Effects of Probiotics 1

Probiotics and their effects on Gingivitis and Periodontitis

Danilla Guillen and Macy LeBlanc

Lamar Institute of Technology

Dental Hygiene Program

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Probiotics and their effects on Gingivitis and Periodontitis

In the last two decades, probiotics have increased in popularity as an alternative to, and in

conjunction with modern medicine to enhance the functions of the gastrointestinal and immune

system while fighting bacterial infections. Over the past decade, research has demonstrated

probiotics’ ability to stabilize oral flora, restrict pathogenic bacteria from adhering to oral

mucosa, and restrict their growth. We believe that the integration of probiotics along with

traditional dental hygiene treatments such as SRP’s can reduce the incidence and prevalence of

periodontal disease and gingivitis.

Probiotics have been proven clinically effective and have been used for over a century for

gastrointestinal health. “Elie Metchnikoff… initially proposed the use of fermented products…

to improve the health of the GIT” (Mishra 2020) in 1908. After years of clinical studies and

research, probiotics can now be found over the counter at your local grocery and drug store in

food products and supplements. Comparatively, the probiotics capability to balance gut health

can also be applied to the maintenance of oral flora homeostasis. “A total of 500-700 species of

bacteria combine to form the oral microflora” (Mishra 2020), and overpopulation of a bacterial

species creates diseases and conditions such as periodontitis. An overabundance of anaerobic

bacteria in the oral cavity increases gingival inflammation, biofilm retention and an

overproduction of microbes causing gingivitis and periodontitis. Gingivitis is classified as

generalized gingival inflammation and is the precursor to periodontal disease. “Periodontitis is

an infection-driven inflammatory disease in tooth-supporting tissues” (Könönen 2019) that

causes clinical attachment loss, bone loss, and can put patients at risk for systemic diseases. “P.

gingivalis is suggested to be the principal pathogen in the process [of periodontal disease],

causing a disturbed interplay between the subgingival biofilm and the host response” (Könönen
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2019). There are a multitude of factors, such as bacterial composition, quantity, and biofilm

retention that alter the symbiotic relationship of the host and oral microbiome; this ultimately

leads to periodontal disease and an increased risk of developing other health issues. We believe

that having a variety of treatment options, such as probiotic supplements along with traditional

dental hygiene care and good oral hygiene, could reduce the incidence of gingivitis and

periodontitis.

There are several probiotics that help mitigate and disrupt the overpopulation of bacteria

that causes periodontal disease. The main probiotic that has been observed in helping in the

reduction of P. gingivalis, is the bacteria lactobacillus and its many strains. P. gingivalis is an

anaerobic gram-negative bacteria that is the main contributor to the onset of gingivitis and

periodontitis. Lactobacillus strains have been shown to suppress the growth of the periodontal

pathogen P. gingivalis. (Chugh 2020). The strains reduce the numbers of P. gingivalis by

releasing bacteriocin, which is an antibacterial agent, that causes a damage to the pathogenic

bacteria's plasma membrane, thus leading to cell lysis or cell death. Clinical studies identified the

probiotic lactobacillus strains; L. bevis, L. plantarum, L. ruteri, L. rhamnosus, and L. salivarius

in the improvement of periodontal diseases during clinical studies. Patients saw a reduction in

gingival inflammation, better plaque and bleeding scores, and a reduction of bone resorption in

those suffering with periodontitis. Other probiotic strains that are great are streptococcus

salivarius K12 and M18. Certain strains work better against a variety of dental issues.

Further details of comprehensive research complied by Chugh 2020, “A critical appraisal of the

effects of probiotics on oral health”, is listed below.

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Probiotics usage in the treatment of periodontal disease is still fairly new, having only

been discovered about 20 years ago. There are still many studies that must be conducted in

consideration of potential side effects and contraindications of taking probiotics. Allergy to the
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probiotic lactobacillus is rare but can affect certain patients like infants and children. However,

in the clinical trials of treatment of periodontal diseases using probiotics in adjunction with other

treatments, there have been no contradictions or side effects reported. The usage of probiotics

has become a great alternative to patients that suffer from side effects or allergies or have

contradictions to other forms of therapy. “Periodontal diseases are sometimes treated with

antibiotics, which can lead to GI side effects, antibiotic resistance, and severe allergic reactions”

(Mishra 2020).

In conclusion, probiotics such as strains of lactobacillus can reduce the incidence of

gingivitis and periodontitis by selective microbe reduction and overall balancing of the oral flora.

Additionally, probiotics provide an abundance of other benefits such as reduction of

Streptococcus mutans, the bacteria responsible for dental caries, and the reduction of Candida

albicans, the microbe responsible for oral candidiasis. There are a multitude of additional

benefits that probiotics can be used for in dentistry, and further research is needed to explore all

potential benefits and risks.

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Works Cited

Chugh, P., Dutt, R., Sharma, A., Bhagat, N., & Dhar, M. S. (2020). A critical appraisal of

the effects of probiotics on oral health. Journal of Functional Foods, 70, 103985.

https://doi.org/10.1016/j.jff.2020.103985 Accessed November 2023.

Ferrer, M. D., Salvadora-Perez-Vilaplana, & et al. (2020, August 31). Topic Application

of the Probiotic Streptococcus dentisani Improves Clinical and Mth and m

iicrobiological Parameters Associated With Oral Health. Fronteirs

https://www.frontiersin.org/articles/10.3389/fcimb.2020.00465/full

Accessed November 2023.

Kang, M.-S., Lee, D.-S., Lee, S.-A., Kim, M.-S., & Nam, S.-H. (2020). Effects of p

robiotic bacterium Weissella cibaria CMU on periodontal healcrobiota: a r

andomised, double-blind, placebo-controlled trial. BMC Oral Health, 20.

https://doi.org/10.1186/s12903-020-01231-2

Accessed November 2023.

Könönen, Eija, et al. “Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues.”

Journal of Clinical Medicine, U.S. National Library of Medicine, 31 July 2019,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723779 Accessed

February 2024.

Mishra, S., Rath, S., & Mohanty, N. (2020). Probiotics—A complete oral healthcare

package. Journal of Integrative Medicine, 18(6), 462–469.

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https://doi.org/10.1016/j.joim.2020.08.005

Accessed November 2023.