**4. Oral probiotics and their influence on oral cavity diseases**

### **4.1 Importance of probiotics to the oral cavity health**

The authorship of the concept of probiotics has been attributed to the Russian scientist and Nobel prize winner Elie Metchnikoff, who at the turn of the nineteenth and twentieth centuries theorised that Bulgarian pheasants own their long life to the consumption of fermented milk products. Since then, the scientists confirmed that the use of probiotic strains, particularly those of the genera *Lactobacillus* and *Bifidobacterium*, can support gastrointestinal, genitourinary and oral health by maintaining the microbial balance of these ecosystems [49]. According to the upto-date definition, probiotics are live microorganisms, which when administered in adequate amounts confer a health benefit on the host [50].

In the past decade, the awareness of probiotics and their contribution to human and animal populations increased and a wide range of probiotic products appeared on the market. Research activities focused on the search for new probiotics help to understand the process of development of probiotic products and their potential role in prevention or treatment of diseases [51]. Composition of microbiota of today's man differs from that in the past. Modern people are exposed to a number of negative influences that affect their microbiological balance. As long as the harmony and balance is maintained, we speak about symbiosis. The imbalance of microbiota is referred to as dysbiosis, which involves changes in proportions and heterogeneity of commensal species resulting in disturbed functioning of protective barriers and subsequent development of diseases [52]. The adverse influences that cause dysbiosis include particularly the use of antibiotics and chemotherapeutics, stress situations resulting from the lifestyle of the modern man, unsuitable eating habits or drinking regimen and changes in composition of food or the environment. Searching for amendment of the developed dysbiosis became the prime stimulus of the study of probiotics.

The increasing bacterial resistance to antibiotics and the demands of the wide public on natural therapy resulted in decreased use of conventional antimicrobials and raised the need for development of new ways of treatment [53]. A separate issue is the probiotics intended for oral cavity. People associate the term probiotic with the health of the intestinal tract and necessity to use them during antibiotic treatment, which became a common practice but oral antibiotics also play an important role in the overall health of an individual. It was demonstrated that probiotics have the potential for modification of the oral microbiota and are effective in the prevention and treatment of oral cavity diseases, such as dental caries and periodontal diseases associated with dysbiosis [54]. Today, the global market already offers some probiotic preparations that prevent formation of dental plaques, support health of gingivae and teeth and help to fight the bad breath [55]. The most frequently investigated bacteria include representatives of the genera *Lactobacillus*, *Streptococcus* and *Bifidobacterium*. Species of these taxons are members of normal microbiota found in the gastrointestinal tract, while some of them prefer to colonise the oral cavity [56]. Potentially, pathogenic microorganisms enter the body through the mouth or nose and thus the oral probiotics constitute and excellent first-line protective barrier of the mouth and throat. Clinical studies in humans that investigated treatment of periodontal diseases by probiotics reported overall contributions such as the decreased bleeding of gums. The studies that involved the use of probiotics as a supplement to clinical periodontal treatment showed a more pronounced improvement of the clinical status of patients in comparison with the clinical treatment alone [57]. One of the preparations used in Slovakia is ProDentis [58], a preparation containing mostly *Lactobacillus reuteri*. One clinical study was

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**Figure 7.**

*Mechanism of the effect of probiotics in the oral cavity.*

*Oral Microbiota from the Stomatology Perspective DOI: http://dx.doi.org/10.5772/intechopen.89362*

probiotics are presented as follows [60]:

4. reduction of the inflammatory response.

1.binding to dental surfaces,

supragingival plaques [59].

based on the use of pastilles containing *Lactobacillus reuteri* strains as a supplement of therapy of chronic periodontitis. Results of this study revealed a marked decrease of occurrence of *Porphyromonas gingivalis* in the saliva and in subgingival and

The effectiveness of probiotic microorganisms in the oral cavity depends on their ability to resist to the environmental conditions and protective mechanisms, to adhere to the surfaces coated by saliva, easily colonise the mouth and grow in it and inhibit oral pathogens without harming the host [55]. Ideal properties of oral

The mechanism of effect of probiotics in the oral cavity (**Figure 7**) is almost identical with that in the gastrointestinal tract, i.e., modulation of the immune response, metabolic effects and harmonisation of the intestinal or oral microbiota. Probiotic bacteria excrete various antimicrobial compounds such as organic acids, hydrogen peroxide and bacteriocins [61]. In addition, they compete with pathogens for the adhesive sites on mucous membranes. They can also modify their environment by modulation of its pH or the oxidation–reduction potential, which can interfere with the ability of pathogens to establish themselves on the mucosa. The beneficial effects of probiotics may include stimulation of the nonspecific immunity and modulation of humoral and cellular immune responses [14, 62].

