role and effects of probiotics on oral health

1. • PAEDIATRIC &PREVENTIVE DENTISTRY
• KGMU LKO
PRESENTED BY – DR.KRITIKA SINGH
JR-3
PAEDIATRIC &PREVENTIVE DENTISTRY
KGMU LKO
PROBIOTICS
&
PREBIOTICS
1

2. 1ST concept of PROBIOTICS –
introduced by Noble prize winner,
Elie Metchnikoff
(1845-1916).
2

3. • Body houses - probiotics and prebiotics.
Probiotics and prebiotics in the diet :
 Can modify the composition and some
metabolic activities of the microflora .
 Help the body in producing vitamin K and
ensuring that the immune system works properly.
 Affect immune modulation and there are varied
but encouraging results in vaginosis , IBS
(Irritable Bowel Syndrome) and IBD (Inflammtory
Bowel Diseases)”.
INTRODUCTION
3

4. HISTORY OF PROBIOTICS
• Bulgarian yoghurt (sour milk), made from
Lactobacillus bulgaricus and Streptococcus
thermophilus culture strains used in Bulgaria In 1907 .
• Metchnikoff - Acid producing bacteria in fermented
milk products could prevent “fouling" in the large
intestine and, if consumed regularly, lead to a longer,
healthier life.
• In early 1930’s, in Japan, Minoru Shirota developed a
fermented milk product called Yakult .
• Yakult made by fermenting a mixture of skimmed milk
with a special strain of Lactobacillus casei shirota .
4

5. 5

6. 6

7. PROBIOTICS
• The word ‘ probiotic’ comes from the Greek word pro,
meaning “promoting” and biotic, meaning “life”.
• The term probiotic was first used by Lilly and Stillwell in
1965.
• The Food and Agriculture Organization of the United
Nation (FAO) defines probiotics as“ live micro-organisms,
which, when administered in adequate amount produce
beneficial effect to the host when taken orally”.
• (WHO 2001) Defined as, live microbes which when
administered in adequate amounts confer a beneficial
health effect on the host.
7

8. • Probiotics are also consumed in fermented foods with
active live cultures, such as yogurt.
• They are available in supplement form as capsules,
liquids, and powders.
• The human body contains approximately 3.5 pounds
(lb) of probiotic bacteria. This is more than the weight
of the brain.
• Probiotics appear effective in treatment of
childhood diarrhea, post-antibiotic diarrhea, and
pouchitis .
Medically reviewed by Alan Carter, Pharm.D. on August 22, 2017 — Written by
Joseph Nordqvist 8

9. MODES OF ACTION OF PROBIOTICS
1. Production of inhibitory
compounds
2. Competition for
chemicals/available energy
3. Competition for adhesion sites
(exclusion)
4. Enhancement of the immune
response
5. Improvement of water quality
6. Interaction with phytoplankton
7. Enzymatic contribution to
digestion
9

10. Properties of probiotics
• It should be safe to the host.
• It should not produce any pathogenic or toxic effect.
• It must be resistance to hydrochloric acid, bile and
pancreatic juice.
• It should have anti-carcinogenic activity.
• It should produce lactic acid.
• It should retain viability during storage and use.
• It should stimulate the immune system of the body.
• It should have the ability to colonize the
gastrointestinal tract bacteria.
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11. 11

12. 12

13. 400+ species of Probiotics in our body 13

14. Home of the probiotic bacteria:
The gastro-intestinal tract (GIT) is the best home where the probiotic
bacteria lived.
Within GIT- Small amount is found in stomach and small intestine,
but the majority is found in the large intestine.
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15. PROBIOTIC MICROORGANISMS
• Most commonly used Probiotics are lactic acid
bacteria - Lactobacilli, Streptococci and
Bifidobacteria
Possible modes of Action:
• Competitive exclusion
• Production of Bacteriocins
• Production of organic acids
• Altered absorption of the intestinal mucosa
Dr.T.V.Rao MD for Medical and Premedical Students in the Developing World • Email • doctortvrao@gmail.com
DR.T.V.RAO MD
15

