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USAGE OF PROBIOTICS IN CHRONIC PERIODONTAL DISEASES.ppt
- 1. USAGE OF PROBIOTICSIN CHRONIC USAGE OF PROBIOTICS IN CHRONIC PERIODONTAL DISEASES PERIODONTAL DISEASES
- 2. Probiotics: definition Probiotics: definition World Health Organization: “live microorganisms which when administered in adequate amounts confer a health benefit on the host” The concept of beneficial for health microorganisms dates back to the ideas of Nobel prize laureate Ellie Metchnikoff in the early 20th century.
- 3. Prebiotics “Prebiotics are non-digestiblebut fermentable oligosaccharides that are specifically designed to change the composition and activity of the intestinal microbiota with prospect to promote the health of the host.” Fructo-oligosaccharides (chicory, inulin),Lactulose. Positively affect the endogenous flora, Stimulate the growth of one or a limited number of bacterial species. FOSBifidobacteria LactuloseLactobacilli
- 4. Synbiotics Synbiotics A probioticorganism in combination with its prebiotic food Providing both the organism and substrate at the time of ingestion, an improved chance of survival in GI tract
- 5. Probiotics Probiotics Candidates Candidates Lactobacillus acidophilus,reuteri, casei, rhamnosus “GG”, salivarius, gasseri, fermentum. Bifidobacteria bifidum, breve, infantis, longum Streptococcus thermophilus Saccharomyces
- 6. Probiotics: Proposed uses Probiotics:Proposed uses Infectious diarrhea Antibiotic-associated diarrhea IBD, IBS, and pouchitis Necrotizing Enterocolitis Bacterial vaginosis Recurrent UTI’s Atopic diseases Immune system enhancement H pylori infections Chronic periodontitis Dental caries Radiation induced diarrhea Cardiovascular risk reduction Rheumatoid arthritis
- 7. Mechanism of actionagainst periodontal diseases Provide favourable Environment for growth Of beneficial bacteria Competition for Essential nutrients Induction of expression Of cytoprotective proteins On host cell surfaces Inhibition of pathogen Adhesion, colonization & Biofilm formation Production of Antimicrobial Factors Such as bacteriocin Reduction in bacterial translocation Modification of toxins or toxin receptors Production of short-chain fatty acids with anti-inflammatory properties Probiotics Proinflammatory pathways modulation Inhibition of collagenases Modulation of host Immune response Prevention of cytokine Induced apoptosis
- 8. Is the oralcavity a natural habitat for Is the oral cavity a natural habitat for probiotics probiotics ? ? Lactobacillus rhamnosus GG , has been found to be incapable of establishing permanent residence in the oral cavity. Yli-Knuuttila et al ,2006. Yli-Knuuttila et al ,2006. Saliva samples shows that Lactobacillus salivarius , L.gasseri, & L.fermentum are among the most prevalent species in the mouth, but no significant difference in their number was seen between healthy patients & patients with periodontitis Hojo et al 2007 Hojo et al 2007. .
- 9. Lactobacilli arerarely detected in subgingival Lactobacilli are rarely detected in subgingival samples and they could not be found in any of samples and they could not be found in any of the patients with chronic periodontitis in a the patients with chronic periodontitis in a study carried out by Koll-klais et al ,2005. study carried out by Koll-klais et al ,2005. Based on these results,it may be assumed that Based on these results,it may be assumed that beneficial bacteria reside in the oral cavity & beneficial bacteria reside in the oral cavity & might provide favourable environmental might provide favourable environmental conditions for periodontal health maintenance. conditions for periodontal health maintenance.
