Probiotics in Dentistry, Our Microbiome in action!
- Dr. Peter Jacobsen, PhD, DDS
- Feb 3
- 4 min read
Updated: 1 day ago
Bacteria, fungi, and viruses are present everywhere on and in our bodies. Some are beneficial, and are critically important to our overall health and well-being. Others are detrimental to our health and well-being. Our goal as oral health practitioners is to help create and maintain a healthy microbiome, where we have more beneficial bacteria, fungi, and viruses in our oral cavity than harmful ones.
We constantly attempt to tip the bacterial and fungal balance by killing harmful organisms with antifungals, antivirals, and antibacterials (often collectively referred to as antibiotics or antimicrobials).
However, this approach comes with risks. Antimicrobials are not particularly specific; they can potentially kill a wide range of organisms. As a result, the use of antibiotics disrupts our healthy, homeostatic relationship with bacteria and fungi, often to the detriment of our overall health. That's why using the correct antibacterial/antibiotic only when necessary, at the proper dose, and for the shortest time needed, are the key considerations for good Antibiotic Stewardship. When required, antimicrobials are lifesaving in many situations; however, even a short course of antibiotics can have a long-lasting, detrimental impact on the health of our GI flora.
Medical research is slowly discovering and understanding the essential role our Microbiome plays in our overall health. These are the vast number of organisms that coat every surface inside our gastrointestinal tract and every surface outside our body. Our Microbiome aids in digestion, immune system regulation, metabolic health, and overall health, including skin and brain health.
In this Breaking Dental Drug News (BDDN) edition, we will focus on ways to promote and nourish, predominantly, the bacteria, as well as fungi and viruses, that keep us alive and healthy. We will explore how the Microbiome applies to the oral cavity.
The predominant organisms consumed to promote and nourish our GI tract health are in the Lactobacillus genus. These bacteria are some of the 'probiotics', the live, beneficial organisms found in yogurt, fermented cabbage, and some other fermented foods. Some organisms in the Lactobacillus genus are specifically associated with oral cavity health.
We can ingest these probiotics to supplement the Lactobacillus and other beneficial organisms already in our GI tract. We can also support the good bacteria already present in our gut by feeding them the unique sugars and long-chain carbohydrates found commonly in fruits and vegetables, These compounds, as a group are referred to as Prebiotics.
The ongoing research and lessons we learn from medicine about our Microbiome also apply to our oral health and the oral cavity. This is especially true relative to bacterial organisms.
Dentists and dental hygienists are well aware that certain bacteria are associated with a healthy mouth, while others are associated with an unhealthy one. An unhealthy oral cavity has pathogenic organisms living on the teeth, gums, and tongue.
Oral microbiological testing can identify the specific organisms most commonly associated withdental decay, periodontal disease, and/or halitosis.
The knowledge we obtain from identifying the organisms present in the oral cavity through testing, can help us shift the balance of organisms in the oral cavity towards health, thereby reducing and eventually eliminating the patients oral cavity problems.
A variety of probiotic and prebiotic products are available on the market to address a wide range of human health concerns. There are fewer probiotic and prebiotic products specifically designed to treat oral pathology and/or support oral health.
There are oral cavity-specific products available designed to correct the bacterial pathology (also referred to as dysbiosis) in the oral cavity. Products created by Bristle Health and Probiora 3, for example, provide probiotics and prebiotics specifically designed and intended to reestablish a healthy oral flora.
Clinicians and patients should recognize that the existing disease and the conditions that caused it must be addressed first, before healthy organisms can reestablish themselves.
It is essential, in any healthcare situation, to have a diagnosis before providing a treatment. If the intention is to create a healthier oral microbiome, evaluating the oral organisms present before treatment, particularly when pathology is present, is appropriate. This evaluation enables post-treatment reevaluation of the oral flora, allowing for specific recommendations to guide the restoration of a healthy oral bacterial balance. Bristle Health and Viome are two companies that provide oral organism testing.
A 2023 NIH study, "The Benefits of Probiotics on Oral Health: Systematic Review of the Literature," is an excellent and thorough review of the literature related to probiotics and the Microbiome of the oral cavity.
The authors evaluated 3460 articles published from 2019 to 2023. They concluded, "Although probiotic microorganisms have been found to have proven therapeutic benefits, their application (emphasis mine) in dental health is not yet solidly backed by evidence. "
My conclusion from reviewing the area of probiotics in dentistry is that probiotics can be beneficial for some patients in certain situations; however, there is currently no conclusive scientific evidence to inform us specifically when (before, during, or after treatment) and how to prescribe and use them.
I suspect that eventually evidence will show that probiotics will be the most useful after all needed dental treatment is completed and the patient's oral hygiene improves. At that point, probiotic use can help reestablish and maintain normal, healthy oral flora (Microbiome) to keep the mouth disease-free in the future.
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DEFINITIONS, The emerging language of the Microbiome and probiotics.
Live microorganisms, such as bacteria and yeasts. They provide health benefits when consumed in adequate amounts, supporting a healthy gut microbiome and boosting immunity.
Non-digestible fibers that act as food for beneficial gut bacteria, stimulating their growth and activity. Examples include certain types of specialized plant fibers found in foods.
A preparation of inanimate microorganisms and/or their components that confers a health benefit on the host
Products containing a combination of both a probiotic and a prebiotic. The prebiotic provides fuel for the probiotic, working together to enhance gut health.
An imbalance in the community of microorganisms living in your gut (the gut microbiome). This imbalance can involve a decrease in beneficial bacteria and an increase in harmful ones, potentially leading to various health issues.
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