106 CFU/mL, the risk of caries increases significantly (Klock and Krasse, 1979). In this regard, 105 CFU/mL has been considered the threshold of caries in clinical studies (Caglar et al., 2008b; Ghasemi et al., 2017; Bafna et al., 2018).
Probiotic bacteria may cause chemical and physical alterations in the microbial flora of people’s oral cavity (Teughels et al., 2007). Theoretically, probiotics have stronger adhesion to oral tissues than pathogens and can compete for adhesive surfaces. This leads to bacterial aggregation and co-aggregation and the formation of a new biofilm (Twetman, 2012; Piwat et al., 2015; Takahashi, 2015; Morales et al., 2016). Probiotics compete with the oral microbial flora and pathogens for adhesion sites, nutrients, and growth factors, thus protecting oral health. These bacteria aggregate after sticking to the oral cavity and prevent the adhesion of pathogenic bacteria through the production of antimicrobial components like acids, bacteriocins, and peroxides. Therefore, probiotic bacteria may prohibit the growth of caries-causing bacteria and periodontal diseases, create an immune response against pathogens, and prevent oral tissue destruction and inflammation in the oral cavity (Sanders, 1969; Yasui et al., 1999; Roberts and Darveau, 2002; Wilson, 2005; Twetman, 2012; Twetman and Keller, 2012; Devine et al., 2015; Laleman et al., 2015; Gruner et al., 2016; Morales et al., 2016). Various researchers have surveyed the effect of the consumption of probiotics on tooth decay.
Oral microbiota in health and disease
More than 700 species of oral microbiota have been detected in the human mouth. Tongue is a microorganism laden organ. It is densely populated with salivary microbes, supragingival and subgingival plaque microorganisms. Probiotic bacteria guard the oral health by competing with the oral pathogens for nutrients, growth factors and site of adhesion. Once adhered to the oral cavity, probiotic bacteria aggregate and inhibit the adhesion of the harmful microorganisms by producing bacteriocins or other antimicrobial compounds such as acids or peroxides. Thus, Probiotics help to prevent the inflammation of oral cavity and the oral tissue destruction by oral pathogens (Strus et al., 2001; Roberfroid, 2002). Probiotic first needs to adhere successfully to the surfaces of oral cavity in order to avoid or reduce its rapid exclusion from the oral cavity.
Mechanism of probiotic action in the oral cavity and probiotic therapy
Probiotics first competes with the oral pathogens for adhesion site and then colonizes the oral surface. After the probiotics aggregate the oral surface, they compete with oral pathogens for nutrients, growth factors and also produce antimicrobial compounds, including organic acids, hydrogen peroxide, carbon peroxide, diacetyl, low molecular weight antimicrobial substances, bacteriocins, and adhesion inhibitors (Silva et al., 1987; Ouwehand, 1998). Probiotics can also activate and modulate the immune system (Kato et al., 1983), and they have been shown to reinforce gut defence by immune exclusion, immune elimination, and immune regulation (Isolauri et al., 2002).
The Probiotics have a three step action mechanism
1. Stimulates and modulates immune response,
2. Normalize intestinal microflora: Ensures colonization resistance, Controls irritable bowel syndrome and other inflammatory bowel diseases.
3. Have the metabolic effects like: Bile salt deconjugation and secretion, Lactose hydrolysis, Reduction in toxigenic and mutagenic reactions in gut, Supply of nutrients to colon epithelium.
probiotic therapy
Probiotics first competes with the oral pathogens for adhesion site and then colonizes the oral surface. After the probiotics aggregate the oral surface, they compete with oral pathogens for nutrients, growth factors and also produce antimicrobial compounds, including organic acids, hydrogen peroxide, carbon peroxide, diacetyl, low molecular weight antimicrobial substances, bacteriocins, and adhesion inhibitors (Silva et al., 1987; Ouwehand, 1998). Probiotics can also activate and modulate the immune system (Kato et al., 1983), and they have been shown to reinforce gut defence by immune exclusion, immune elimination, and immune regulation (Isolauri et al., 2002).