**4.2 Properties of oral probiotics and mechanism of their effect**

2.production of antimicrobial substances against oral pathogens,

3. aberration of environmental conditions in the mouth, and

*Oral Microbiota from the Stomatology Perspective DOI: http://dx.doi.org/10.5772/intechopen.89362*

*Bacterial Biofilms*

**4. Oral probiotics and their influence on oral cavity diseases**

The authorship of the concept of probiotics has been attributed to the Russian scientist and Nobel prize winner Elie Metchnikoff, who at the turn of the nineteenth and twentieth centuries theorised that Bulgarian pheasants own their long life to the consumption of fermented milk products. Since then, the scientists confirmed that the use of probiotic strains, particularly those of the genera *Lactobacillus* and *Bifidobacterium*, can support gastrointestinal, genitourinary and oral health by maintaining the microbial balance of these ecosystems [49]. According to the upto-date definition, probiotics are live microorganisms, which when administered in

In the past decade, the awareness of probiotics and their contribution to human and animal populations increased and a wide range of probiotic products appeared on the market. Research activities focused on the search for new probiotics help to understand the process of development of probiotic products and their potential role in prevention or treatment of diseases [51]. Composition of microbiota of today's man differs from that in the past. Modern people are exposed to a number of negative influences that affect their microbiological balance. As long as the harmony and balance is maintained, we speak about symbiosis. The imbalance of microbiota is referred to as dysbiosis, which involves changes in proportions and heterogeneity of commensal species resulting in disturbed functioning of protective barriers and subsequent development of diseases [52]. The adverse influences that cause dysbiosis include particularly the use of antibiotics and chemotherapeutics, stress situations resulting from the lifestyle of the modern man, unsuitable eating habits or drinking regimen and changes in composition of food or the environment. Searching for amendment of the developed dysbiosis became the

The increasing bacterial resistance to antibiotics and the demands of the wide public on natural therapy resulted in decreased use of conventional antimicrobials and raised the need for development of new ways of treatment [53]. A separate issue is the probiotics intended for oral cavity. People associate the term probiotic with the health of the intestinal tract and necessity to use them during antibiotic treatment, which became a common practice but oral antibiotics also play an important role in the overall health of an individual. It was demonstrated that probiotics have the potential for modification of the oral microbiota and are effective in the prevention and treatment of oral cavity diseases, such as dental caries and periodontal diseases associated with dysbiosis [54]. Today, the global market already offers some probiotic preparations that prevent formation of dental plaques, support health of gingivae and teeth and help to fight the bad breath [55]. The most frequently investigated bacteria include representatives of the genera *Lactobacillus*, *Streptococcus* and *Bifidobacterium*. Species of these taxons are members of normal microbiota found in the gastrointestinal tract, while some of them prefer to colonise the oral cavity [56]. Potentially, pathogenic microorganisms enter the body through the mouth or nose and thus the oral probiotics constitute and excellent first-line protective barrier of the mouth and throat. Clinical studies in humans that investigated treatment of periodontal diseases by probiotics reported overall contributions such as the decreased bleeding of gums. The studies that involved the use of probiotics as a supplement to clinical periodontal treatment showed a more pronounced improvement of the clinical status of patients in comparison with the clinical treatment alone [57]. One of the preparations used in Slovakia is ProDentis [58], a preparation containing mostly *Lactobacillus reuteri*. One clinical study was

**4.1 Importance of probiotics to the oral cavity health**

adequate amounts confer a health benefit on the host [50].

prime stimulus of the study of probiotics.

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based on the use of pastilles containing *Lactobacillus reuteri* strains as a supplement of therapy of chronic periodontitis. Results of this study revealed a marked decrease of occurrence of *Porphyromonas gingivalis* in the saliva and in subgingival and supragingival plaques [59].
