Probiotic Lozenges Improve Oral Health

The rapid surge of microbiome science in recent years has spurred an equally rapid growth in the number of probiotic supplements, foods, and beverages hitting the consumer market.

The vast majority of these products are promoted for intestinal health. But one unique new product-- a probiotic lozenge for oral health -- is shifting the focus upstream, bringing with it a reminder that the digestive tract begins in the mouth.Strep Salivarius 1

Researchers in Mangalore, India, examined the efficacy of probiotic lozenges containing Streptococcus salivarius in treating gingivitis and periodontitis, two common oral diseases characterized by chronic inflammation and associated with increased risk of cardiovascular disease.

The results of the trial, published earlier this year in the International Journal of Pharma and Bio Science, suggest that supplementation with the probiotic lozenges may offer significant oral health benefits.

The study included 28 adults between the ages of 20-60 years. Although they were otherwise healthy, the subjects all presented with moderate to severe gingivitis and moderate periodontitis.

They were separated into control and test groups, with test group taking probiotic lozenges called BLIS M18, a branded form of S. salivarius M18, produced by BLIS Technologies in New Zealand.

Each lozenge contained at least 100 million S. salivarius bacteria. Test subjects took two lozenges per day -- one in the morning after brushing and another in the evening -- for a total of 30 days. Control group subjects did not receive probiotics.

The researchers note that they selected S. salivarius because of its “innate capacity to bind and persist on the tongue dorsum.” Additionally, some strains of S. salivarius may promote good oral health by inhibiting the growth of deleterious bacteria such as Streptococcus mutans, which can contribute to tooth decay. S. salivarius also “regularly produce the enzymes dextranase and urease, which could help reduce dental plaque accumulation and acidification, respectively.”

Participants were evaluated according to several clinical parameters including the plaque index (PI), gingival index (GI), modified sulcular bleeding index (mSBI), and probing pocket depth (PPD). Scores were recorded at baseline and again at days 15, 30, 45, and 60. All participants received a deep dental cleaning at the beginning of the trial period.

After 30 days, the group taking the BLIS M18 lozenges showed a significant reduction in all indices of periodontal disease as compared to the control group.

Notably, on day 30, the test group showed significant reductions in their mean PI, GI, and mSBI scores. Probing pocket depth was the only measure that did not change.

The investigators add that while participants’ oral health status did appear to decline somewhat after stopping the supplements (days 45 through 60), their PI, GI, and mSBI scores still generally remained lower than corresponding scores in the control group. PPD stayed almost constant throughout the trial among all subjects (Scariya, L. et al. Int J Pharm Bio Sci. 2015; 6(1): 242-250).

While test group participants fared better overall, the lozenges’ beneficial effects did appear to be strongest during the dosing phase. The authors conclude that, “probiotic therapy should not be seen as a treatment that permanently alters the oral microbiota.” Though it does produce temporary positive changes, a finite period of supplementation with S. salivarius does not “sustain a shift to a stable non-pathogenic microbiota.” In order to achieve maximum periodontal benefits, it seems, the probiotic lozenges must be taken regularly.

Oral probiotics like BLIS M18 are not a substitute for regular oral care in controlling plaque build-up and preventing gum disease and inflammation.  But they can potentially be a valuable adjunct in people for whom brushing and flossing may not be adequate.

The researchers call for additional studies that also incorporate microbial analysis, which theirs did not, in order to more fully explore the potential impact of oral probiotics.

The exploration of oral probiotics adds to our knowledge of the microbiome as a whole, and opens a new category in the market for probiotic products, a domain that has experienced remarkable steady growth in recent years.

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