Review Article
Probiotics and Periodontal Health- Review Article
Rutuja Tote*
Corresponding Author: Rutuja Tote, final BDS student, Periodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe) Wardha, India.
Received: June 01, 2023; Revised: June 19, 2023; Accepted: June 22, 2023 Available Online: Aug 04, 2023
Citation: Tote R. (2024) Probiotics and Periodontal Health-Review Article. J Oral Health Dent, 7(1): 568-572.
Copyrights: ©2024 Tote R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Periodontal diseases, including gingivitis and periodontitis, are prevalent conditions characterized by inflammation and infection of the gums and supporting structures of the teeth. The oral microbiome plays a crucial role in the development and progression of these diseases, with dysbiosis, or an imbalance in microbial populations, being a contributing factor. Traditional treatment approaches primarily focus on mechanical debridement and antimicrobial therapies. However, emerging research has investigated the potential benefits of probiotics in promoting periodontal health. When consumed in appropriate proportions, probiotics are live bacteria that are taken as dietary supplements and provide a wide range of health advantages. Probiotics are currently widely employed in a variety of applications in a variety of medical settings such as in urinary tract infections, cancer risk reduction, gastrointestinal tract infections, as well as in dentistry such as caries prevention, periodontal health, and halitosis reduction. Periodontitis is a chronic inflammatory disease of the gums which affects gingival and tooth supporting structures. The etiology is obviously bacterial, and a variety of suspected bacterial infections, including Aggregatibacter actinomycetemcomitans, Tannerella forsythus, and Porphyromonas gingivalis, have been linked to the condition. Probiotics work through a variety of ways, including direct suppression of harmful microorganisms and modification of the mucosal immune system.

Keywords: Probiotics, Gingivitis, Periodontitis, Plaque, Periodontics

Periodontal disorders cannot be classified as simple bacterial infections any longer. Rather, they are multifactorial complicated disorders involving a complex interplay between subgingival microorganisms, host immunological and inflammatory responses, and environmental variables. As a result, periodontal health must be evaluated not just in terms of plaque or bacteria levels and management, but also in terms of a comprehensive assessment of all aspects that contribute to the formation of illness as well as the preservation of health. The use of probiotics can enhance the symbiotic relationship of the native micro flora that promotes periodontal health. The usefulness of probiotics in enhancing dental health is highlighted in this review [1].

Probiotics are simply the "live microorganisms that have a positive impact on the host's health when supplied in suitable concentrations, "They are basically live microbes that have positive health advantages on the host when fed in suitable quantities, according to the "World Health Organization." Probiotics are organisms that aid in the prevention, slowing, or postponement of periodontal diseases. Probiotics, "For life" is a direct translation," are microorganisms that have been demonstrated in humans and animals to promote health [2]. It offers a lot of potential in periodontics, particularly when it comes to plaque alteration, oral malodor reduction, bacterial colonization, pocket depth improvement, and clinical attachment. Probiotic bacteria belong to the Lactobacillus and Bifidobacterium genera. Yeast and molds like Saccharomyces cerevisiae, Aspergillus Niger, Aspergillus Oryzae, and Sochromyces boulardii are included in this group. Probiotics encourage the development of good microorganisms while preventing the growth of harmful bacteria. Commensal bacteria collaborate with the immune system of host to create defensive responses that prevent pathogens from colonizing and invading. Commensal bacteria are essential because of the reason that they adhere to mucosal surfaces and prevent pathogenic microorganisms from adhering, and reducing adhesion, which is the first step in pathogenicity.

Commensal organisms control the expression of cellular mediators, which boosts immunity, restores normal hemostatic functions, and alters the inflammatory response. According to the definition of prebiotic, "fermented compounds that cause changes in the composition and/or activity of the resident microflora, resulting in benefits to the host's well-being and health".


Probiotics: Yogurt is an extraordinary wellspring of probiotics, which are valuable microorganisms that can assist you with feeling good. Matured veggies dishes like Sauer Ruben (turnips) and sauerkraut (cabbage) are additionally high in accommodating microbes. Fermented tea, an aged beverage professed to have started in Russia or China, is another without dairy wellspring of helpful microscopic organisms. Water kefir, at times called tibicos or Japanese water gems, is a probiotic drink similar to Kombucha with microorganisms and yeasts having powdered ginger and sugar). Moroccan protected lemons are utilized a starter and are matured suddenly. Coconut water is utilized to make coconut kefir, a probiotic refreshment. Acrid pickles are an exemplary option in contrast to vinegar pickles, made with a straightforward arrangement of crude ocean salt and clean, sans chlorine water to advance lactobacillus growth. Dairy items are another source [3].

