One of the most common concerns for patients in the dental chair is the battle with bad breath. It is also one of the most uncomfortable topics for patients to bring up during a dental appointment. Overall, about 25% of people suffer from malodor, and it has many social implications that affect a person’s overall confidence and well-being.1,2
Patients look to their dental professionals for answers to this problem, but are we providing the best solutions? Is there a better way to solve the problem of bad breath?
There are many causes for bad breath, including lack of oral hygiene, dry mouth, and ear-nose-throat issues. Eighty-five percent of the time breath malodor arises from insufficient oral hygiene, such as periodontitis, coating of the tongue, and lack of plaque control. These conditions in the mouth favor the formation and microbial degradation of offensive smelling volatile sulfur compounds (VSC).
Methyl mercaptan, hydrogen sulfide, and dimethyl sulfide are three of the most well-known VSCs, which form from gram-negative anaerobic bacteria. Hydrogen sulfide smells like rotten eggs, and methyl mercaptan smells like rotten cabbage.3 Even more strange, the smell of dimethyl sulfide is comparable to rotten seaweed.
The advantage of using oral probiotics
Over-the-counter dental products used for fighting bad breath focus on masking the odor or attempting to kill bacterial culprits in the oral cavity. Some of these products specifically target VSCs. The problem with this is that bacteria repopulate quickly, so the relief from bad breath is usually short-lived.4 Another aspect to consider is that when a bacterial population is reduced, something always replaces it, whether good or bad. This is where dental probiotics step in to combat bad breath in an entirely different way.
Dental probiotics focus on promoting the growth of good bacteria in the oral cavity and curtailing the growth of pathogenic bacteria. There are normally more than 700 different bacterial species found in the human mouth.5 With dental probiotics, daily exposure helps to colonize the oral cavity with bacteria that do not produce VSCs. Research has shown that 85% of people who took oral probiotics for one week experienced a significant reduction in volatile sulfur compounds.4 Even more impressive is the fact that the majority of study participants maintained a reduced level of VSCs for two weeks following exposure to oral probiotics. With this treatment modality, there is finally potential for a more long-term solution to bad breath.
How dental probiotics differ from conventional probiotics
When most people think of “probiotics,” I imagine yogurt comes to many of their minds. It is common knowledge that we need beneficial bacteria for gut digestion to properly occur. One of the most well-known species is Lactobacillus, which is commonly found in yogurt and other fermented foods.6Bifidobacterium is another beneficial species that can be found in the gut days after birth. Saccharomyces boulardii is the only probiotic that is a yeast.
Dental probiotics are completely different from the probiotics needed for digestion. Specifically, the Streptococcus salivarius strains K12 and M18 have been found to be especially beneficial when it comes to the health of the oral cavity.3 In the study mentioned earlier, K12 is the strain that is effective in combating bad breath.4
Gut probiotics typically come in capsule form so they can reach the stomach and quickly begin to do their job. Oral probiotics, on the other hand, are typically in the form of a lozenge that is chewed or sucked on after normal oral care. Using a lozenge provides longer exposure time than other methods so that more bacteria are able to colonize the oral cavity.
Other benefits of dental probiotics
One of the most amazing things about oral probiotics is that they have multiple applications beyond simply treating oral malodor. Conditions such as dental caries, gingivitis, periodontitis, pharyngitis, tonsillitis, and oral candidiasis are all inhibited by exposure to the K12 and M18 strains of S. salivarius.4 These additional benefits hold much promise in dentistry, as many patients have difficulty with home care and these probiotics are easy to use.
In the battle against dental caries, the M18 strain has a molecular mechanism that reduces plaque formation and increases oral pH. Specifically, this bacteria releases salivaricin M, a substance that limits the growth of the caries-causing bacterial species, such as Streptococcus mutans and Streptococcus sobrinus.7
In patients with gingivitis, M18 lozenges have been found to significantly reduce supragingival plaque, gingival inflammation, sulcular bleeding, and pocket depth.8 Both strains K12 and M18 have been found to be effective in reducing levels of P. gingivalis, A. actinomycetemcomitans, and F. nucleatum-induced IL-6 and IL-8, which are typically indicators of periodontal disease.4
The multiple applications of dental probiotics could provide substantial benefits to patients who have ongoing issues with oral hygiene due to their ability level. Imagine in the future that a nursing home patient could receive a dental probiotic, along with his or her normal medications, as part of a regimen to positively affect the person’s oral health. It’s amazing to think how a little lozenge provided on a regular basis could help so many people so easily.
