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 Table of Contents  
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 57-60

Effect of direct administration of functional foods on oral flora in patients undergoing fixed orthodontic treatment

1 Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India
2 Department of Orthodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. T Jaya Chandra
Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmd.ijmd_12_18

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Introduction: Orthodontic treatment facilitates the growth of pathogens and leads to white spot lesions and caries formation. This study was carried out to compare the efficacy of probiotics, prebiotics, and symbiotics on the salivary levels of Streptococcus mutans, Lactobacillus, and Bifidobacterium.
Materials and Methods: Saliva samples were collected from the patients who were undergoing comprehensive orthodontic treatment at two different time intervals, baseline (T0) and postintervention (T1) that is 1 month after administration of prebiotic, probiotic, and symbiotic bacteria, respectively, for Groups A, B, and C; placebo was included in Group D. Samples were inoculated on selective media, after incubation growth was identified. Colony counts were recorded in colony forming units per milliliter. Paired t-test, analysis of variance, and post hoc Tukey's honest significant difference test were used for analysis, and P < 0.05 was considered to be statistically significant.
Results: Among the participants, S.mutans counts were found to be decreased (P < 0.05) and lactobacilli and bifidobacterium counts were found to be increased (P > 0.05).
Conclusion: Short-term consumption of probiotics, prebiotics, and symbiotics had effectively reduced the S. mutans levels in the oral cavity with increased levels of Lactobacillus and Bifidobacterium when compared with the placebo group.

Keywords: Prebiotics; probiotics; symbiotics

How to cite this article:
Chandra T J, Manda A. Effect of direct administration of functional foods on oral flora in patients undergoing fixed orthodontic treatment. Indian J Multidiscip Dent 2018;8:57-60

How to cite this URL:
Chandra T J, Manda A. Effect of direct administration of functional foods on oral flora in patients undergoing fixed orthodontic treatment. Indian J Multidiscip Dent [serial online] 2018 [cited 2020 Oct 1];8:57-60. Available from: http://www.ijmdent.com/text.asp?2018/8/2/57/249110

  Introduction Top

The oral cavity provides shelter for a great diversity of microbial species; one-third of oral microbiota usually cannot be isolated from any other oral niche.[1] The oral flora has an important role in maintaining oral health.[2] Fixed orthodontic appliances considered to jeopardize dental health because of accumulation of microorganism may cause enamel demineralization, clinically visible as white spot lesions.[3] Of all the microorganisms, Streptococcus mutans and lactobacilli are the important causative agents in the initiation of enamel demineralization.[4] Other than immunity, any change in the flora will allow the pathogen to cause infection. Introducing a foreign body in the form of treatment surely can influence the flora in the oral cavity. The foreign bodies that are introduced in the orthodontic treatment in the form of braces, brackets, graft medicaments, and so on create such an environment that facilitates the growth of pathogens. This leads to white spot lesions as well as caries formation. One of the strategies in preventing white spot lesions is by ingestion of functional foods with probiotic,[5] prebiotic,[6] and symbiotic bacteria.[5] This study was undertaken to compare the efficacy of probiotics, prebiotics, and symbiotics on the salivary levels of S. mutans, Lactobacillus, and Bifidobacterium.

  Materials and Methods Top

A study was conducted in the Department of Microbiology, GSL Medical College, Rajamahendravaram, Andhra Pradesh, India, from July to November 2014. The study protocol was approved by the Institutional Ethics and Review Board. An informed written consent was taken from all the study participants.

This study was comprised of patients who were undergoing comprehensive orthodontic treatment for at least 3 months in the Department of Orthodontics, Vishnu Dental College. Participants with a history of systemic antibiotic or professional topical fluoride treatment within 4 weeks before baseline measurements and those who habitually used products containing probiotics and/or antibiotics were excluded from the study. The study participants were divided into test and control categories. Test categories consisted of Groups A, B, and C; Group D was the control category. Participants of Groups A, B, and C were given 10 mg of probiotics, prebiotics, and symbiotics, respectively, in 50 mL of water per day for 1 month. Group D received placebo. Allocation of participants into the groups was done by block randomization.

All the participants were instructed to brush twice daily for 2 min, were asked to avoid curd and antibiotics throughout the study, and were restricted on the intake of food or beverages 1 h before taking medication. After thorough rinsing the oral cavity with water, the participants were asked to chew a piece of paraffin wax for 2 min and then saliva was collected in a sterile, new leak-proof sample container and the cap was closed tightly. Samples were collected at two different time intervals, baseline (T0) and 1-month postintervention (T1). Samples were transported in ice containers to GSL Medical College for microbiological analysis.[6]

In the laboratory, samples were centrifuged at 4000 rpm for 10 min. The supernatant was discarded and the pellet was suspended in 1 mL sterile phosphate buffer saline (PBS). Then, the mixture was subjected to serial dilution in the ratio of 1:10, 1:100, 1:1000, and 1:10,000 in PBS. From each dilution, an aliquot of 10 mL was cultured. Samples were inoculated in Mutans–Sanguis Agar, Bifidobacterium Agar, and Rogosa SL Agar – selective media for streptococci, bifidobacteria, and lactobacilli, respectively.