Lactobacillus is a kind of probiotic often found in fermented foods such as yoghurt.

Bifidobacterium: This probiotic may be found in a variety of dairy products and can assist with the irritable bowel syndrome symptoms. Saccharomyces boulardii is a yeast that might be found in an assortment of probiotics. These probiotics, too as others, can be found in supplements and certain dinners.

In the treatment of periodontal infection, "probiotics" use is becoming more prevalent. In 1965, Lilley and Stillwell presented the term "probiotic". Hull et al. in 1984 identified Lactobacillus as the most important probiotic species to consider, followed by Holcombh [4]. According to the "World Health Organization," probiotics are "live bacteria that, when supplied in appropriate fixations, provide benefits to the host's health. Oral organization of probiotics may likewise advance oral wellbeing by hindering the arrangement of pathogenic microbes or adjusting oral mucosal invulnerability [5]. It very well may be used to work on clinical connection, adjust plaque, change anaerobic living being colonization, and change pocket profundity. As well as scaling and root arranging, the organization of chose helpful microorganisms would obstruct periodonto-microbe recolonization of periodontal pockets, considering the accomplishment and support of periodontal wellbeing [6].


Mechanisms of action of probiotics are classified under three main categories:

Direct interaction

Probiotics compete with bacteria for bacterium attachment and produce antimicrobial chemicals, directly affecting plaque formation and its complicated ecology [7].

Competitive Exclusion

Beneficial microorganisms compete directly for nourishment on adhesion sites with disease-causing germs.

Modulation of the Immune Response of the Host.

Probiotics connect with the safe framework, aiding the declaration of Th1 and Th2 cells, just as regulating microorganism prompted aggravation through dendritic cell cost like receptors. Intracellular microbes are phagocytosed in a Th1 reaction, while extracellular microorganisms are phagocytosed in a Th2 response [8].

Probiotics works against periodontal diseases mainly by:

  • Particular pathogens are inhibited, or specific pathogens are inhibited.
  • Alteration of the host immune response.
  • Specific pathogens are inhibited.
  • Pathogen adhesion, colonization, and biofilm formation are all inhibited.
  • Various chemicals, such as organic compounds, inhibit pathogen development.
  • Against oral pathogens, acids, hydrogen peroxide, and bacteriocins are used.
  • Collagenases are inhibited, and inflammation-related chemicals are reduced.
  • The induction of cytoprotective proteins on the host cell's surface.
  • Pathogen-induced pro-inflammatory pathways are modulated.

Cytokines-induced apoptosis is inhibited. Probiotics' general method of action may be split into three categories:

  • intestinal microflora normalization
  • immune response modulation
  • metabolic effect

Recent research suggests that probiotic bacteria's anti-inflammatory effects may be systemic rather than localized, at least in part. After parenteral injection of inactivated and fractionated microorganisms, beneficial benefits were reported. The inflammatory response elicited by coculture of L. casei or L. bulgaris with mucosal explants from CD-affected intestinal mucosa was decreased in this investigation. This was linked to a significant decrease in proinflammatory cytokines like TNF-, a decrease in CD4 cells, and TNF expression among intraepithelial lymphocytes, implying that the anti-inflammatory effect could be systemic [9].

The resident microbiota isn't just a bystander when it comes to maintaining one's health, but rather actively participates in it. The enormous, a diverse resident microbial community coexists with the host at mucosal areas, causing harm only in immunocompromised host, if the particular microbial populations are reduced, or if microbes gain access to areas where they would not ordinarily be coming upon (i.e., through trauma). The immune system, which defends the host, is aided by resident microbial populations.


Probiotics are commercially available in the form of lozenges, toothpaste, chewing gums, or mouthwash. Probiotic Lozenges Prescription After scale and root planning, the probiotic lozenges were advices to take twice a day to the second group. Each probiotic lozenge includes five distinct strains of bacteria- bifid bacteria, including Lactobacillus acidophilus, Lactobacillus rhamnoses, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus salivary.

Halitosis management

Halitosis is brought about by unpredictable sulfur compounds (VSC). Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola are the microbes that produce VSC. VSC blend can be repressed by a probiotic bacterium (Weissella ciboria). It has a lot of evidence that it can be used as a probiotic in the periodontium. Fusobacterium nucleatum conglomeration with different microbes causes biofilm colonization and prompts VSC development in the oral depression. Lactobacillus acidophilus and Lactobacillus casei produce a solid corrosive that forestalls anerobic microorganisms from duplicating. Bacteriocins created by Streptococcus salivaris repress microorganisms that produce unstable sulfur compounds. In a new report, it was found that Streptococcus salivaris tablets and gum diminish unstable sulfur compounds in halitosis patients [11]. Halitosis can be caused by a number of things, including the consumption allergies to certain foods, metabolic problems, and respiratory illnesses. although it is most commonly linked to an imbalance of the mouth cavity's commensal microbiota. Microorganisms convert salivary and dietary proteins into amino acids are transformed into Sulphur compounds that are volatile, such as hydrogen sulphide, methyl mercaptan, and dimethyl sulphide, resulting in halitosis. Probiotics have also been researched for their ability to prevent halitosis in laboratory and clinical settings.