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PROBIOTICS
Probiotics as prevention of Streptococcus mutans
Streptococcus mutans is the most destructive grampositive bacterial strain in the mouth which ferments the sugar (carbohydrates) in the diet. This bacterial digestion of sugar produces lactic acid which destroys the enamel of teeth by creating an acidic environment around it. The initial microscopic damage gradually penetrates deeper through the layers of the tooth causing a cavity to form which leads to decay. Streptococcus mutans widely known as the main etiological agent of dental caries is a gram-positive bacteria which forms an insoluble glucan for adhesion, aggregation and biofilm formation. This glucan is synthesized from the glucose moiety of sucrose and plays an important role in the ability of S. mutans to potentiate the formation of dental caries. Lactobacilli and Bifidobacteria have been reported as promising bacteria for prevention of dental caries.
Probiotics and halitosis
Halitosis, or the nasty odor that comes out of the mouth, is a disease that depends on various factors, and its origin may be oral or non-oral (Van den Broek et al., 2007; Oliveira-Neto et al., 2013). Halitosis is usually attributed to biofilm in the interdental spaces, the back of the tongue, and chronic inflammatory diseases. The incidence of this disease in different populations is estimated between 22 and 50 percent (Miyazaki, 1995; Meningaud et al., 1999; Yaegaki and Coil, 2000; Quirynen et al., 2009; Akaji et al., 2014). Sulfuric gases such as dimethyl sulfide, hydrogen sulfide, and methyl mercaptan play an important role in causing bad breath. These gases are released in the oropharynx (tongue coating, tonsillitis, gingivitis, periodontitis) through bacterial degradation of sulfur-containing amino acids (Figure 3). F. nucleatum, Treponema denticola, P. intermedia, and P. gingivalis can be mentioned among the diverse range of bacteria that contribute to this disease (Corcoran et al., 2004). On the other hand, the levels of bacterial species that form the dominant microbiota in the oral of healthy people are not significant in people with halitosis (Kazor et al., 2003). Current treatments seek to eliminate these pathogenic bacteria using chemical or physical antibacterial agents. Antimicrobial treatment indiscriminately reduces the population of pathogenic bacteria and bacteria that are not involved in causing halitosis but are probably effective in maintaining a normal oral microenvironment. However, the result of this cure is to reduce the bad smell temporarily, and after some time, the bacteria causing halitosis appear again (Burton et al., 2005). Probiotics that are effective in maintaining periodontal health may also be useful for eliminating bad breath by helping to keep a healthy ecology of the tongue because in oral health, access to certain areas of the tongue, such as the dorsal posterior surface to the circumvallate papillae, which acts as a shelter for the large number of gram-negative bacterial species correlated with bad breath, is more difficult (Allaker et al., 2008). Nevertheless, it is known that the tongue is a more palpable recess than the periodontal recesses in terms of species that normally colonize, suggesting the necessity of recess-specific conformity, and probiotic strains intended to colonize the periodontal recesses may not freely colonize the tongue to exert health-promoting impacts (Zaura et al., 2009; Eren et al., 2014).
Probiotics and periodontal diseases.
Periodontal disease is inflammation of dental support tissues, which comprises gums, the bony socket, the outer layer of the roots of teeth, and the associated connective tissue. This disease begins with the formation of plaque. Symptoms of periodontal disease are bleeding on probing, color alterations, swelling, pain, and in advanced stages, dental mobility. Probiotics prevent plaque formation by reducing the pH of saliva and producing antioxidants that use free electrons used in plaque mineralization because, in this condition, carcinogenic bacteria are not able to form plaque. Therefore, in this way, probiotics prevent periodontal disease. Also, encouraging results of the consumption of probiotics in the cure of plaque level, gingivitis, periodontitis, and significant reduction of periodontopathogens have been reported in various studies.
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