USAGE OF PROBIOTICS IN CHRONIC PERIODONTAL DISEASES.ppt

PROBIOTICS
CHRONIC PERIODONTAL DISEASES

1. USAGE OF PROBIOTICS IN CHRONIC USAGE OF PROBIOTICS IN CHRONIC
PERIODONTAL DISEASES PERIODONTAL DISEASES

2. Probiotics: definitionProbiotics: definition
World Health Organization:
“live microorganisms which when administered in
adequate amounts confer a health benefit on the
host”
The concept of beneficial for
health microorganisms dates
back to the ideas of Nobel
prize laureate Ellie Metchnikoff
in the early 20th century.

3. Prebiotics
“Prebiotics are non-digestible but fermentable
oligosaccharides that are specifically designed to
change the composition and activity of the intestinal
microbiota with prospect to promote the health of the
host.”
Fructo-oligosaccharides (chicory, inulin),Lactulose.
Positively affect the endogenous flora,
Stimulate the growth of one or a limited number of bacterial
species.
FOSBifidobacteria
LactuloseLactobacilli

4. SynbioticsSynbiotics
A probiotic organism in combination
with its prebiotic food
Providing both the organism and
substrate at the time of ingestion, an
improved chance of survival in GI tract

5. ProbioticsProbiotics
CandidatesCandidates
Lactobacillus
acidophilus, reuteri, casei,
rhamnosus “GG”, salivarius, gasseri,
fermentum.
Bifidobacteria
bifidum, breve, infantis, longum
Streptococcus
thermophilus
Saccharomyces

6. Probiotics: Proposed usesProbiotics: Proposed uses
Infectious diarrhea
Antibiotic-associated diarrhea
IBD, IBS, and pouchitis
Necrotizing Enterocolitis
Bacterial vaginosis
Recurrent UTI’s
Atopic diseases
Immune system enhancement
H pylori infections
Chronic periodontitis
Dental caries
Radiation induced diarrhea
Cardiovascular risk reduction
Rheumatoid arthritis

7. Mechanism of action against periodontal diseases
Provide favourable
Environment for growth
Of beneficial bacteria
Competition for
Essential nutrients
Induction of expression
Of cytoprotective proteins
On host cell surfaces
Inhibition of pathogen
Adhesion, colonization &
Biofilm formation
Production of
Antimicrobial Factors
Such as bacteriocin
Reduction in bacterial
translocation
Modification of toxins
or toxin receptors
Production of short-chain
fatty acids with
anti-inflammatory properties
Probiotics
Proinflammatory pathways
modulation
Inhibition of
collagenases
Modulation of host
Immune response
Prevention of cytokine
Induced apoptosis

8. Is the oral cavity a natural habitat for Is the oral cavity a natural habitat for
probioticsprobiotics ? ?

Lactobacillus rhamnosus GG , has been found to be
incapable of establishing permanent residence in the oral
cavity.
Yli-Knuuttila et al ,2006.Yli-Knuuttila et al ,2006.

Saliva samples shows that Lactobacillus salivarius ,
L.gasseri, & L.fermentum are among the most prevalent
species in the mouth, but no significant difference in their
number was seen between healthy patients & patients with
periodontitis
Hojo et al 2007Hojo et al 2007..

9. 
Lactobacilli are rarely detected in subgingival Lactobacilli are rarely detected in subgingival
samples and they could not be found in any of samples and they could not be found in any of
the patients with chronic periodontitis in a the patients with chronic periodontitis in a
study carried out by Koll-klais et al ,2005.study carried out by Koll-klais et al ,2005.

Based on these results,it may be assumed that Based on these results,it may be assumed that
beneficial bacteria reside in the oral cavity & beneficial bacteria reside in the oral cavity &
might provide favourable environmental might provide favourable environmental
conditions for periodontal health maintenance.conditions for periodontal health maintenance.

10. After Kornman, 1997.
Pathogenesis of Periodontal Pathogenesis of Periodontal
DiseaseDisease
Genetic Risk FactorsGenetic Risk Factors
Host Host
Immuno-Immuno-
inflam-inflam-
matorymatory
ResponseResponse
MicrobialMicrobial
ChallengeChallenge
ConnectiveConnective
TissueTissue
andand
AlveolarAlveolar
Bone Bone
DestructionDestruction
Clinical Clinical
Signs ofSigns of
DiseaseDisease
PMNPMN
AntigensAntigens
LPSLPS
Other Other
VirulenceVirulence
FactorsFactors
Environmental Environmental
& Acquired& Acquired
Risk FactorsRisk Factors
Tissue Breakdown Products & Ecological Tissue Breakdown Products & Ecological FactorsFactors
AntibodyAntibody
MMPsMMPs
ProstanoidProstanoid
CytokinesCytokines

11. Possibilities for probiotic therapyPossibilities for probiotic therapy

Four strains of lactobacilli-L.rhamnosus5.1a,5.3a,5.5a & Lc705 Four strains of lactobacilli-L.rhamnosus5.1a,5.3a,5.5a & Lc705
when tested with periodontal pathogens like when tested with periodontal pathogens like
A.actinomycetemcomitans, P.gingivalis, T.forsythia & T.denticola, A.actinomycetemcomitans, P.gingivalis, T.forsythia & T.denticola,
were found to inhibit all periodontal pathogens & were found to inhibit all periodontal pathogens &
A.actinomycetemcomitans were the most susceptible species.A.actinomycetemcomitans were the most susceptible species.
Stamatova et al , 2008 ( in vitro study )Stamatova et al , 2008 ( in vitro study )

