Probiotics Reduce the Prevalence of Oral Candida in the Elderly—a Randomized Controlled Trial

The feasibility of serving liquid yoghurt supplemented with probiotic bacteria, Lactobacillus rhamnosus LB 21, and Lactococcus lactis L1A--a pilot study among old people with dementia in a residential care facility

BACKGROUND

Constipation and body weight loss are prevalent among old people. Treatment with different species of lactic acid bacteria has been suggested for various forms of gastrointestinal disorders. OBJECTIVE, PARTICIPANTS AND INTERVENTION: This pilot study was performed to assess the feasibility of administering and consuming a drinkable yoghurt containing Lactobacillus rhamnosus LB 21 and Lactococcus L1A, and to evaluate the influence on bowel movements and body weight in 15 people with dementia, aged 65-95 years in residential care facility.

DESIGN

A drinkable yoghurt (Verum Drickyoghurt) with added bacteria was served daily for 6 months in conjunction with ordinary food intake. Body weight, bowel movement frequency and consistency, food and fluid intake and time spent in various activities were recorded for two weeks pre-intervention, and 3 times during the follow-up period.

RESULT

This study showed that the yoghurt was easy to serve, with few side effects for the participants and that the various recording forms and diaries were easy for the staff to complete. The extra intake of yoghurt did not have any detectable beneficial effect on bowel movements. The overnight fast was almost 15 hours per day. Body weight decreased by 0.65 kg/month (95% confidence interval. 0.27-0.97).

CONCLUSIONS

The present study design was feasible in this group of old people with dementia. The absence of any detectable effect of the supplement on constipation, but rather a considerable loss in body weight, indicate that further research is needed in a large randomised controlled trial, if associations between dementia, constipation and energy balance are to be understood.

Prospects for the development of probiotics and prebiotics for oral applications

There has been a paradigm shift towards an ecological and microbial community-based approach to understanding oral diseases. This has significant implications for approaches to therapy and has raised the possibility of developing novel strategies through manipulation of the resident oral microbiota and modulation of host immune responses. The increased popularity of using probiotic bacteria and/or prebiotic supplements to improve gastrointestinal health has prompted interest in the utility of this approach for oral applications. Evidence now suggests that probiotics may function not only by direct inhibition of, or enhanced competition with, pathogenic micro-organisms, but also by more subtle mechanisms including modulation of the mucosal immune system. Similarly, prebiotics could promote the growth of beneficial micro-organisms that comprise part of the resident microbiota. The evidence for the use of pro or prebiotics for the prevention of caries or periodontal diseases is reviewed, and issues that could arise from their use, as well as questions that still need to be answered, are raised. A complete understanding of the broad ecological changes induced in the mouth by probiotics or prebiotics will be essential to assess their long-term consequences for oral health and disease.

Mechanisms of probiosis and prebiosis: considerations for enhanced functional foods

The technologies of metagenomics and metabolomics are broadening our knowledge of the roles the human gut microbiota play in health and disease. For many years now, probiotics and prebiotics have been included in foods for their health benefits; however, we have only recently begun to understand their modes of action. This review highlights recent advances in deciphering the mechanisms of probiosis and prebiosis, and describes how this knowledge could be transferred to select for enhancing functional foods targeting different populations. A special focus will be given to the addition of prebiotics and probiotics in functional foods for infants and seniors.

Improvement of periodontal condition by probiotics with Lactobacillus salivarius WB21: a randomized, double-blind, placebo-controlled study

AIM

This randomized clinical study was designed to evaluate the effect of probiotic intervention using lactobacilli on the periodontal condition of volunteers without severe periodontitis.

MATERIAL AND METHODS

Freeze-dried Lactobacillus salivarius WB21 (WB21)-containing tablets or a placebo were given to volunteers in a double-blind randomized study. A total of 66 volunteers were finally enrolled and randomly assigned to receive tablets containing WB21 (6.7 x 10(8) CFU) with xylitol or xylitol alone (placebo) three times a day for 8 weeks. Periodontal clinical parameters and whole saliva samples were obtained at baseline (BL), 4 weeks, and the end of the interventional period (8 weeks). Salivary lactoferrin (Lf) levels were measured by enzyme-linked immunosorbent assay. Lactobacilli in saliva and plaque samples was detected by semi-quantitative RT-PCR using 16S rRNA primers.

RESULTS

Periodontal clinical parameters were improved in both groups after an 8-week intervention. Current smokers in the test group showed a significantly greater improvement of plaque index and probing pocket depth from BL when compared with those in the placebo group. Salivary Lf level was also significantly decreased in the test group smokers.

CONCLUSION

Our results indicate that probiotics could be useful in the improvement/maintenance of oral health in subjects at a high risk of periodontal disease.