16. 1.Lactobacillus (Lactic acid producing)
• Gram-positive rods, obligate and facultative
anaerobes, found in gastrointestinal and
genitourinary tracts.
• They provide nutritional benefits including inducing growth
factors and increasing the bioavailability of minerals.
• Stabilize the mucosal barrier and decrease intestinal
permeability.
• Fermented foods like yogurt, contain these bacteria.
• They helps in preventing yeast infections, urinary tract infection,
IBS, traveler's diarrhea, diarrhea resulting from Clostridium
difficile , treating lactose intolerance, skin disorders (fever
blisters, eczema, acne) and prevention of respiratory infections .
Reid, Gregor. “The scientific basis for probiotic strains ofLactobacillus.” Applied and environmental microbiology 65.9 (1999): 3763-3766.
<http://aem.asm.org/content/65/9/3763.short
16

17. 2.Bifidobacteria- ( lactic and acetic acids )
• Anaerobic, Gram-positive,
non spore forming, pleomorphic rod.
• BB536 - probiotic bacteria, which was first isolated from the
intestinal tract of healthy infants.
• Bifidobacteria , in combination with Lactobacillus species and
the probiotic yeast Saccharomyces boulardii, can reduce the
adverse effects of Helicobacter therapy.
• They are found in the intestinal tract within days of birth,
especially in breastfed infants.
• They help in the improvement of abdominal pain, bloating,
bowel dysfunction, incomplete evacuation, straining, and the
passage of gas.
Havenaar, Robert, Bart Ten Brink, and Jos HJ Huis. “Selection of strains for probiotic use.” Probiotics. Springer
Netherlands, 1992. 209-224 17

18. 3.Bacillus coagulans – (lactic acid)
Gram-positive rod, and therefore is often
misclassified as lactic acid bacteria, such as
lactobacillus. It is not a component
of the normal human flora.
4. SACCHAROMYCES-SPECIES
• S. boulardii also known as Saccharomyces
cerevisiae, is a non-pathogenic yeast
strain that has been used for the
treatment and prevention of diarrhea
resulting from multiple etiologies.
• Isolated from the skins of tropical fruits
found in Indochina.
Havenaar, Robert, Bart Ten Brink, and Jos HJ Huis. “Selection of strains for probiotic use.” Probiotics.
Springer Netherlands, 1992. 209-224
18

19. 5.Streptococcus: Produces large quantities of
the enzyme lactase, It helps in the prevention of
lactose intolerance.
6.Enterococcus: Normally found in the intestinal
tract of humans . Enterococcus faecium SF68 is a
specific probiotic strain that has been used in
the management of diarrhoeal illnesses.
7.Leuconostoc : Very often used in production of
fermented foods because of their ability to
produce lactic acid and diacetyl.
Leuconostoc are used to inhibit Listeria
monocytogenes in dairy and meat products
Havenaar, Robert, Bart Ten Brink, and Jos HJ Huis. “Selection of strains for probiotic use.” Probiotics. Springer
Netherlands, 1992. 209-224 19

20. COMMON PROBIOTIC AGENTS USED AS
THERAPEUTIC OPTIONS
• Lactobacillus acidophilus
• Lactobacillus ramnosus
• Lactobacillus paracasei
• Lactobacillus plantarum
• Lactobacillus bulgaricus
• Bifidobacterium infantis
• Bifidobacterium longum
• Bifidobacterium breve
• Streptococcus Thermophilus
20

21. Lactobacillus and Bifidobacterium have been
associated with :
• Alleviation of lactose intolerance
• Prevention and cure of viral infection
• Bacterial and antibiotic or radiotherapy induced
diarrhoeas
• Immunomodulation
• Anti-mutagenic and anti-carcinogenic effects,and
blood cholesterol reduction
Dr.T.V.Rao MD for Medical and Premedical Students in the Developing World • Email • doctortvrao@gmail.com
DR.T.V.RAO MD 21

22. NEED OF PROBIOTICS
1.Your Gut Health Is In Danger
• Digestive Issues- bloating, gas, abdominal pains, diarrhea, upset
stomach, constipation, cramps, IBS, or food poisoning.
2.Weakened Immunity:
• Common cold, flu, coughing, certain allergies, or sinus
congestion.
3.Mental Illness:
• Depression, brain fog, mood swings, irritability, or "senior
moments".
4.Medication Use:
• Taking antibiotics, anti-inflammatory medication, or birth control.
5.Skin Problems:
• Acne, skin blemishes, breakouts, dry/dull skin, Psoriasis, Rosacea,
or Eczema.
Probiotics &NIH: Plant polyphenols inhibit VacA, a toxin secreted by the gastric pathogen Helicobacter pylori
22

