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

4.  Periodontitis Multifactorial
Conventional treatment modalities
Mechanical Debridement
• Non surgical
• Surgical Antibiotics
Eliminate entire microflora

5. ANTIBIOTIC RESISTANCE AND

RECOLONIZATION BY Need for new treatment
PATHOGENIC BACTERIA
 paradigm

6.  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.

7. Probiotic
 Currently adopted definition
By FAO /WHO
Live microorganisms which when administered in
adequate amounts confer a health benefit on the host

8. 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

9. 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

10. ANTIBIOTICS VS PROBIOTICS
Antibiotics Probiotics
Favours good bacteria
Pathogenic bacteria
Good bacteria Pathogenic Bacteria

11. 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

12. Bifidobacterium species
 B. bifidum
 B. breve
 B. Infantis
 B. longum
 B. lactis
 B. adolescentis

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

14.  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.

15.  Bifidobacterium
 metabolization of lactose, generate lactic ions from lactic acid
and synthesize vitamins.
 ferment indigestible carbohydrates and produce beneficial
short chain fatty acids.

16.  Streptococcus thermophilus and
Lactobacillus bulgaricus
 metabolize lactose, improve lactose tolerance and
antimicrobial activity

17.  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.

18. 1. Direct interaction
2. Competitive exclusion
3. Modulation of host immune response

19. 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

20. Competitive exclusion:
 Beneficial microbes directly compete with the disease
developing microbes for nutrition or enterocyte adhesion sites.

21. 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

23.  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

24.  Glycoprotein-carbohydrate cell surface interaction mediate by
interspecies interactions
 Apoptosis is yet another proposed mechanism.
 Probiotics stimulate apoptosis of tumor cells

25. Production of • Organic acids
antimicrobial • Hydrogen peroxide
substances • Bacteriocins
• Compete with pathogens for
adhesion sites
Binding in Oral • Involvement in metabolism of
Cavity substrates (competing with oral
micro organisms for substrates
available)
• Stimulate non specific immunity
Co-Immuno
modulatory • Modulate humoral and cellular
immune response

26.  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

27.  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

28.  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

29.  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.
-.

30.  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

31. 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.

32.  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.

34.  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)

35.  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

36. LOZENGES

37. Yoghurt

38. Probiotic Mints
Chewing gums

39. 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 activities
Immune deviation or excessive immune
stimulation

40. Major risk factors
1) Immune compromise, including a debilitated state or malignancy
2) Premature infants
Minor risk factors
1) CVC
2) Impaired intestinal epithelial barrier, eg, diarrheal illness,
intestinal inflammation
3) Administration of probiotic by jejunostomy
4)Probiotics with properties of high mucosal adhesion or known
pathogenicity
5) Cardiac valvular disease (Lactobacillus probiotics only)

41.  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.

42.  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.

43.  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

44. PRESENTED BY
AYSHA JABEEN.M.
2007-2012 BATCH
VIVEKANANDHA DENTAL COLLEGE FOR WO