Probiotics are live microorganisms that are intended to have benefits when consumed or applied to the body. In the Oral cavity they aim to reduce the incidence of dental decay, gum disease, bad breath, gingivitis, Candida infections and various other problems.
Which microorganisms are being used in Oral probiotics?
- B. Lactis
- L. Acidophilus,
- L. Rhamnocsus
- S. Cereviasae,
- L. Salivarius
- L. Reuteri
- B. Longum
- L. Lactis,
- E. Faecium
How do they work?
The mechanism by which they may work is unclear but it seems probiotics may have several actions.
- Decreasing the number of disease-causing bacteria.
- Modulation of the body’s inflammatory response
- Production of antimicrobial substances
- Competing for nutrients
- Displacing disease-causing bacteria within the oral space.
How much do they cost?
A quick google search shows formulations from $30 to $300 dollars for various sized bottles of various probiotic mixtures. They are an over the counter supplement, not a specific prescribed medication.
Great when do I start?
Hold on. Despite other fields of medicine having clear go-to probiotics whose use is evidence based, the clinical results we have for oral probiotics are mixed.
It maybe that the studies undertaken so far differ enough in the probiotic strain used, in the dosage or mix of microorganisms used, in the disease studied, in the delivery of probiotic and also in the length of follow up, that no clear picture can be seen despite a positive effect being present.
It is telling that the Cochrane Library, which is the Gold standard for evidence-based science has zero articles recommending oral probiotics.
Why might they not be effective?
The common Oral diseases are believed to be the result of multiple factors. Even if the probiotics were able to reduce some of these factors, the remaining would still drive pathology to some degree. At best probiotics could be seen as additional adjunct to disease prevention and not a universal panacea.
Is there any harm in trying?
It seems few side effects have been reported in the studies so far. Those that were reported were gastrointestinal discomfort and atopic eczema. It should be noted that the participants in the studies were generally healthy. Should you be immuno-suppressed the introduction of foreign microorganisms in the form of a Probiotic may not be wise.
Is further research being conducted?
As can be seen from the graph above, yes, the amount of research being conducted is significant and is increasing. 1619 papers have been produced over the last 5 years researching the topic and reviewing the findings.
Summary
The general tone of article discussions is optimistic but the present evidence is weak in advocating their use. It may be that with further randomized controlled trials with long term follow ups scientists may conclude that an actual benefit does exist.