- 10. After Kornman, 1997. Pathogenesisof Periodontal Pathogenesis of Periodontal Disease Disease Genetic Risk Factors Genetic Risk Factors Host Host Immuno- Immuno- inflam- inflam- matory matory Response Response Microbial Microbial Challenge Challenge Connective Connective Tissue Tissue and and Alveolar Alveolar Bone Bone Destruction Destruction Clinical Clinical Signs of Signs of Disease Disease PMN PMN Antigens Antigens LPS LPS Other Other Virulence Virulence Factors Factors Environmental Environmental & Acquired & Acquired Risk Factors Risk Factors Tissue Breakdown Products & Ecological Tissue Breakdown Products & Ecological Factors Factors Antibody Antibody MMPs MMPs Prostanoid Prostanoid Cytokines Cytokines
- 11. Possibilities for probiotictherapy Possibilities for probiotic therapy Four strains of lactobacilli-L.rhamnosus5.1a,5.3a,5.5a & Lc705 Four strains of lactobacilli-L.rhamnosus5.1a,5.3a,5.5a & Lc705 when tested with periodontal pathogens like when tested with periodontal pathogens like A.actinomycetemcomitans, P.gingivalis, T.forsythia & T.denticola, A.actinomycetemcomitans, P.gingivalis, T.forsythia & T.denticola, were found to inhibit all periodontal pathogens & were found to inhibit all periodontal pathogens & A.actinomycetemcomitans were the most susceptible species. A.actinomycetemcomitans were the most susceptible species. Stamatova et al , 2008 ( in vitro study ) Stamatova et al , 2008 ( in vitro study ) Lactobacillus sp. vary greatly in their adherent capacity to saliva Lactobacillus sp. vary greatly in their adherent capacity to saliva coated surfaces . coated surfaces . Stamatova et al, 2009 ( in vitro study ) Stamatova et al, 2009 ( in vitro study ) Thus there is a need to identify the best probiotic strains & species Thus there is a need to identify the best probiotic strains & species for different purposes for different purposes
- 12. Adherence to salivacoated surfaces & Adherence to saliva coated surfaces & integration into plaque biofilm integration into plaque biofilm In vitro studies have shown that putative probiotic sp. can maintain their viability when exposed to saliva & that saliva mediates their adherence to oral surfaces Krasse et al, 2006. L.rhamnosus & L.paracasei possess strong binding capacity Haulioja et al, 2006. High cell surface hydrophobicity correlate with superior adhesive properties ( L.casei921& L.acidophilus NCFM ) Collado et al, 2007.
- 13. Haukioja et alin 2008 have shown that L.rhamnosus Haukioja et al in 2008 have shown that L.rhamnosus GG, L.casei Shirota & L.casei 11578 may affect the oral GG, L.casei Shirota & L.casei 11578 may affect the oral ecology by preventing adherence of other pathogenic ecology by preventing adherence of other pathogenic bacteria & by modifying the protein composition of the bacteria & by modifying the protein composition of the salivary pellicle. salivary pellicle. L.casei 921, L.casei 921, L.bulgaricus LBL-6, L.bulgaricus LBL-6, L.acidophilus & L.acidophilus & L.rhamnosus 11.4a L.rhamnosus 11.4a coaggregate with coaggregate with F.nucleatum ATCC F.nucleatum ATCC at nearly 90% at nearly 90% Stamatova et al,2008 Stamatova et al,2008
- 14. Anticipated mechanisms ofprobiotic activity- Anticipated mechanisms of probiotic activity- in vitro & in vivo studies in vitro & in vivo studies Ishikawa et al (2003) reported daily intake of L.salivarius, Ishikawa et al (2003) reported daily intake of L.salivarius, decreases number of black pigmented anaerobic rods. decreases number of black pigmented anaerobic rods. Koll-Klais et al (2005) showed Koll-Klais et al (2005) showed facultative heterofermentive facultative heterofermentive lactobacilli are the strongest lactobacilli are the strongest inhibitor of inhibitor of A.actinomycetemcomitans, A.actinomycetemcomitans, P.gingivalis,& P.intermedia P.gingivalis,& P.intermedia It is recognized that probiotics can produce lactic It is recognized that probiotics can produce lactic acid,H2O2, &bacteriocins which inhibit pathogens acid,H2O2, &bacteriocins which inhibit pathogens
- 15. Modulation of immunityby probiotics Modulation of immunity by probiotics. . Alter the balance of proinflammatory & antiinflammatory cytokines secreted by epithelial cells In the intestine L.plantarum, L.Rhamnosus GG effectively Reduces the levels of IL-8 before H.pylori infection of the epithelial cells Rokka et al, 2008 Enhances innate immunity & modulates Pathogen induced inflammation Via toll-like receptor –regulated Signalling pathways. Vanderpool et al,2008 The potentially protective role of probiotics in periodontal disease might benefit from studies in gastrointestinal tract.
- 16. Clinical evidence ofprobiotic effectiveness Clinical evidence of probiotic effectiveness in periodontal disease in periodontal disease
- 17. Route of administration Routeof administration Generally probiotics are delivered in dairy Products( fermented milks) , as foodsupplement in tablet forms , or in soft drinks. However , these rotes of administration cannot provide prolonged contact with oral tissues, facilitating probiotic adhesion to saliva coated surfaces. A lozenge form or a chewing tablet or gum might better serve the needs for periodontal health prophylaxis The frequency of intake needs further evaluation because of the inability of most probioticspecies tested to reside permanently in the oral cavity To date, no studies have been performed to investigate the concentration – should not be lower than 106 colony forming Units/ml
- 18. Conclusions Conclusions Based on currentresearch data the effects of Based on current research data the effects of probiotics on periodontal health & its maintenance are probiotics on periodontal health & its maintenance are not clear. Systematic in vitro studies are first needed not clear. Systematic in vitro studies are first needed to learn more about the eventual interactions of to learn more about the eventual interactions of probiotic species & periodontal pathogens & oral probiotic species & periodontal pathogens & oral biofilms, & also about their effects on periodontal biofilms, & also about their effects on periodontal tissue reactions tissue reactions. . Thereafter, properly controlled, randomized , Thereafter, properly controlled, randomized , long term clinical trials are needed long term clinical trials are needed using the most promising strains . using the most promising strains . However, there is every reason to believe However, there is every reason to believe that results from the that results from the studies of probiotic effectiveness in the GI tract could studies of probiotic effectiveness in the GI tract could be adopted & executed in the mouth, provided be adopted & executed in the mouth, provided that siutable probiotic strains are identified that siutable probiotic strains are identified. . Thus probiotic approach might be of interest & Thus probiotic approach might be of interest & we can see several possibilities for we can see several possibilities for the success of this support therapy in the future the success of this support therapy in the future
- 19. References References 1. 1. Cagler E,Kargul B, Tanboga I- Bacteriotherapy & probiotics role on Cagler E, Kargul B, Tanboga I- Bacteriotherapy & probiotics role on oral health. Oral Dis 2005: 11:131-137 oral health. Oral Dis 2005: 11:131-137 2. 2. Collado MC, Hernandez M-production of bacteriocin like inhibitory Collado MC, Hernandez M-production of bacteriocin like inhibitory compouds by human fecal Bifidobacterium strains.J Food Prot compouds by human fecal Bifidobacterium strains.J Food Prot 2005:68:1034-1040 2005:68:1034-1040 3. 3. Haukioja A, Loimaranta V-probiotic bacteria affect the composition Haukioja A, Loimaranta V-probiotic bacteria affect the composition of salivary pellicle & streptococcal adhesion in vitro:Oral Microbiol of salivary pellicle & streptococcal adhesion in vitro:Oral Microbiol Immunol 2008:23:336-343. Immunol 2008:23:336-343. 4. 4. Hojo k, Mijoguchi C, Takemoto N- distribution of salivary lactobacilli Hojo k, Mijoguchi C, Takemoto N- distribution of salivary lactobacilli & Bifidobacterium species in periodontal health & disease. Biosci & Bifidobacterium species in periodontal health & disease. Biosci Biotechnol Biochem 2007:71:152-157 Biotechnol Biochem 2007:71:152-157 5. 5. Ishikawa H, Aiba Y, Nakanishi M- suppression of periodontal Ishikawa H, Aiba Y, Nakanishi M- suppression of periodontal pathogenic bacteria in the saliva of human by the administration of pathogenic bacteria in the saliva of human by the administration of L.salivarius T12711. J Jap Soc Periodontol 2003:45:105-112 L.salivarius T12711. J Jap Soc Periodontol 2003:45:105-112
- 20. 6. 6. Koll-Klais P,Mander R, Leibur E-oral lactobacilli in chronic Koll-Klais P, Mander R, Leibur E-oral lactobacilli in chronic periodontitis & periodontal health. Oral Microbiol Immunol periodontitis & periodontal health. Oral Microbiol Immunol 2005:20:354-361 2005:20:354-361 7. 7. Socransky S, Haffajee A-periodontal microbial ecology. Socransky S, Haffajee A-periodontal microbial ecology. Periodontal 2000,2005:38:135-187 Periodontal 2000,2005:38:135-187 8. 8. Stamatova I, kari K, Meurman JH-in vitro evaluation of Stamatova I, kari K, Meurman JH-in vitro evaluation of antimicrobial activity of probiotic lactobacilli against oral antimicrobial activity of probiotic lactobacilli against oral pathogens. Int J Probiotics Prebiotics 2008:2:225-232. pathogens. Int J Probiotics Prebiotics 2008:2:225-232. 9. 9. Yli-Knnuttila H, Snall J, Kari K, Meurman JH- colonization of Yli-Knnuttila H, Snall J, Kari K, Meurman JH- colonization of L.rhamnosus GG in the oral cavity. Oral Microbiol Immunol L.rhamnosus GG in the oral cavity. Oral Microbiol Immunol 2006: 21:129-131. 2006: 21:129-131. 10. 10. Stamatova I & Meurman JH- probiotics & periodontal disease. Stamatova I & Meurman JH- probiotics & periodontal disease. 2009: Periodontology 2000:51:141-151. 2009: Periodontology 2000:51:141-151.