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What strains of probiotics are beneficial for oral care and what do they do?

The specialized strains of probiotics, S. salivarius K12 and M18, produce 3 antimicrobial agents:

  • Salivaricin A
  • Salivaricin B
  • Salivaricin 9

Salivaricins are Bacteriocins (proteins which have antimicrobial powers).  Salivaricins puncture cell walls of pathogens, forming pores, that result in leaking of cell metabolites and death.  Salivaricin 9 specifically attacks S. mutans, the main producer of lactic acid.  Lactic acid eats away at tooth enamel, eventual creating painful cavities (tooth decay) as well as the natural layer covering root surfaces, cementum.  When cementum is lost, tooth sensitivity increases, especially to hot and cold, as well as touch.

Tooth decay (dental cavities) is one of the most common diseases in the world.  What causes cavities?  Bacteria!  Specifically strains of Streptococcus mutans and Lactobacillus. They produce lactic acid in the presence of fermentable carbohydrates (sugars) such as sucrose, glucose, and even fructose. and lactic acid eats away at tooth enamel, eventually creating painful cavities.  Once the enamel layer is compromised, the underlying layer, known as dentin, is much softer, and decay can run rampant at that point.  Eventually, the decay process continues into the tooth pulp, at which time extreme pain is common because the nerve tissue and blood supply are open.  At that time, the most typical option to save the tooth is a root canal (endodontia) or the tooth may be lost.  Bacterial infection, in some cases may continue if root canal or extraction is not done in the early stages of infection. In those cases, systemic infection, such as cellulitis may occur, at which time general health may be compromised.

As these bacteria gather in mass around the teeth, root surfaces, and gums they create a sticky biofilm, commonly known as plaque.  Some tooth surfaces and areas retain plaque and bacteria more easily because of the deep ridges and grooves, such as on the biting surface of the molars. If left untreated, and over time, tooth decay can lead to eventual tooth loss, oral and systemic infections and in severe cases, even death (1).

The main bacterial culprit in producing cavities is S. mutans.  What makes it so tricky in its goal is that besides producing lactic acid it also converts sucrose (table sugars) to an extremely adhesive glue known as dextran polysaccharide (dextrans) by using an enzyme dextransucranase (don’t worry memorizing this because you will soon learn what K12 and M18 can do about this). 

Nature’s method of preventing tooth decay is through the saliva. Healthy saliva helps to keep tooth enamel properly mineralized. But, when the pH at the tooth surface drops below 5.5, the balance changes so that demineralization is greater than remineralization.  In effect, tooth decay has begun. (This is one major reason why ALL TheraBreath products are pH balanced above 7.0 in order to act as an antacid.  MOST mouthwash formulas are extremely acid and acids wear away precious tooth and gum tissue over time.  – for a list of mouthwash acid levels, see www.therabreath.com/art_mouthwash.asp).

Unfortunately, there is no known treatment that regenerates significant amounts of dental enamel, cementum (the tissue covering the root surfaces) and dentin (the layer beneath enamel), which protects the nerve and blood inside very tooth, (known as the pulp).  That leaves prevention as the main focus.  Prevention may include altering the diet, as well as increased levels of oral hygiene.

Reduction of acids, which lead to tooth decay and tooth sensitivity:

In addition to the production of antimicrobial agents, S. salivarius M18 , was shown to convert urea, a naturally secretion found in saliva, into ammonia.  This is significant because ammonia naturally neutralizes lactic acid, the acid which causes destruction of tooth structure, leading to cavities.  Lactic acid can also wear away the cementum layer which protects root sensitivity.  Consquently, the ability of M18 to produce urease not only helps to prevent tooth decay but also painful and annoying tooth sensitivity.  This is a special function of S. salivarius M18 and is not found in any other bacteria or probiotics.

Reduction of plaque, biofilm, tooth staining:

As mentioned earlier, tooth decay becomes more prevalent in the presence of plaque (a true biofilm, consisting of layers of bacteria and the sticky natural glue, known as dextrans). 

Plaque (biofilm) is also crucial in the development of all levels of gum disease, including gingivitis and full blown periodontal disease. The good news is that S. salivarius M18 can produce dextranase, the natural enzyme that dissolves dextrans.  The result is revolutionary because without dextrans, we can expect increased prevention of the development of plaque, biofilm, tongue coating, tooth staining, tooth decay, gum disease, and a wide variety of health issues.

Reduction of Periodontal Inflammation (Gingivitis, Bleeding Gums):

The first step in gum disease is the swelling of the gums (inflammation), followed by gum bleeding, tooth mobility, and eventually tooth loss, if the process is not halted somewhere along this line.  In the process of inflammation, several steps take place including. 

Gum disease is caused by a group of anaerobic bacteria including P. gingivalis, A actinomycecomitans, and F. nucleatum (which also create severe bad breath). The first step after invasion by these bacteria is a natural immune response by what are called macrophages (white blood cells whose job is to clean up debris and dead cells). As part of this process, macrophages release chemical hormones, known as cytokines. Cytokines cause the inflammation associated with periodontal disease. Cytokines cause the blood vessels to dilate and become porous, leading to increased local blood flow, thus causing increased inflammation. The inflammation attracts neutrophils (more abundant white blood cells which cause bleeding) and more macrophages, which starts the process all over.

In a study entitled “Streptococcus salivarius K12 and M18 Probiotics Reduce Periodontal Pathogen induced Inflammation” presented in 2010 at the International Association for Dental Research, both K12 and M18 were able to reduce the production of cytokines associated with inflammatory conditions like gingivitis and periodontitis. Therefore, these strains may offer novel preventive and therapeutic options for patients suffering from both diseases.