Lactobacillus sp. vary greatly in their adherent capacity to saliva Lactobacillus sp. vary greatly in their adherent capacity to saliva
coated surfaces .coated surfaces .
Stamatova et al, 2009 ( in vitro study )Stamatova et al, 2009 ( in vitro study )

Thus there is a need to identify the best probiotic strains & species Thus there is a need to identify the best probiotic strains & species
for different purposesfor different purposes

12. Adherence to saliva coated surfaces & Adherence to saliva coated surfaces &
integration into plaque biofilmintegration into plaque biofilm
In vitro studies have shown that putative
probiotic sp. can maintain their viability when
exposed to saliva & that saliva mediates their
adherence to oral surfaces
Krasse et al, 2006.
L.rhamnosus & L.paracasei possess strong
binding capacity
Haulioja et al, 2006.
High cell surface hydrophobicity correlate with
superior adhesive properties ( L.casei921&
L.acidophilus NCFM )
Collado et al, 2007.

13. Haukioja et al in 2008 have shown that L.rhamnosus Haukioja et al in 2008 have shown that L.rhamnosus
GG, L.casei Shirota & L.casei 11578 may affect the oral GG, L.casei Shirota & L.casei 11578 may affect the oral
ecology by preventing adherence of other pathogenic ecology by preventing adherence of other pathogenic
bacteria & by modifying the protein composition of the bacteria & by modifying the protein composition of the
salivary pellicle.salivary pellicle.
L.casei 921,L.casei 921,
L.bulgaricus LBL-6,L.bulgaricus LBL-6,
L.acidophilus &L.acidophilus &
L.rhamnosus 11.4aL.rhamnosus 11.4a
coaggregate withcoaggregate with
F.nucleatum ATCC F.nucleatum ATCC
at nearly 90%at nearly 90%
Stamatova et al,2008Stamatova et al,2008

14. Anticipated mechanisms of probiotic activity-Anticipated mechanisms of probiotic activity-
in vitro & in vivo studiesin vitro & in vivo studies
Ishikawa et al (2003) reported daily intake of L.salivarius, Ishikawa et al (2003) reported daily intake of L.salivarius,
decreases number of black pigmented anaerobic rods.decreases number of black pigmented anaerobic rods.
Koll-Klais et al (2005) showed Koll-Klais et al (2005) showed
facultative heterofermentive facultative heterofermentive
lactobacilli are the strongest lactobacilli are the strongest
inhibitor ofinhibitor of
A.actinomycetemcomitans, A.actinomycetemcomitans,
P.gingivalis,& P.intermediaP.gingivalis,& P.intermedia
It is recognized that probiotics can produce lactic It is recognized that probiotics can produce lactic
acid,H2O2, &bacteriocins which inhibit pathogensacid,H2O2, &bacteriocins which inhibit pathogens

15. Modulation of immunity by probioticsModulation of immunity by probiotics..
Alter the balance of
proinflammatory
& antiinflammatory
cytokines
secreted by
epithelial cells
In the intestine L.plantarum,
L.Rhamnosus GG effectively
Reduces the levels of IL-8
before H.pylori infection of
the epithelial cells
Rokka et al, 2008
Enhances innate
immunity & modulates
Pathogen induced
inflammation
Via toll-like
receptor –regulated
Signalling pathways.
Vanderpool et al,2008
The potentially protective role of probiotics in periodontal
disease might benefit from studies in gastrointestinal tract.

16. Clinical evidence of probiotic effectiveness Clinical evidence of probiotic effectiveness
in periodontal diseasein periodontal disease

17. Route of administrationRoute of administration
Generally probiotics are delivered
in dairy Products( fermented milks)
, as foodsupplement in tablet forms
, or in soft drinks. However , these
rotes of administration cannot
provide prolonged contact with oral
tissues, facilitating probiotic
adhesion to saliva coated surfaces.
A lozenge form or a chewing tablet
or gum might better serve the
needs for periodontal health prophylaxis
The frequency of intake needs further
evaluation because of the inability
of most probioticspecies tested
to reside permanently
in the oral cavity
To date, no studies have been
performed to investigate the
concentration – should not be
lower than 10
6
colony forming
Units/ml

18. ConclusionsConclusions
Based on current research data the effects of Based on current research data the effects of
probiotics on periodontal health & its maintenance are probiotics on periodontal health & its maintenance are
not clear. Systematic in vitro studies are first needed not clear. Systematic in vitro studies are first needed
to learn more about the eventual interactions of to learn more about the eventual interactions of
probiotic species & periodontal pathogens & oral probiotic species & periodontal pathogens & oral
biofilms, & also about their effects on periodontal biofilms, & also about their effects on periodontal
tissue reactionstissue reactions..
Thereafter, properly controlled, randomized , Thereafter, properly controlled, randomized ,
long term clinical trials are neededlong term clinical trials are needed
using the most promising strains .using the most promising strains .
However, there is every reason to believeHowever, there is every reason to believe
that results from the that results from the
studies of probiotic effectiveness in the GI tract could studies of probiotic effectiveness in the GI tract could
be adopted & executed in the mouth, provided be adopted & executed in the mouth, provided
that siutable probiotic strains are identifiedthat siutable probiotic strains are identified..
Thus probiotic approach might be of interest & Thus probiotic approach might be of interest &
we can see several possibilities forwe can see several possibilities for
the success of this support therapy in the futurethe success of this support therapy in the future

19. References References
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Immunol 2008:23:336-343.Immunol 2008:23:336-343.
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