Probiotic Leuconostoc mesenteroides ssp. cremoris and Streptococcus thermophilus induce IL-12 and IFN-γ production

AIM: To investigate the capacity of potentially probiotic strains from six bacterial genera to induce cytokine production alone or in combinations in order to identify potential enhancing or synergistic effects in order to select probiotic bacteria for in vivo purposes.

METHODS: Cytokine production in human peripheral blood mononuclear cells (PBMC) in response to stimulation with eleven different potentially probiotic bacterial strains from Streptococcus, Lactobacillus, Bifidobacterium, Lactococcus, Leuconostoc and Propionibacterium genera was analysed. Production and mRNA expression of TNF-α, IL-12, IFN-γ and IL-10 were determined by ELISA and Northern blotting, respectively.

RESULTS: All tested bacteria induced TNF-α production. The best inducers of Th1 type cytokines IL-12 and IFN-γ were Streptococcus and Leuconostoc strains. All Bifidobacterium and Propionibacterium strains induced higher IL-10 production than other studied bacteria. Stimulation of PBMC with any bacterial combinations did not result in enhanced cytokine production suggesting that different bacteria whether gram-positive or gram-negative compete with each other during host cell interactions.

CONCLUSION: The probiotic S. thermophilus and Leuconostoc strains are more potent inducers of Th1 type cytokines IL-12 and IFN-γ than the probiotic Lactobacillus strains. Bacterial combinations did not result in enhanced cytokine production.

Probiotics and oral health effects in children

BACKGROUND

Probiotics are living micro-organisms added to food which beneficially affect the host by improving its intestinal microbial balance.

OBJECTIVE

This paper aims to present a general background on probiotics and its health effects in children, and to examine the evidence for oral colonization and the possible impact on oral health in children and young adults.

METHODS

For delivery and general health effects, recent systematic reviews, meta-analyses, and other relevant papers were used. Concerning oral installation and oral effects, a broad search for publications in English was conducted through February 2007 in PubMed. Studies describing an installation or intervention trial in humans with a controlled design and an oral endpoint measure were considered. Fourteen papers with dental focus were identified, of which two were narrative reviews.

RESULTS

Only one study of dental interest was conducted in children. Four papers dealt with oral installation of probiotic bacteria, and although detectable levels were found in saliva shortly after intake, the studies failed to demonstrate a long-term installation. Seven papers evaluated the effect of lactobacilli- or bifidobacteria-derived probiotics on the salivary levels of caries-associated bacteria in placebo-controlled designs. All but one reported a hampering effect on mutans streptococci and/or yeast. The single study carried out in early childhood reported a significant caries reduction in 3- to 4-year-old children after 7 months of daily consumption of probiotic milk.

CONCLUSION

Bacteriotheraphy in the form of probiotic bacteria with an inhibitory effect on oral pathogens is a promising concept, especially in childhood, but this may not necessarily lead to improved oral health. Further placebo controlled trials that assess carefully selected and defined probiotic strains using standardized outcomes are needed before any clinical recommendations can be made.

Safety issues of Lactobacillus bulgaricus with respect to human gelatinases in vitro

In oral medicine and dentistry probiotics have shown promising results in controlling dental diseases and yeast infections. This study was made to investigate the effect of eight strains of Lactobacillus bulgaricus and their effects on human matrix metalloproteinase-9 (MMP-9). The hypothesis was that these bacteria used in yoghurt production for centuries are not proteolytic and thus can be safely used in the development of probiotic preparations. Bacterial cell fractions and supernatant specimens were prepared and studied with gelatinase zymography and MMP-9 activation was assessed by immunoblotting. The effect of synthetic MMP inhibitors and a serine protease inhibitor (Pefabloc) on bacterial proteinases was studied with zymography. The results showed very low gelatinolytic activity. There was a slight difference between the supernatant and cell fractions so that the supernatant specimens produced weak gelatinolytic bands in zymography while hardly anything was seen in the cell fraction series. The tested synthetic MMP inhibitors and Pefabloc did not affect the proteolytic activity of the lactobacilli strains. The lactobacilli did not seem to induce the conversion of proMMP-9 to its active form. Consequently, our study hypothesis was confirmed and the studied Lactobacillus strains are not likely to degrade host tissue components.

Probiotics: contributions to oral health

Probiotics have been extensively studied for their health-promoting effects. The main field of research has been in the gastrointestinal tract. However, in the past few years probiotics have also been investigated in the oral health perspective, which is the topic of the present review. We discuss the mechanisms of bacterial adhesion, potential of probiotics in oral cavity colonization, interspecies interactions, and possible effects on immunomodulation, and means of probiotic administration. We suggest that probiotic treatment of diseases other than dental caries and periodontal disease should also be systematically investigated. In general, hardly any randomized controlled trials have been conducted in this area and the studies on probiotics vs oral health are still in their cradle. Hence, much more investigations are called for before any evidence-based conclusions can be drawn: if or not probiotic therapy can be recommended for oral health purposes.