Probiotics

Dr Deepu Mathews
Associate Professor
Malabar Dental College & Research Centre

1. PROBIOTICS IN PERIODONTAL THERAPY Deepu Mathew

2. Deepu Mathews Associate Professor Malabar Dental College & Research Centre Manoor - Chekanoor Road, Manoor , Edappal , Kerala 679582 https://macity.edu.in/

3. History

4. The word “ Probiotics ” means “for life”. The term is a combination of the Latin preposition pro ("for") and the Greek adjective ( biotic ), which means life The origin of the term “ probiotic ” is credited to Werner Kollath , who used “ Probiotika ” in a 1953 publication entitled “Nutrition and the tooth system.

5. He hypothesized that the apparent longevity of Bulgarian peasants was because they consumed large quantities of fermented milk products like curd and buttermilk. He believed that the lactic acid bacteria in these products replaced the harmful organisms found in the intestine and thus reduced the production of toxins that lead to disease and infection

6. In the 1900’s Henry Tissier , a French paediatrician , observed that children with diarrhea had in their stools a low number of bacteria characterized by a peculiar, Y shaped morphology . These “bifid” bacteria were, on the contrary, abundant in healthy children .He suggested that these bacteria could be administered to patients with diarrhoea to help restore a healthy gut flora

7. In 1917 Alfred Nissle isolated a nonpathogenic strain of Escherichia coli. Disorders of the intestinal tract were frequently treated with viable nonpathogenic bacteria to change or replace the intestinal microbiota . The Escherichia coli strain is one of the few examples of a non-LAB probiotic

8. Bacteria are normal inhabitants of humans. More than 500 bacterial species are found. Bacterial colonisation of the gut begins at birth, and continues throughout life.

9. Definitions

10. Lilly and Stillwell (1965) defined probiotics as “Growth promoting factors produced by microorganisms. Fuller (1989) defined it as “A live microbial feed supplement which beneficially affects the host by improving its intestinal microbial balance

11. ILSI (International Life Sciences Institute) Europe Working Group (1998): “A viable microbial food supplement which beneficially influences the health of the host. Tannock (2000) defined as “Microbial cells which transit the GI tract and which, in doing so, benefit the health of consumer.”

12. The most popular definition is: FAO/WHO (Food and Agriculture Organization and World Health Organization) (2001): “ Live microorganisms which when administered in adequate amounts confer a health benefit on the host

13. Prebiotics and Synbiotics

14. Prebiotics are selectively fermented constituents that allow specific changes, both in the composition and/or in the activity of the GI microbiota . Most prebiotics are used as food ingredients — in biscuits, cereals, chocolate, spreads, and dairy products

15. Commonly known prebiotics are: Oligofructose Inulin Galacto -oligosaccharides Lactulose

16. Effective prebiotics  not digested in the upper gut,  reach the large colon,  utilised by a group of healthy microorganisms. Lactulose  treatment of constipation and hepatic encephalopathy. Oligofructose (OF)  in many foods, such as wheat, onions, bananas, honey, garlic etc.

17. Synbiotics are appropriate combinations of pre- and probiotics . A synbiotic product exerts both a prebiotic and probiotic effect. Examples are : Bifidobacteria , Fructo oligosaccharides, Lactobacillus rhamnosus and Inulins

18. Criteria for Use As Probiotics

19. To be considered for use as probiotic following criteria needs to be fulfilled. (Collins, M.D., Gibson, G.R. 1999) 1) a beneficial effect on the host , e.g. increased growth or resistance to disease. 2) human origin. 3) high cell viability. 4) non-pathogenic and non-toxic. 5) interact or to send signals to immune cells. 6) to influence local metabolic activity

20. 7) capable of surviving and metabolising in the gut environment e.g. resistance to low pH and organic acids. 8) stable and capable of remaining viable for periods under storage and field conditions.

21. Microorganisms considered as probiotics

22. Lactobacillus species Bifidobacterium species Other lactic acid bacteria Nonlactic acid bacteria L. acidophilus L. amylovorus L. casei L. crispatus L. delbrueckii L. gallinarum L. gasseri L. johnsonii L. paracasei L. plantarum L. reuteri L. rhamnosus B. adolescentis B. animalis B. bifidum B. breve B. infantis B. lactis B. longum Enterococcus faecalis Enterococcus faecium Lactococcus lactis Leuconstoc mesenteroides Pediococcus acidilactici Sporolactobacillus inulinus Streptococcus thermophilus Bacillus cereus var. toyoi Escherichia coli strain nissle Propionibacterium freudenreichii Saccharomyces cerevisiae Saccharomyces boulardii

23. Mechanisms of action of Probiotics

24. Enhancement of epithelial barrier integrity: Probiotic  enhancement of intestinal barrier function through modulation of cytoskeletal and epithelial tight junction in the intestinal mucosa. The probiotic bacteria can increase the secretion of mucus by triggering inflammation in enterocytes of the intestines.

25. Competitive Exclusion Competitive exclusion refers to physical blocking of pathogenic bacteria  two ways Probiotic bacteria compete with pathogenic bacteria for nutrients and energy source thus, preventing them from acquiring energy required for growth and proliferation Probiotics produce several organic acid and Volatile Fatty Acids (VFA) as a result of their metabolism and fermentation .