My personal experience with dental probiotics
While writing this article, I decided to try dental probiotics on myself as an experiment on their efficacy. I’ve always had problems with morning breath, and the possibility of waking up without that yucky taste in my mouth sounded appealing. I also have many issues with my sinuses and allergies, and these lead to my breath not being as fresh as I would like.
I bought a product called Pro-Dental by Hyperbiotics that I found on Amazon. The product had some great reviews, so I thought it was worth a try. Pro-Dental contains the S. salivarius strains K12 and M18 that were shown to be highly effective in the research. The probiotics come in a lozenge that can be either chewed or left to dissolve in the mouth. The recommended dosage is one to two tablets a day to be taken after brushing or using a mouth rinse. One lozenge contains three billion colony-forming units.9
When I began using the product, I was very skeptical, and I wondered how much it would really help me. But as the days went by, I was amazed by the results. When I woke up in the morning, I no longer noticed the stale breath that I was so accustomed to. My mouth felt fresh. The lozenges were also quite palatable, with a slightly sweet mint flavor.
An unexpected occurrence elevated my enthusiasm even more for dental probiotics. A week into my experiment, I was sitting on my couch with my six-year-old on my lap, and out of the blue she commented that my breath smelled. I asked her, “Good or bad?” knowing that I had not eaten or drank anything for several hours. With a smile, she said, “Good.” That’s just what I wanted to hear. I needed no further proof to show me how well dental probiotics work for breath issues, and I couldn’t wait to share my story with others.
Bad breath has been an ongoing concern for many dental patients and often holds them back from living their lives to the fullest. For too long patients have tried to treat this frustrating problem with only limited and short-term success. Now the science has shown that by adjusting the focus from destroying bad bacteria to promoting the growth of the good species, we have a new way to combat offending odors. Additionally, these bacteria have been shown to provide numerous benefits to further improve patients’ oral health. We finally have a promising and effective solution for bad breath that we can be excited to share with our patients.
1. Bollen C, Beilken T. Halitosis: A multidisciplinary approach. Int’l J of Oral Sci. 2012;4:55-63.
2. National Institutes of Health website. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412664/. Published June 22, 2012. Accessed July 8, 2018.
3. Franklin D. To beat bad breath, keep the bacteria in your mouth happy. Scientific American website. https://www.scientificamerican.com/article/beat-bad-breath-keep-mouth-bacteria-happy/. Published May 1, 2013. Updated May 2013. Accessed July 8, 2018.
4. Stowic TA. Contribution of probiotics Streptococcus salivarius strains K12 and M18 to oral health in humans: A review. UConn website. https://opencommons.uconn.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1484&context=srhonors_theses. Published May 1, 2016. Accessed July 27, 2018.
5. Aas J, Paster B, Stokes L, et al. Defining the normal bacterial flora of the oral cavity. J Clin Microbiology. 2005;43:5721-5732.
6. Probiotics. MedicineNet website. https://www.medicinenet.com/probiotics/article.htm. Accessed July 8, 2018.
7. Di Pierro F, Zanvit A, Nobili P, Risso P, Fornaini C. Cariogram outcome after 90 days of oral treatment with Streptococcus salivarius M18 in children at high risk for dental caries: results of a randomized, controlled study. Clin, Cosm, & Investigational Dent. 2015;3:107-113.
8. Scariya L, Nagarathna DV, Varghese M. Probiotics in periodontal therapy. Int’l J of Pharma & Bio Sci. 2015;6:242-250.
9. Hyperbiotics promotional website. https://www.hyperbiotics.com/products/pro-dental. Accessed July 27, 2018.