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Probiotic supplements (Lactobacillus reuteri DSM 17938 and ATCC PTA 5289) do not affect regrowth of mutans streptococci after full-mouth disinfection with chlorhexidine: a randomized controlled multicenter trial
Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
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2012 (English)In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 46, no 2, 140-146 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate the effectiveness of tablets containing two probiotic Lactobacillus reuteri strains in inhibiting regrowth of salivary mutans streptococci (MS) after full-mouth disinfection (FMD) with chlorhexidine. The null hypothesis was that the levels of MS would not differ in comparison with a placebo protocol. The study population was comprised of 62 young adults (mean age 23 years) with moderate or high counts of salivary MS who volunteered after informed consent. The study was a double-blinded randomized controlled trial with two parallel groups. After a 3-day chlorhexidine regimen, the subjects were randomly assigned to a test group (n = 32) with probiotic lozenges (2/day) or a placebo group (n = 30). The intervention period was 6 weeks, and stimulated whole saliva was collected at baseline and after 1, 6, and 12 weeks. The samples were processed for MS by a chair-side test and DNA-DNA hybridization as an estimate of 19 bacterial strains associated with oral health and disease. There was no significant difference between the groups at inclusion, and FMD reduced the salivary MS levels significantly in both groups. The MS suppression lasted less than 6 weeks and there were no statistical differences in salivary MS regrowth between the test and control groups at any of the follow-ups. Likewise, there were no major differences in the regrowth patterns of the checkerboard panel between the two groups. We conclude that daily oral administration of L. reuteri did not seem to affect or delay the regrowth of salivary MS after FMD with chlorhexidine. Copyright (c) 2012 S. Karger AG, Basel

Place, publisher, year, edition, pages
S. Karger, 2012. Vol. 46, no 2, 140-146 p.
Keyword [en]
Biofilm, Caries, DNA hybridization, Mutans streptococci, Saliva
National Category
URN: urn:nbn:se:umu:diva-55682DOI: 10.1159/000337098ISI: 000303368300008OAI: diva2:528803
Available from: 2012-05-28 Created: 2012-05-28 Last updated: 2013-04-12Bibliographically approved
In thesis
1. Probiotic Lactobacilli in the context of dental caries as a biofilm-mediated disease
Open this publication in new window or tab >>Probiotic Lactobacilli in the context of dental caries as a biofilm-mediated disease
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The World Health Organization defines probiotics as ‘live microorganisms which, when administered in adequate amounts, confer a health benefit to the host’. Traditionally, probiotic microorganisms have been used to prevent or treat gastrointestinal tract diseases. In the last 15 years, there has been increasing interest of a possible probiotic impact on the oral microbiota and dental caries. Dental caries is a multifactorial disease, and the causative factor in the oral microbiota includes a shift from a balanced microflora to a microflora that includes more aciduric species such as mutans streptococci (MS), non-mutans streptococci, and Actinomyces. MS is considered an opportunistic pathogen although several other bacteria also contribute to the disease. Early acquisition of MS is associated with early development of caries; therefore a desirable complement to other prophylactic measures would be a MS colonization inhibitor.

Objective: To better understand how selected strains of probiotic lactobacilli interact with MS in vitro and in vivo and to study the impact of probiotic lactobacilli on caries development during childhood.

Material and methods: The in vitro properties of probiotic lactobacilli were studied with regard to (i) acid production from sugars and sugar alcohols, (ii) growth inhibition capacity on clinical isolates and reference strains of MS as well as Candida albicans and (iii) the capacity to co-aggregate with MS. A randomized controlled trial (RCT) tested the short-term effect of intervention with two Lactobacillus reuteri strains on MS, which was evaluated after treatment with chlorhexidine. The re-growth patterns of MS and 19 other selected strains were also evaluated. In the second clinical study  we investigated the long-term effect on MS prevalence and dental caries after an intervention with Lactobacillus paracasei ssp. paracasei F19 (LF19) between 4 and 13 months of age.

Results: The results from the in vitro testing showed that strains of probiotic lactobacilli differed in their fermentation patterns, inhibition capacity and their capacity to co-aggregate, which should be kept in mind in the translation to clinical research. The clinical study on short-term effects of two L. reuteri strains on MS and other oral strains showed no effect on re-growth patterns after intervention. The clinical study on long-term effects of LF19 showed no effect on the prevalence of MS. Furthermore, the clinical follow-up at 9 years of age showed no differences in either decayed, missing, and filled surface (dmfs) or DMFS between the probiotic and placebo groups. Evaluation of saliva samples showed no signs of oral colonization with LF19 in the study group.

Conclusion: The in vitro testing showed potentials of the selected probiotic Lactobacillus strains for interference with MS and C. albicans. The results from the clinical studies showed no such effect on MS or dental caries. Evidence regarding the effectiveness of specific probiotic applications in the prevention of dental caries is limited and does not allow for conclusions concerning the use of probiotic bacteria as a preventive measure.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 57 p.
Umeå University odontological dissertations, ISSN 0345-7532 ; 125
caries prevention, co-aggregation, dental caries, growth inhibition, mutans streptococci, probiotic lactobacilli, re-colonization
National Category
Research subject
urn:nbn:se:umu:diva-67843 (URN)978-91-7459-574-1 (ISBN)
Public defence
2013-05-03, Sal B, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 13:00 (Swedish)
Available from: 2013-04-12 Created: 2013-04-04 Last updated: 2013-04-12Bibliographically approved

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