Probiotics and oral health – current understanding and latest evidence

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Welcome to the third in Health Professional Academy’s (HPA’s) short series of articles – examining the reserarch evidence underscoring the benefits of using specialised oral probiotics to restore and preserve good oral health. Despite the many routine oral health interventions practised today, oral disease remains a huge problem worldwide. To maintain oral health and prevent disease, people rely largely on mechanical cleaning and dietary modifications. But perhaps we’re overlooking an essential element of maintaining oral health – looking after the community of micro-organisms that reside in the mouth, known as the oral microbiota.

The oral microbiota and oral health

A healthy, balanced oral microbiota contains multiple species and strains of commensal (friendly) bacteria, which help maintain the integrity of oral tissues, and keep pathogens in check. An unbalanced, or dysbiotic, oral microbiota can cause significant oral problems, including caries, periodontal disease, halitosis, oral mucositis (including aphthous ulcers) and yeast infections. Supporting a healthy, balanced oral microbiota, eg through eating fermented foods or taking specialised oral probiotic supplements, may help to maintain good oral health.

Oral probiotics work by:1,2,3,4,5

• Competing with pathogens

• Producing antimicrobial compounds, which help to eradicate pathogens

• Producing surfactants

• Modulating the host’s immune response and reducing inflammation

• Enhancing epithelial barrier function.

What are the benefits of oral probiotics?

The benefits of oral probiotics have been clinically assessed, examined and reviewed by many research groups (Table 1).

Are all probiotics the same?

The evidence for probiotics’ clinical benefits comes from a variety of clinical trials using multiple different bacterial species and strains. When selecting which a probiotic to use, it’s good practice to look for robust clinical evidence of effect for a specified proprietary strain/combination of strains at a specified dose for a specified indication.

Oral probiotics designed for the management of oral conditions have enormous potential for maintaining and improving oral health, but before recommending them, check the evidence underpinning any claims. Also be mindful that different strains (even of the same species) can have different effects.

Advise patients to adopt/continue good oral hygiene practices, and to use oral probiotics daily as an additional measure to their current regime.

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