Mutans–Sanguis Agar and Rogosa SL Agar plates were incubated at 37°C in candle jar for 48 h, whereas Bifidobacterium Agar plates were placed in anaerobic jar with Gas-pak and incubated at 37°C for 48 h. Growth was identified by Gram staining and colony morphology on culture media. Colony counts were recorded in colony forming units per milliliter.

The data were analyzed by SPSS software version 18.0 (SPSS Inc., Chicago, Illinois, USA) by taking patient as the unit of analysis. Descriptive statistics such as mean and standard deviation were calculated for each group. Within the group, paired t-test was used to find the difference between T0 and T1; analysis of variance was used to find the group difference; and post hoc Tukey's honest significant difference (HSD) test was used for multiple comparisons. P <0.05 was considered statistically significant.

  Results Top

Among the study participants, the mean age was 21.2 years and the age range was 18 – 25 years. Fifteen participants were included in each group, the total number was 60. Among the test groups, S. mutans counts were decreased; whereas lactobacillus and bifidobacterium counts were increased. For all the three organisms the difference was statistically significant (P < 0.05) between T0 and T1 and the difference was statistically not significant (P > 0.05) for group D [Table 1].
Table 1: Comparison of streptococcus, Lactobacillus, and bifidobacteria counts and comparison in groups, between groups, and multiple comparisons among the groups

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For all the three bacteria, when groups were compared, for T0, the difference was statistically not significant (P > 0.05). Whereas for T1, the difference was statistically significant (P < 0.05) for S.mutans levels in all the groups and lactobacillius, bifidobacterium counts did not show significant difference (P > 0.05) [Table 1].

Tukey's HSD showed statistically significant difference (P < 0.05) between group C and D for bifidobacterium levels with T1[Table 1].

  Discussion Top

Among the patients with fixed orthodontic appliances, there is a change in normal oral environment, which might disrupt the balance between the host and the established microorganisms. This new oral environment might favor the growth of pathogens and also might induce disease-like state such as decalcification and caries development.[7] In this situation, the use of antimicrobials had given good results;[8] however, development of drug resistance is the major limitation.[9] At this juncture, use of live microorganisms in the form of functional foods with probiotics, prebiotics, and symbiotics might be ideal as these could reestablish normal oral flora because it is a well-known fact that this flora inhibits the disease-causing properties of the pathogens. The most common probiotic strains belonged to genera Lactobacillus and Bifidobacteria. Hence, in this study too, probiotics containing Lactobacillus rhamnosus and Bifidobacterium longum were administered to the participants.

Several studies were reported on the beneficial effects of probiotics among the patients with orthodontic treatment.[10],[11],[12],[13] This study as well as the previous reports concluded that probiotics decreased the levels of S. mutans. Montalto et al.[14] reported that probiotics did not have any effect on S. mutans counts even after 45 days of administration. Cildir et al.[10] administered probiotics in the form of yoghurt; Caglar et al.[11],[12] administered the probiotic tablet with telescopic straw; and Krasse et al.[13] used chewing gum-containing bacteria as probiotic. But yoghurt or chewing gum or the administration procedure surely influenced the saliva levels, which further changed the oral flora.[15] However, this was not discussed by the investigators. Hence, in this study, functional foods with probiotics, prebiotics, and symbiotics were administered directly.

The participants used probiotic powder containing L. rhamnosus in the morning till the day of the second sample collection. This might be the reason for increased levels (P > 0.05) of lactobacilli in this study. However, among the normal participants, it was reported that L. reuteri-containing products were found to be of no significant change.[11],[12],[16] This study also evaluated the effect of prebiotics and symbiotics on oral microflora. The prebiotic is a nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus, it improves the host health.[17],[18] A symbiotic bacteria is a combination of probiotic and prebiotic bacteria, which can stimulate the survival of probiotic and autochthonous-specific strains in the intestinal tract.[19] Especially, in the dentistry, the application of probiotics and symbiotics is limited and not evaluated much.