There are mainly two forms of periodontal disease: gingivitis and periodontitis.

Periodontitis is a condition that damages the teeth's supporting tissues, particularly the alveolar bone, and causes them to deteriorate. Periodontitis is a persistent inflammatory disorder that causes cytokines to be released [12]. Gingivitis is an inflammation of the gingiva that is limited to the gingiva. The link between plaque and gingival inflammation has long been known as an etiological factor [13]. Irritating factors such as plaque, calculus, overhanging edges, and defective restorations are etiological factors for the formation of these lesions [14]. P. gingivalis, Treponema denticola, Tannerella forsythus, and Aggregatibacter actinomycetemcomitans are the primary pathogenic pathogens linked to periodontitis. These bacteria possess a number of pathogenic features that enable them to colonize subgingival locations, can cause tissue damage by eluding the host's defense mechanism. The immunological reactions of the host endurance are also a critical role in the disease's progression. [15]. Probiotic usage in periodontal disorders is the subject of fewer experimental research [16]. The impact of probiotic tablets on gingivitis and various stages of periodontitis was investigated, and it was observed that probiotic medicine enhanced microbiota normalization more than the control group. Lactobacilli, notably L. gasseri and L. fermentum, in a recent study, they were shown to be more numerous in the healthy people's oral cavity than in those with chronic periodontitis. Lactobacilli have been displayed in exploration to forestall the development of diseases.

The utilization of chose advantageous microbes in scaling and root planning is used as adjuvants to each other. May assist with forestalling periodontal-microorganism recolonization of periodontal pockets thus create and keep up with periodontal wellbeing. Probiotics secure the epithelial hindrance by keeping up with tight intersection articulation of qualities like that of a microbe without the periodontal harm [17].

Notwithstanding huge decreases in the major pathogenic microorganisms, In the subgingival plaque, P. gingivalis, A. actinomycetemcomitans, and T. forsythia were found. The addition of probiotics to successful mechanical plaque removal in the treatment of gum disease has resulted in considerable decreases in the major periodontopathogens, P. gingivalis, A. actinomycetemcomitans, and T. forsythia in while treatment of gum disease with L. reuteri tablets alone has been displayed to essentially lessen the abundance of P. gingivalis and A. actinomycetemcomitans in the subgingival plaque accumulation, P. gingivalis has been displayed to recuperate and show an expansion in predominance in the subgingival plaque inside about a month after treatment has finished [18]. In a preliminary, probiotic L. reuteri was devoured double a day for a very long time as an adjuvant to Persistent periodontitis is treated clinically [19]. In the subgingival plaque, the fraction of necessary anaerobes was dramatically decreased.


Environmental overviews acted in investigations taking a gander at probiotics for precaution oral consideration have alterations in the oral microbiota were discovered of solid individuals who burn-through probiotics. Lactobacillus rhamnoses GG and Bifidobacterium animalism species in a course. Sound individuals who took lactis-containing capsules showed no huge changes in salivary environment contrasted with pattern as estimated by human oral organism recognizable proof, however they improved gingival wellbeing. Notwithstanding, in a review utilizing L. reuteri as a protection probiotic, huge wellbeing related adjustments in the supragingival plaque microbiota were distinguished, inferring specific biological changes notwithstanding impacts explicit to the probiotic strain utilized. The people group structure returned to standard during the 1-month observe up when the probiotics were halted, with a critical fall in the pervasiveness of L. reuteri in the salivation.


Probiotics are antibiotic's equivalents, thus there's no risk of resistance developing, and because they're made out of the body's own flora, they're the easiest to adapt to the host. Designer probiotics offer a significant chance to cure diseases in a natural and non-invasive approach, thanks to rapidly expanding technology and the merging of biophysics and molecular biology. Periodontitis has been linked to the development of systemic disorders such as diabetes, atherosclerosis, chronic kidney disease, and spontaneous premature birth. It's difficult to say if probiotics have any therapeutic benefit in the treatment of periodontal disease based on existing data. Most studies show a small and transient improvement in periodontal markers when probiotics are administered. Larger sample numbers and longer follow-ups are necessary in clinical trials.

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