23. Keys to Choosing an Effective Probiotic
Following criteria should followed to make the right choice:
1. Doctor Formulated: The exact combination of strain type,
quantity and prebiotics determines the product's quality. Look for
real doctors specializing in gut health backing the product.
2. Strain Diversity: Many probiotic only contain 1-2 strains, which
are not nearly enough to make a difference. Look for a probiotic
formula that has a diverse set of strains (8-12) for the most
comprehensive approach to your digestive and immune health
3. Number of CFUs: The Quantity of CFUs has a huge impact on the
product's efficacy. Look for 40-50 billion of CFUs per serving.
Probiotics &NIH: Plant polyphenols inhibit VacA, a toxin secreted by the gastric pathogen Helicobacter pylori
23

24. 24

25. Beneficial effects of probiotics in human Diseases :
1. Diarrhoea
2. Irritable Bowel Syndrome(IBS): Lactobacillus
plantarum 299V.
3. Helicobacteriosis
4. Necrotising Enterocolitis
5. Urogential infection
6. Colon cancer
7. Blood pressureCholestrol
25

26. Probiotics in oral cavity
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27. 27

28. ANTI-CARIES EFFECT OF VARIOUS PROBIOTICS
1) Improvement of intestinal barrier integrity and up-regulation
of mucin production :
• Long-term consumption of milk containing Lactobacillus
rhamnosus GG strain can reduce initial caries in children.
• Ingestion of Lactobacillus reuteri ATCC 55739 or Bifido-
bacterium DN-173 010 can induce significant reduction of
cariogenic S. mutans in saliva.
• Mollstam, et al. disclosed several new strains of Lactobacillus,
including L. reuteri CF2-7F (ATCC PTA-4965), L. reuteri MF2-3
(ATCC PTA-4964) and especially L. reuteri FJ1 “Prodentis”
(ATCC PTA-5289) and L. reuteri FJ3 (ATCC PTA- 5290), that have
good antimicrobial activity against S. mutans and good binding
characteristics to oral mucin and thereby prevent, reduce or
treat dental caries. 28

29. 2) Involvement in binding of oral microorganisms to proteins
(biofilm formation), action on plaque formation and on its
complex ecosystem by competing and intervening with
bacteria-to-bacteria attachments :
• Several mutated strains of S. mutans that lack the machinery
to efficiently metabolize fermentable carbohydrates to organic
acids have been developed.
• In one case, a non-acid producing S. mutans strain BCS3-L1
that produces an antibiotic called mutacin 1140 active against
other S. mutans strains to replace the naturally occurring
cariogenic strains in oral cavity has been developed.
• This strain was significantly less cariogenic than the parent
strain JH1140 due to the delete of lactic acid dehydrogenase
open reading frame. 29

30. 3) Killing or inhibition of growth of pathogens through
production of bacteriocins or other products, such as
acid or peroxide, which are antagonistic towards
pathogenic bacteria. Involvement in binding of oral
micro-organisms to proteins (biofilm formation) :
• Calgar et al (2007) evaluated the effect of xylitol and
probiotic chewing gums on salivary mutans
streptococci and lactobacilli and concluded that daily
chewing on gums containing probiotic bacteria or
xylitol reduced the levels of salivary mutans
streptococci in a significant way .
30

31. 4) Interference with signaling mechanisms :
• Several pathogenic properties of S. mutans are
regulated by quorum sensing mechanism involving
Competence Stimulating Peptide (CSP) as the
signaling molecule.
• Addition of a high concentration of CSP can
interfere with signaling events of S. mutans and
induce the death of the bacterium, thus exhibiting
a potential beneficial effect against dental caries.
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32. 5) Targeted antimicrobial therapy via a novel STAMP technology :
• Eckert et al. reasoned that, with the exception of a limited number
of pathogens, the majority of indigenous oral microorganisms are
benign or beneficial.
• These investigators formulated a new class of antimicrobials called
Specifically Targeted Anti-Microbial Peptides (STAMPs).
• A “STAMP” is a fusion peptide with two moieties: a killing moiety
made of a nonspecific antimicrobial peptide and a targeting
moiety containing a species specific binding peptide.
• The targeting moiety provides specific binding to a selected
pathogen and facilitates the targeted delivery of an attached
antimicrobial peptide. 32

