Abstract
Recent insights in medical science indicate that human biofilms play an important role in health and well-being, and have put microbiota modulation through bacteriotherapy into focus. In dentistry, bacterial interference with probiotic bacteria to support the stability and diversity of oral biofilms has gained similar interest. Investigations in vitro into metabolic activity, co-aggregation, growth inhibition, bacteriocin production, and adhesion have collectively suggested a potential role for probiotic lactobacilli and bifidobacteria to modulate the oral microbial ecology. Likewise, short-term clinical studies with intermediate microbial endpoints indicate that interference with caries-associated bacteria seems possible through probiotic dairy products, tablets, lozenges and chewing gum in various dose regimens. Few randomized controlled clinical trials with caries outcomes are available, but three studies with preschool children and the elderly have demonstrated preventive fractions between 21% and 75%, following regular intake of milk supplemented with probiotic lactobacilli. However, further large-scale trials with orally derived anti-caries candidates are needed before we can say that we are ready for bacteriotherapy as an adjunct to complement the existing evidence-based methods for preventing and controlling caries in daily practice.
Highlights
The interest in bacteriotherapy to prevent and control medical and oral conditions has grown remarkably in recent years
The most common probiotic bacteria belong to the lactobacilli and bifidobacteria genera, but certain strains of streptococci have been investigated.[3]
The first of these studies investigated the effects of probiotic bacteria given to 594 preschool children aged 1–6 years, and showed a significant reduction in caries increment in the probiotic milk group after 7 months, compared to the control group, but only in the subgroup of the 3–4 year-olds.[31]
Summary
The interest in bacteriotherapy to prevent and control medical and oral conditions has grown remarkably in recent years. The most common probiotic bacteria belong to the lactobacilli and bifidobacteria genera, but certain strains of streptococci have been investigated.[3] Lactobacilli are highly acidogenic and aciduric, and grow optimally under slightly acidic conditions They are considered a part of the normal oral flora and comprise about 1% of the cultivable species. Three randomized controlled trials (RCT) using milk supplemented with L. rhamnosus (LB21 or GG), with caries as an endpoint, have been published (Table 2).[31,32,33] The first of these studies investigated the effects of probiotic bacteria given to 594 preschool children aged 1–6 years, and showed a significant reduction in caries increment in the probiotic milk group after 7 months, compared to the control group, but only in the subgroup of the 3–4 year-olds.[31] It was claimed that the 5-day-aweek intake of probiotic milk reduced the risk of caries significantly (OR = 0.56). No statistically significant reductions in the levels of S. mutans or lactobacilli were seen in any of the three clinical studies, yet all three showed an obvious effect on caries
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