GOOD AFTERNOON

PROBIOTICS AND PERIODONTAL HEALTH

Introduction History Definitions Mechanism of action Probiotics in periodontal health Risks during probiotic treatment Conclusion References

CONTENTS

Periodontitis Multifactorial

Conventional treatment modalities Mechanical Debridement• Non surgical• Surgical Antibiotics

Introduction

Eliminate entire microflora

Need for new treatment paradigm

ANTIBIOTIC RESISTANCE ANDRECOLONIZATION BY

PATHOGENIC BACTERIA

PROBIOTICS

Probiotics = ‘pro’(for) and ‘bios’( life) term coined by Lilley and Stillwell(1965)

Concept of probiotics by Elie Metchnikoff in his book “prolongation of life”(1907) proposed a diet containing milk fermented by lactobacilli, which produce large amounts of lactic acid that could increase the life span of humans.

History

Probiotic

Currently adopted definition By FAO /WHO

Live microorganisms which when administered in adequate amounts confer a health benefit on the host

Definitions

Prebiotic

A non-digestible food ingredient that confers benefits on the host by selectively stimulating the growth and/or activity of one bacterium or a group of bacteria in the colon, and thus improve the host health

Synbiotic

The term synbiotic is used when a product contains both probiotics and prebiotics. Because the word alludes to synergism, this term should be reserved for products in which the prebiotic compound selectively favors the probiotic compound

Pathogenic bacteria

ANTIBIOTICS VS PROBIOTICS

Antibiotics

Good bacteria

Favours good bacteria

Pathogenic Bacteria

Probiotics

Lactobacillus species. L acidophilus L. casei L. crispatus L. delbrueckii subsp. L. fermentum L. Gasseri L. johnsonii L. paracasei L. plantarum L. reuteri L. rhamnosus

Microorganisms that are considered to be probiotics

Bifidobacterium species

B. bifidum B. breve B. Infantis B. longum B. lactis B. adolescentis

Others

Lactococcus lactis subsp. Cremoris Enterococcus faecalum Streptococcus salivarius subsp.thermophilus S. diacetylactis S. Intermedius Yeasts and moulds (Saccharomyces boulardii,Aspergillus

niger)

Lactobacillus: enhance innate and acquired immunity inhibition of pro-inflammatory mediators production of enzymes to digest and metabolize proteins and

carbohydrates. synthesis of vit. B and vit.K and facilitates breakdown of bile

salts.

Health benefits

Bifidobacterium

metabolization of lactose, generate lactic ions from lactic acid and synthesize vitamins.

ferment indigestible carbohydrates and produce beneficial short chain fatty acids.

Streptococcus thermophilus and Lactobacillus bulgaricus

metabolize lactose, improve lactose tolerance and antimicrobial activity

Saccharomyces boulardii: secrete proteases and other substances that breakdown

bacterial enterotoxins and inhibits their binding to intestinal receptors.

They also help in immune function enhancement.

1. Direct interaction2. Competitive exclusion3. Modulation of host immune response

Mechanism of action

Direct interaction:

Probiotics interact directly with the disease-causing microbes, making it harder for them to cause the disease.

Production of antimicrobial substances against periodonto pathogens

Competitive exclusion:

Beneficial microbes directly compete with the disease developing microbes for nutrition or enterocyte adhesion sites.

Modulation of host immune response:

Probiotics interact with and strengthen the immune system and help prevent disease.

Modulation of host defenses including the innate as well as the acquired immune system

Modulate host immunity both systemically and locally Stimulate dendritic cells (antigen presenting cells)

Expression of Th1 and Th2

Modulate pathogen induced inflammation through ‘toll like receptors’ on dendritic cells.

Th1 response: Phagocytose intracellular pathogens Th2 response: Extracellular pathogens

Glycoprotein-carbohydrate cell surface interaction mediate by interspecies interactions

Apoptosis is yet another proposed mechanism. Probiotics stimulate apoptosis of tumor cells

In oral health, possible mechanisms may be

• Organic acids• Hydrogen peroxide• Bacteriocins

Production of antimicrobial

substances• Compete with pathogens for

adhesion sites• Involvement in metabolism of

substrates (competing with oral micro organisms for substrates available)

Binding in Oral Cavity

• Stimulate non specific immunity• Modulate humoral and cellular

immune response

Co-Immuno modulatory

Produce antioxidants- neutralize free electrons that are needed for mineral formation.

Break down putrescense odours by fixating the toxic gases ( volatile sulphur compounds) and change them into gases

needed for metabolism

High cell viability, resistant to low pH and acids Ability to persist Adhesion to cancel the flushing agent Able to interact or to send signals to immune cells Should be of human origin Should be non pathogenic Resistance to processing Influence local metabolic activity

Criteria of an ideal microorganism used as probiotic

Plaque modification, altering anaerobic organisms colonization,altering pocket depth, improving clinical attatchment.