33. COMMERCIAL ORAL PREPARATIONS
1.Gum Perio Balance (marketed by Sunstar, Etoy, Switzerland)
• This is the 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 periodontal pathogens.
• Each dose of lozenge contains at least 2 × 108 living cells of L. reuteri
Prodentis.
• Advised-to use a lozenge every day, either after a meal or in the
evening after brushing their teeth, to allow the probiotics to spread
throughout the oral cavity and attach to the various dental surfaces.
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34. 2.Wakamate D (Wakamoto Pharmaceutical Co., Tokyo, Japan)
This probiotic tablet contains 6.5x108 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 WB.
3. Prodentis (BioGaia, Stockholm, Sweden)
• This probiotic lozenge is a blend of two Lactobacillus reuteri
strains containing a minimum of 1x 108 colony forming units
(CFU) for each of the strains DSM 17938 and ATCC PTA 5289.
34

35. Sporolac, Saccharomyces boulardii and yogurt (L. bulgaricus + L.
thermophillus) are the most common probiotics used in India.
Lactobacilli solution is an example of a probiotic, usually given to paediatric
patients in India.
The latest and recent addition to the list of probiotics in India is ViBact
(which is made up of genetically modified Bacillus mesentricus), which acts
as an alternate to B-complex capsules.
In India, only sporulating lactobacilli are produced and they are sold with
some of the antibiotic preparations.
A formulation of approximately 10⁸ probiotic bacteria per gram or mililitre
(10⁸ /ml) with a daily intake of 1.5-2 dl per day is recommended dose.
PROBIOTICS - IN INDIA
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36. • India play a major role for
producing largest
probiotic products milk.
Therefore, Amul Prolife,
Mother diary, Nestle
Nesvita (first India’s Dahi
with probiotics) and Yakult
Danone produces by the
Indian market.
India’s first probiotic icecream
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37. PROBIOTICS SUPPLEMENTS
BIOTRUST PRO-X10: A SYNBIOTIC LIKE NO OTHER
synbiotic - prebiotic and probiotic.
Pro-X10™ is the probiotics supplement that so far
addresses some fundamental problems:
• Probiotics are live cultures: This means that not only do they
have a finite lifespan; they also need nourishment to live.
• They are extremely sensitive to changes in environmental
conditions.
• From manufacture, to multiple stages of transportation and
storage, many of them will have died.
• A big number of the remaining probiotics, after time get killed
by stomach acids.
WebMD: Probiotics &NIH: Plant polyphenols inhibit VacA, a toxin secreted by the gastric pathogen Helicobacter pylori
37

38. PRECAUTIONS AND CONTRAINDICATIONS OF PROBIOTIC USE
• Since probiotics contain live micro-organisms, there is a slight
chance that these preparations might cause pathological
infection, particularly in critically ill or severely immuno-
compromised patients.
• Probiotic strains of Lactobacillus have also been reported to
cause bacteremia in patients with short-bowel syndrome,
possibly due to altered gut integrity.
• Lactobacillus preparations are contraindicated in persons with
a hypersensitivity to lactose or milk.
• S. boulardii is contraindicated in patients with a yeast allergy.
• No contraindications are listed for Bifidobacteria. 38

39. Recently, major and minor risk factors for probiotics-associated
sepsis have been identified.
• Major risk factors include:
 Immunosuppression (including a debilitated state or malignancy)
 Prematurity infants.
• Minor risk factors include-
 Presence of a central venous catheter,
 Impairment of the intestinal epithelial barrier (such as with diarrhoeal
illness),
 Cardiac valvular disease (Lactobacillus probiotics only),
 Concurrent administration with broad-spectrum antibiotics to which the
probiotic is resistant.
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40. 40

41. 41

42. PREBIOTICS
• The concept of prebiotic was introduced by Gibson &
Roberfroid, in 1995
• Prebiotics are an alternative for probiotics or their
cofactors.
• “Non-digestible food ingredients that beneficially affect
the host by selectively stimulating the growth and/or
activity of one or a limited number of bacteria in the
colon that can improve host health."
• Oligosaccharide is the main constituent of prebiotic food
products.
• Oligosaccharides stimulate the growth of benefic
bacteria and increase the resistance to invading
pathogens.
42