In this study, administration of prebiotics also showed similar effects like that of probiotics. However, effectiveness of prebiotics was less when compared with that of probiotics, as prebiotics selectively stimulated the growth of probiotic strains during the period of storage or during its passage through the gut. The results were almost similar with that of symbiotics, although their effects observed were greater than that of prebiotics but less than that of probiotics. The literature also suggested that combination of prebiotics and probiotics might have additive and synergistic effect in providing better oral health conditions.[20]

  Conclusion Top

Short-term consumption of probiotics, prebiotics, and symbiotics had effectively reduced the S. mutans levels in the oral cavity with increased levels of Lactobacillus and Bifidobacterium when compared with the placebo group. Thus, the consumption of these might provide favorable environment to arrest or to prevent white spot lesions in patients undergoing fixed orthodontic treatment. However, further studies were needed to clarify whether this approach could be used as an alternative for the prevention of white spot lesions and also to determine whether the effects would persist for longer duration. However, direct interaction of bifidobacteria on S. mutans and Lactobacillus was not investigated. This was the limitation of this study.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Keijser BJ, Zaura E, Huse SM, van der Vossen JM, Schuren FH, Montijn RC, et al. Pyrosequencing analysis of the oral microflora of healthy adults. J Dent Res 2008;87:1016-20.  Back to cited text no. 1
Brown AC, Valiere A. Probiotics and medical nutrition therapy. Nutr Clin Care 2004;7:56-68.  Back to cited text no. 2
Mitchell L. Decalcification during orthodontic treatment with fixed appliances – An overview. Br J Orthod 1992;19:199-205.  Back to cited text no. 3
Kestenbaum RC. Bacterial specificity in the etiology of caries and periodontal disease. J Dent Res 1968;47:925.  Back to cited text no. 4
Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics – Approaching a definition. Am J Clin Nutr 2001;73:361S-4S.  Back to cited text no. 5
Alves PV, Alviano WS, Bolognese AM, Nojima LI. Treatment protocol to control streptococcus mutans level in an orthodontic patient with high caries risk. Am J Orthod Dentofacial Orthop 2008;133:91-4.  Back to cited text no. 6
Thomas JG. Prebiotics, probiotics, and oral microbial wellness. Compendium 2011;32:13-7.  Back to cited text no. 7
Emilson CG. Potential efficacy of chlorhexidine against mutans streptococci and human dental caries. J Dent Res 1994;73:682-91.  Back to cited text no. 8
DePaola LG. Antimicrobial resistance – The global threat: State of the science. J Dent Hyg 2014;88:146-8.  Back to cited text no. 9
Cildir SK, Germec D, Sandalli N, Ozdemir FI, Arun T, Twetman S, et al. Reduction of salivary mutans streptococci in orthodontic patients during daily consumption of yoghurt containing probiotic bacteria. Eur J Orthod 2009;31:407-11.  Back to cited text no. 10
Caglar E, Kuscu OO, Cildir SK, Kuvvetli SS, Sandalli N. A probiotic lozenge administered medical device and its effect on salivary mutans streptococci and lactobacilli. Int J Paediatr Dent 2008;18:35-9.  Back to cited text no. 11
Caglar E, Cildir SK, Ergeneli S, Sandalli N, Twetman S. Salivary mutans streptococci and lactobacilli levels after ingestion of the probiotic bacterium lactobacillus reuteri ATCC 55730 by straws or tablets. Acta Odontol Scand 2006;64:314-8.  Back to cited text no. 12
Krasse P, Carlsson B, Dahl C, Paulsson A, Nilsson A, Sinkiewicz G, et al. Decreased gum bleeding and reduced gingivitis by the probiotic lactobacillus reuteri. Swed Dent J 2006;30:55-60.  Back to cited text no. 13
Montalto M, Vastola M, Marigo L, Covino M, Graziosetto R, Curigliano V, et al. Probiotic treatment increases salivary counts of lactobacilli: A double-blind, randomized, controlled study. Digestion 2004;69:53-6.  Back to cited text no. 14
Stamatova I, Meurman JH. Probiotics: Health benefits in the mouth. Am J Dent 2009;22:329-38.  Back to cited text no. 15
Caglar E, Kavaloglu SC, Kuscu OO, Sandalli N, Holgerson PL, Twetman S, et al. Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli. Clin Oral Investig 2007;11:425-9.  Back to cited text no. 16
Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: Introducing the concept of prebiotics. J Nutr 1995;125:1401-12.  Back to cited text no. 17
Reddy PS, Swapna LA, Ramesh T, Singh TR, Vijayalakshmi N, Lavanya R, et al. Bacteria in oral health – Probiotics and prebiotics a review. Int J Biol Med Res 2011;2:1226-33.  Back to cited text no. 18
Gourbeyre P, Denery S, Bodinier M. Probiotics, prebiotics, and synbiotics: Impact on the gut immune system and allergic reactions. J Leukoc Biol 2011;89:685-95.  Back to cited text no. 19
Andersson H, Asp NG, Åke B, Roos S, Wadström T, Wold AE, et al. Health effects of probiotics and prebiotics a literature review on human studies. Food Nutr Res 2001;45:58-75.  Back to cited text no. 20


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