Effects of Probiotics on Oral Health
Condition: Periodontal Health; Dental Plaque Accumulation
MeSH terms: Dental Plaque
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Some probiotics have been shown to have preventive effects on infectious diseases and
      allergies. Because their long-term enhancement of the immune responses of children, they have
      been recommended for infants in some countries. The most promising ones seem to be the
      combination of Bifidobacterium lactis BB-12 and Lactobacillus rhamnosus GG. Probiotic
      microbes are mainly ingested orally and the gastrointestinal tract is thus the primary target
      organ for them. However, the mouth is the first part of the gastrointestinal tract. Most
      probiotics are in theory cariogenic, thus their effects on oral health should be known.
      Several probiotics decrease levels of salivary mutans streptococci (MS), but in other
      respects very little is known about their effects on the oral microbiota. Also effects of
      probiotics on dental plaque should be studied. This study aims to find out the effects of the
      combination of BB-12 and LGG, delivered with a lozenge (4 weeks, twice a day) with a mixture
      of them on the amount of plaque and gingival health
    

Detailed description: 
      The Food and Agriculture Organization (FAO) of the United Nations and the World Health
      Organization (WHO) have defined probiotics as "live micro-organisms, which when administered
      in adequate amounts, confer a health benefit to the host" (WHO 2002). They should preferably
      be of human origin, be able to temporarily colonize the gastrointestinal tract and survive in
      it. They must also be non-pathogenic and non-toxic.

      Probiotics are used in the prevention and treatment of infectious diseases and allergies
      (Hatakka and Saxelin, 2008; Salminen et al., 2010). In some countries probiotics are
      recommended for infants and adults because of their long-term enhancement of the immune
      responses. Combinations of probiotics, like Bifidobacterium lactis BB-12 (BB-12) and
      Lactobacillus rhamnosus GG (LGG), appear to be most effective in this respect (Isolauri et
      al., 2000; Rautava et al., 2009; Smith et al., 2012). Probiotics are mainly ingested orally,
      and the gastrointestinal tract is thus the primary target organ for probiotic
      micro-organisms. However, when ingested in the form of for example tablets, chewing gums,
      cheese and milk, the oral cavity is exposed to the probiotics. With the world-wide increase
      in the use of probiotics their effects of on oral health have become a hot topic.

      Many types of probiotic bacteria have been explored but the most widely studied species are
      those that belong to the genera Lactobacillus and Bifidobacterium. Yogurt and fermented milk
      products are considered the simplest source of probiotic administration for humans. The
      proven effects of probiotics in general health has led to more research in the oral health
      field including dental caries, periodontal disease and halitosis. Some clinical studies have
      demonstrated a decrease in the cariogenic mutans streptococci counts and in dental plaque
      (Näse et al. 2001, Ahola et al. 2002, Nikawa et al. 2004, Caglar et al. 2007, Twetman &
      Keller 2012). Probiotics have also shown improvements in the periodontal status in patients
      with periodontal disease (Riccia et al. 2007, Shimauchi et al. 2008, Teughels et al. 2013,
      Yanine et al. 2013). Recently, Toiviainen et al. (2015) found that the combination of
      Lactobacillus rhamnosus GG (LGG) and Bifidobacterium strain Bifidobacterium lactis (BB-12)
      improved the periodontal health in healthy adults by reducing the plaque amount and
      subsequently the gingival inflammation without affecting the oral microbiota.

      More evidence is necessary to confirm the efficacy of the combination of LGG and BB-12 in the
      oral health.
    

Intervention name(s): Probiotics; Placebo
Intervention type(s): Dietary Supplement; Dietary Supplement
Intervention description(s): A half of the participants will be randomly allocated to the probiotics group. They will receive a probiotics lozenge twice a day for 4 weeks. Pre and Post intervention clinical exam will be conducted; A half of the participants will be randomly allocated to the placebo group. Lozenges with no probiotics will be given twice daily for 4 weeks. Pre and Post intervention clinical exam will be conducted
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention