PennWell Dental Community
Several companies produce probiotics for the oral environment. Recently, Oragenics Inc. introduced a probiotic for children, EvoraKids, which offers a different probiotic blend than the adult product known as EvoraPlus.
Dr. Jeffrey Hillman, the chief scientific officer at Oragenics, developed both products. Dr. Hillman
is the company’s founder, a project initiated after 25 years of research on caries and other oral diseases at the Forsyth Institute and the University of Florida of Dentistry. An author of more than 125 articles and textbook chapters, he earned his dental degree from Harvard, as well as a doctorate from the Harvard Medical School.
He was kind enough to answer some questions that I had about probiotics, and I would like to share his responses. In his comments below, he refers to Probiora3, which is the proprietary blend developed by Oragenics. More information about it can be viewed at www.evoraplus.com.
Hartley: Since probiotics in dentistry are still a relatively new option, what do you think most dental professionals need to understand about incorporating probiotics as part of a patient’s home care regimen?
Dr. Hillman: Probiotics, in general, are new to most Americans. In this regard, we lag behind much of the world by failing to appreciate that not all germs are bad. Most dentists are taught that, among the hundreds of species that form our dental plaque, there is a small, select group of bacteria that are responsible for tooth decay and gum disease. These pathogens are present in almost everyone’s mouth most of the time, but cause disease only sporadically. To understand and appreciate probiotics for the oral cavity, the dentist needs to learn just two things.
First, the reason that the pathogenic species don’t cause more disease than they do is that there are beneficial species of bacteria normally present in dental plaque, which inhibit the growth of the pathogens to keep them below the threshold number required for them to initiate the disease process.
Secondly, for unknown reasons, the beneficial bacteria sometimes disappear from a particular site, which leads to the outgrowth of the pathogen.
The whole point of oral probiotics is to introduce the beneficial bacteria on a daily basis to make certain that the microflora is balanced in favor of health. The fact that the beneficial bacteria involved in maintaining gum health exert their effect on the pathogens through hydrogen peroxide production provides an additional benefit — tooth whitening.
Hartley: In medicine, there have been cases of where probiotics made a patient more susceptible to the disease that it was supposed to prevent? In other cases, it remains questionable if whether a probiotic can replace natural flora when the latter has been killed off for a specific reason. In terms of thinking of probiotics as being a resource for dental patients, should dental professionals be more
vigorous in screening patients to determine the best candidates for probiotics? If so, in what way?
Dr. Hillman: Probiotics intended for gastrointestinal health or to boost immunity are very difficult to
study relative to oral probiotics for the simple reason that it’s very much harder to sample the microenvironment of the bowel than the oral cavity. For this reason, we feel that we have been able to obtain much more compelling evidence for the safety and efficacy of Probiora3 than other probiotic applications that are vouchsafed as being safe and effective through more anecdotal evidence.
The other consideration is the importance of strain differences; it’s empirically clear that different strains of Lactobacillus reuteri have different effectiveness and, likely, safety profiles. This is the major reason that the big probiotic companies trademark their strains and the informed public is aware of the importance of choosing quality brands for this reason.
Hartley: I’m a little confused. Evora is touted as being chewable, yet there are other reminders that it should “melt” on the tongue. Can you clarify the most effective way for young patients to derive the most benefit from Evora?
Dr. Hillman: It doesn’t really matter if the tablet is chewed or allowed to dissolve in saliva. I personally prefer the former since it releases the active ingredients — the probiotic strains — more quickly. But the important thing is that the probiotic cells have time — 30 seconds is sufficient
— for them to attach to the tooth surfaces. A little swishing, if the child is old enough to perform that step, also helps to obtain a more uniform distribution of the cells over the surfaces of the teeth.
For more information about EvoraKids, visit www.evorakids.com. Dental hygienists can email questions about probiotics to info@EvoraPro.com.