43. Properties of Prebiotics:
• Limited hydrolysis and absorption in the upper
GIT(gastro-intestinal tract).
• Selective growth stimulation of beneficial bacteria in the
colon.
• Immuno-stimulation.
• Stimulation of beneficial flora that promotes
colonization resistance
43

44. How do prebiotics work?
• Increase a number of
bifido-bacterium and lactic
acid bacteria.
• Effect on the metabolism
of lipids.
• Suppression of putrefactive
bacteria.
• Growth of bifido-bacteria.
• It helps to lower colon
cancer risk
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45. 45

46. 46

47. X TEND-LIFE KIWI-KLENZ : ( called Digesten-K )
It is formulated with all of the essential components of kiwifruit,
including skin enzymes and phenolics.
The goal of X tend-Life Kiwi-Klenz is -
1.Cleaning Out the Toxins
2.Balancing Bacteria
3.Restoring Digestive Function
Benefits of Xtend-Life Kiwi-Klenz:
• Aids in digestion
• Supports immune system
• Reduces toxic load
• Increasing nutrient absorption of food and supplements
• Boosts energy levels
This product not sold in stores.
WebMD: Probiotics &NIH: Plant polyphenols inhibit VacA, a toxin secreted by the gastric pathogen Helicobacter pylori
47

48. 48

49. USES OF PREBIOTIC
Improve immune function in both the gut and body.
Establish a healthier balance of bacteria in the gut.
Promote regular bowel movements &Suppress appetite.
Reduces the risk of an intestinal infection.
Increase in mineral absorption and improvement of bone health.
Modulation of gastro-intestinal peptides production, energy
metabolism and satiety.
Initiation (after birth) and regulation/modulation of immune functions.
49

50. FUTURE PROSPECTS
• Probiotics can be used as passive local immunization against dental
caries. High titres of antibodies can also be directed against human
cariogenic bacteria produced in bovine colostrums over the vehicle
of fermented milk.
• Early mucosal colonization with E.coli bacteria in newborns
stimulates mucosal immune system to produce specific antibodies
as well nonspecific secretory immunoglobulins.
• Today NASA, USA carrying out research into probiotics food
product aimed enabling humans to live in space. [ project is known
under name LACMOS]
• Research is directed at the reduction of severity and occurrence of
mucosal lesions, specifically apthous ulcers.
50

51. Conclusion..
Probiotic and prebiotic therapy has shown encouraging
results in many clinical conditions of human beings such
as diarrhoea of multiple etiologies, etc. Since probiotics
are live micro organisms, it is possible that they may
result infection in the host. Therefore, it is emphasized
that proper evaluation with validated results of these
products before bringing probiotics into routine uses for
human health.
‘An apple a day keeps doctor away’ the famous
quote now in recent years will definitely modify into
‘Probiotics per day keeps doctor away’.
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52. 52

53. Q.1 Which of the following are living
microorganisms-
A.Probiotics
B.Prebiotics
C.Synbiotics
D.Pro and prebiotics
53

54. Q.2Most commonly used Probiotics are –
A. Sachromyces
B. lactic acid bacteria
C. Enterococcus
D. Bacillus spc.
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55. Q.3 Minimum Quantity of CFUs required in a
probiotic for increased efficacy –
A. 30-50 billion of CFUs per serving
B. 45-50 billion of CFUs per serving
C. 40-50 billion of CFUs per serving
D. 50-60 billion of CFUs per serving
55

56. Q.4 Main constituent of prebiotic food products -
A. Polysaccharide
B. Diasaccharide
C. Monosaccharide
D. Oligosaccharide
56

57. Q.5 STAMPs is-
A. Specially Targeted Anti-Microbial Peptides
B. Sensitively Targeted Anti-Microbial Peptides
C. Specifically Targeted Anti-Microbial Probiotics
D. Specifically Targeted Anti-Microbial Peptides
57

58. Q.6 “STAMP” is a fusion peptide with moieties-
A. Many killing moiety and a targeting moiety
B. Two killing moiety and a targeting moiety
C. A killing moiety and a two targeting moiety
D. A killing moiety and a targeting moiety.
58