26. Production of Bacteriocins Probiotics can produce various antimicrobial substances which have inhibitory effect on pathogenic bacteria. Lactobacillus reuteri  lactic acid, reuterin , hydrogen peroxide. Lactobacillus acidophilus  acidophilin , lactocidin and acidolin L. plantarum  lactolin

27. Effects of Probiotics on Epithelial Cells Probiotics are distinguished from pathogenic bacteria by the production of cytokines Effect of probiotic bacteria on epithelial cells is production of Toll-like receptors such as TLR-2 and TLR-4.  that enhances epithelial cell regeneration and inhibition of epithelial apoptosis.

28. Immunomodulation Probiotic bacteria are able to influence the inflammatory response elicited by pathogens through specific signalling pathway. Protective effect of probiotics is associated with elevated humoral and cellular immune response which is achieved through increased production of T lymphocytes, CD+cells and antibody secreting cells, expression of pro and anti-inflammatory cytokines, interleukins.

29. Observed Effects of Probiotics on Oral Health

30. Probiotics and cariogenic pathogens Probiotics  reduce the risk for a high Streptococcus mutans level occurrence. Näse et al. (2004)  a reduced tooth decay incidence in children taking probiotic L. rhamnosus GG-enriched milk versus a control group of children taking milk without probiotic enrichment. Caglar et al. (2006)  reduced S. mutans level in patients receiving fluid or tablet probiotic forms

31. Probiotics and periodontal disease The effect of probiotics tablets on gingivitis and different grades of periodontitis was studied by Grudianov et al (2002). Koll- Klais et al.(2005)  high levels of Lactobacillus in microbiota caused an 82% and 65% inhibition in Porphyromonas gingivalis and Prevotella intermedia growth, respectively

32. Krasse (2005)  decreased gum bleeding and reduced gingivitis after consumption of probiotic Lactobacillus reuteri . Shimauchi H (2008)  Improvement of periodontal condition by probiotics with Lactobacillus salivarius WB21 M.R. Vivekananda (2010)  Lactobacilli reuteri ( Prodentis ) in combination with scaling and root planing beneficial in the management of periodontal disease

33. Probiotics and halitosis Regular use of probiotics can help to control halitosis. Kang et al (2006) observed reduced levels of volatile sulfide components produced by Fusobacterium nucleatum after consumption of Weissella cibaria . Hydrogen peroxide production by W. cibaria  F. nucleatum inhibition

34. Probiotics and Candida albicans Hatakka et al. (2007) showed a reduced prevalence of C. albicans after taking cheese containing probiotics L. rhamnosus GG

35. Latency time of probiotics in oral cavity Probiotics have found to have a latency time in the oral cavity even after their discontinuation. A presence of L. reuteri colonization was observed by Wolf et al. (1995) upto two months after having discontinued probiotic use

36. Commercially available Probiotics for periodontal disease management

37.   Gum PerioBalance (marketed by Sunstar , Switzerland) First probiotic specifically formulated to fight periodontal disease. It contains a patented combination of two strains of L.reuteri specially selected for their synergistic properties in fighting cariogenic bacteria and periodontopathogens . Each dose of lozenge  2 × 10 8 living cells of L. reuteri Prodentis .  

38. PeriBiotic (Designs for Health, Inc.,) This toothpaste is an all-natural, fluoride-free oral hygiene supplement containing Dental-Lac, a functional Lactobacillus paracasei probiotics Bifidumbacterin , Acilact , Vitanar (marketed by Alfarm Ltd., Moscow, Russia) This probiotics preparation of a complex of five live lyophilized lactic acid bacteria, can be used in gingivitis and mild periodontitis .

39. Wakamate D (Wakamoto Pharmaceutical Co., Tokyo, Japan) This probiotic tablet contains 6.5x10 8 colony forming units (CFU) per tablet of Lactobacillus salivarius WB21 and xylitol (280 mg/ tablet) was originally prepared to contribute for the intestinal microbial balance by providing acid tolerant L. salivarius WB21

40. Safety aspects of Probiotics

41. When probiotics are applied orally, at least a part of them will be ingested and can interact with a patient’s systemic health. When ingested orally, probiotics are generally considered safe and well tolerated. Although rare, cases of probiotics -related bacteraemia , endocarditis and liver abscess secondary to L. rhamnosus have been reported.

42. Major and minor risk factors for probiotics -associated sepsis have been identified. Major risk factors  Immunosuppressed patients Minor risk factors  I mpairment of the intestinal epithelial barrier it is recommended that probiotics should be used cautiously in patients risk factor

43. To Conclude …

44. Overzealous use of antibiotics has lead to the development of many resistant species. Bacterial infections that were once easily cured with antibiotics are becoming harder to treat. The World Health Organization has called this one of the biggest threats to human health today. This has led to development of ‘Superbugs’.

45. ‘Superbugs are bacteria that are resistant to several different antibiotics. The methicillin resistant Staphylococcus aureus (MRSA) bacteria commonly found in hospitals, and the bacteria that cause tuberculosis. Probiotics are not a replacement for antibiotics ,however they can be useful in various conditions. With more research and clinical trials more potent strains of probiotics can be developed which can be used in various diseases.