The application of selected beneficial bacteria, as an adjunct to scaling and root planing, would also inhibit the periodonto-pathogen recolonization of periodontal pockets and thus achieve and maintain periodontal health.

Probiotics can mimic response similar to a pathogen but without periodontal destruction

Probiotics and periodontal disease

Protect epithelium barrier by maintaining tight junction protein expression

Lactobacillus paracasei and Lactobacillus rhamnosus had a high capacity to antagonize important oral pathogens, including Streptococcus mutans and Porphyromonas gingivalis.

Weissella cibaria, a gram positive facultative anaerobic lactic acid bacterium that has been isolated from humans, is present in fermented foods and is considered a potential probiotic agent.

-.

W. cibaria secretes a significant quantity of hydrogen peroxide as well as bacteriocin that acts against gram positive bacteria.

This bacterial species has the capacity to coaggregate with Fusobacterium nucleatum and to adhere to epithelial cells. These properties could enable W. cibaria to effectively colonize the oral cavity and limit the proliferation of pathogenic bacteria

The antiplaque activity of the Probiotic mouth rinse:.    reduces the adhesion of bacteria to the tooth surface inhibits the growth and proliferation of microorganisms on

the tooth surface inhibits the formation of the intercellular plaque matrix,

modifies plaque biochemistry to reduce the formation of cytotoxic product

modifies plaque ecology to a less pathogenic flora.

A decrease in gingival bleeding and reduced gingivitis has been observed by Krasse et al with the application of L. reuteri

Inhibits the growth of P. gingivalis and Prevotella intermedia.

Probiotics are provided into the food items in one of four basic ways:

(i) as a culture concentrate added to beverages.(e.g. fruit juice)(ii) inoculated into pre-biotic fibres which promote the growth

of probiotic bacteria(iii) inoculated into milk and milk-based foods (e.g. milk drinks,

yoghurt, cheese, kefir, bio-drinks)

Available Probiotic Agents

As lyophilized, dried cells packaged as dietary supplements (tablets, chewing gums, straws).

The archetypical probiotic food is yoghurt and daily consumption of dairy products seems to be the most natural way to ingest probiotic bacteria

LOZENGES

Yoghurt

Chewing gums

Probiotic Mints

Sepsis

Lactobacillus species are a rare but well-recognized cause of endocarditis in adults (and other forms of sepsis in children) in

the absence of probiotic supplementation. Several reports have directly linked cases of Lactobacillus and other bacterial sepsis to the ingestion of probiotic supplements.

Deleterious metabolic activitiesImmune deviation or excessive immune

stimulation

Risks during probiotic treatment

Major risk factors1) Immune compromise, including a debilitated state or malignancy2) Premature infantsMinor risk factors1) CVC2) Impaired intestinal epithelial barrier, eg, diarrheal illness, intestinal

inflammation3) Administration of probiotic by jejunostomy

4)Probiotics with properties of high mucosal adhesion or known pathogenicity5) Cardiac valvular disease (Lactobacillus probiotics only)

Risk Factors for sepsis

Conclusion

Probiotics represent an upcoming field of research, the examination of the close relationships between oral health and our daily diet.

It is a natural way of maintaining health and protecting oral tissues from disease, and datas suggest that the potential benefits increase with an early childhood start.

It still remains to be seen, the extent to which probiotics are applicable to promoting oral health. Although the results of past studies are encouraging, still much needs to be done for identification of the probiotics that are best suited to oral use, as well as the most appropriate vehicles for its delivery.

The application of probiotic strategies may, in near future provide an end to many infections occurring in oral cavity.

Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria (October 2001) Retrieved 2009-11-04

Jürgen Schrezenmeir and Michael de Vrese Am J Clin Nutr February 2001 vol. 73 no. 2 361S-364S

Deepa D,D.S.Mehta Is the role of probiotics friendly in the treatment of periodontal diseases? JISP Vol 13 Issue 1 Jan-Apr 2009 30-31

Anirban Chatterjee,Hirak Bhattacharya,Abhishek Kandwal Probiotics in periodontal health and disease JISP Vol 15 2011 23-24

Gupta G Probiotics and periodontal health Journal of medicine and life Kedar Saraf, MC Shashikanth, Tulasi Priya, Nishat Sultana, Nallan CSK

Chaitanya JAPI • august 2010 • VOL. 58 488-492 Robert J Boyle, Roy M Robins-Browne, and Mimi LK Tang The American

Journal of Clinical Nutrition V Shivakumar, S Pavithrapriyadharshoni, V Gopinath n Journal of

Multidisciplinary Dentistry, Vol. 1, Issue 6, September-October 2011 316-320

References

THANK YOU

PRESENTED BYAYSHA JABEEN.M.2007-2012 BATCHVIVEKANANDHA DENTAL COLLEGE FOR WOMEN