March 1, 2009
I adore my holistic patients, but they often ask me questions that throw me for a loop.

by Lynne H. Slim, RDH, BSDH, MSDH
[email protected]

I adore my holistic patients, but they often ask me questions that throw me for a loop. Here's what a great patient with a very soft, but determined, voice asked me just last week: “Lynne, I've been reading about probiotics in Life Extension magazine. What can you tell me about probiotics in promoting the health of my gums?”

I can't scratch my head while fully gloved (which is what I frequently do when I don't know something), so I told my sweet patient that I'd research the topic and get back to her, which I did. I e–mailed her after searching the literature on this topic.

Since we now know that the periodontium (in chronic periodontitis) is destroyed as a result of inflammation in a susceptible host, and that mature biofilms trigger the inappropriate inflammatory response, researchers are now busy manipulating beneficial biofilm communities in various ways in an attempt to avoid ecological shifts in organisms that would trigger an inflammatory response.1,2 Probiotics are one way in which balanced biofilm communities could be reinforced (like digging a moat around a fort as added protection from enemies) when they feel threatened.1

Probiotics (which means “for life”) have been used for centuries as natural components in health–promoting foods. A good example is yogurt and buttermilk, which contain “friendly” bacteria. Various claims are made in the food industry that these healthy strains of bacteria offer health benefits. There is now growing evidence in medicine that some probiotics do indeed offer such benefits. For example, there are three meta–analyses (research analysis on a large scale) on the use of probiotics in children with acute infectious diarrhea. Duration of diarrhea and number of stools was reduced3 (thank goodness for that!). It was also discovered that the earlier probiotics were initiated, the better the results. In addition, diarrhea of a viral origin derived the most benefit from probiotics and bloody diarrhea from bacteria did not.

There are all types of claims about probiotics and many are unsupported by evidence. Even so, nutritional and alternative health products of all sorts are more popular than ever. Yesterday, for example, I watched the Oprah Winfrey show and witnessed an ad on TV for a belly burning product that supposedly melts the fat away. Oh, do I wish it were so simple!

My patient asked me as a trusted oral health advisor to give her my best assessment of probiotics to promote periodontal health. This is how I began my search: I've learned (and am still learning) that it's best to begin with a good Internet search engine like Pub Med and, once there, I entered the words “periodontal health” and clicked on the search button. Up popped only four citations — one was a good literature review of probiotics in oral health care and another was a single, double–blind, randomized clinical trial from Japan in which Lactobacillus salivarius in tablet form (with xylitol) or a placebo tablet was administered to subjects. After eight weeks of use, there were clinically significant outcomes, even in smokers when compared to the placebo group.4,5 In reading the review article on probiotics in oral health care, the authors point out that we know very little, to date, about the effect of probiotics on biofilm–induced periodontitis.4 The literature review mentions perhaps a handful of studies that attempted to suppress periodontopathogens, and there were also some early studies on probiotics to treat halitosis. The authors mention that there are a large number of Internet sites dedicated to the sale of probiotic products for people with halitosis, but scientific studies to support the efficacy of these products is lacking. In summary, the authors conclude that the role of beneficial bacteria in preventing the emergence of pathogenic species remains obscure but promising.5


  1. Costerton JW. The biofilm primer. 2007; New York: Springer. (180 p.).
  2. Ishikawa I. Host responses in periodontal diseases: a preview. Periodontol 2000. 2007; 43:9–13.
  3. Mack DR. Probiotics; mixed messages. Can Fam Physician. Nov. 10, 2005; 51(11):1455–1457.
  4. Shimauchi H, Mayanagi G, Nakaya S, Minamibuchi M, Ito Y, Yamaki K, Hirata H. Improvement of periodontal condition by probiotics with Lactobacillus salivarius WB21: a randomized, double–blind, placebo–controlled study. J Clin Periodontol. Oct. 2008; 35(10):897–905.
  5. Teughels W, Van Essche V, Sliepen I, Quirynen M. Periodontol 2000. 2008; 48:111–147.