Tag Archives: probiotics

Oral Probiotics


Oral Probiotics

By Richard H. Nagelberg, DDS

 This is a reprint of an excellent article published in Dental Economics Magazine, edited by Dr. Neal Locker, DMD for easier readability by consumers.

 There is an entire category of products that is underutilized in the dental profession — oral probiotics. In fact, they are a category unto themselves. Oral probiotics have the potential to make a significant impact on the oral health of patients, and systemic health by extension. While not a therapeutic modality that could be included in a periodontal patient’s active phase of treatment, oral probiotics are among the best options we can use for patients in differing states of disease or health.

True oral probiotics use oral bacteria rather than intestinal bacteria, and these bacteria are harmless. Probiotics work by replacing existing disease-causing bacteria with harmless bacteria. The company Oragenics markets an oral probiotic called EvoraPro. Its development was the culmination of decades of research at the Harvard-affiliated Forsyth Institute in Boston.

The beauty of this oral probiotic is the simple, commonsense manner in which it works. EvoraPro has three naturally occurring live bacteria, freeze-dried in a mint. The mint contains three different species of Streptococcus, which are natural colonizers of a healthy mouth, rather than genetically engineered. The patient dissolves one mint in the mouth per day. The bacteria are released and compete with various pathogenic bacteria for binding sites. The sites on the teeth and gums occupied by the probiotic bacteria reduce the surface area available for disease-causing bacterial colonization. Furthermore, they also compete for nutrients. And their secretions help to kill the bad bacteria in your mouth.

The three species of bacteria are non-acid-producing, so when they crowd out S. mutans and other cavity causing bacteria, caries incidence is reduced. The probiotic bacteria colonize above and below the gums, and a by-product of their metabolism is hydrogen peroxide. These bacteria release a continuous, low dose of hydrogen peroxide, which is toxic to anaerobic bacteria, including the periodontal pathogens. Reducing the availability of attachment sites for the periodontal pathogens is also important, because they can only cause disease when they are in direct contact with gum tissue. If they are in contact with the tooth or surfaces other than the gum tissue, or if they are freely floating in the mouth, they cannot cause periodontal disease (gum disease).

Antimicrobial agents — including therapeutic doses of systemic and locally applied antibiotics, mouthwashes, subgingival irrigants, etc. — will kill probiotic bacteria. This is why they are not used during active periodontal therapy. One of the ideal situations in which oral probiotics are used is immediately following successful gum treatment. Reducing the repopulation of caries-causing and periodontal bacteria gives the patient a fighting chance to remain healthy. Probiotics are also ideally used in periodontally healthy patients, especially those with a family history of periodontal disease. The optimal time to take the probiotic mint is in the evening, following the use of flossing and brushing. But the second best time to use EvoraPro is in the morning right after flossing and brushing and rinsing with water.

The patient’s health and family history are sources of considerable impactful information. A patient with a strong family history of diseases and conditions such as cardiovascular disease, diabetes, periodontal disease, high blood pressure, and rheumatoid arthritis, among many others, has a potentially heightened risk for these diseases as well. A large body of research has demonstrated several different mechanisms of oral-systemic associations. One is the effect of the chronic inflammatory properties of periodontal disease on various diseases and conditions. Another is the effect of the periodontal pathogens on cardiovascular diseases and events, independent of periodontal disease. There is also the increase in insulin resistance from the inflammatory and infectious components of periodontal disease. Insulin resistance is the biggest root cause of atherosclerosis, which is the initiating event for heart attacks and strokes. Reducing the number of pathogenic bacteria, along with the oral contribution to the total inflammatory burden in the body, by consistently and effectively controlling periodontal disease can only result in better patient health.

It is important to take these risk elements into account when evaluating a patient and developing a treatment plan for periodontal disease. The maintenance phase of periodontal therapy, along with the effectiveness of the patient’s home care, determines how long a perio patient will remain healed. Using all the tools at our disposal, including oral probiotics, will help to optimize our patients’ oral and general health.

EvoraPro is available from Gentle Family Dentistry in Duncansville, PA because we believe it may help you control and conquer dental caries and gum disease. It is $49.95 for a 90 day supply.

You can also order it directly from Oragenics at www.evoraprobiotics.com or by calling them at: 813-286-7900. You will have to provide them this special code: 300623EvoraPro is a professional product and cannot be purchased over the counter.

Legal CMA Disclaimer:

Although this article may contain factual information, the information contained in this article has probably not been evaluated by the FDA nor is it in any way intended to be medical advice.

Unfortunately I must recommend that for any change in medical or health behavior or for any change in the way you use prescribed drugs by your healthcare providers or before acting upon any of the advice given in this or any other article, that you consult with your licensed healthcare provider or physician.

Dr. Locker and his friendly, knowledgeable staff invite you to call Gentle Family Dentistry in Duncansville, PA for the greatest, most advanced, painless dental experience you have ever had.

You can call us at: 814-693-6777 or just click the link to
go to our webpage for more information.
Click here now: www.gfdentistry.com

And remember, You only have to floss daily the ones you want to keep.

Richard Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations, and lecturer on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity.

Oral Probiotics And Their Relationship To Your Health

Research has confirmed that many conditions such as dental caries (cavities), periodontal disease, Candida, bad breath, and chronic sinus infections can often be cured or greatly improved by maintaining bacterial balance in the oral cavity.

The bacteria in your mouth do far more than protect your teeth, gums, throat, and sinuses from harmful bacteria. And I’m sure it’s probably plain to see how all of the conditions mentioned above could benefit from an oral probiotic. Some of the other advantages aren’t so obvious.

For several years, we have been told to cut the consumption of “cancer-causing” nitrates and nitrites used to preserve and cure various foods. Just like the false warnings we had in the past about eggs, cholesterol, and saturated fat, words of caution about nitrates and nitrites are also false.

Nitrates, Nitrites, and Oral Bacteria

Before going any further, let me explain what nitrates and nitrites have to do with oral bacteria.

In comparison, to get the same amount of nitrates found in one serving of arugula or four servings of celery or beets, you ‘d have to eat 467 hotdogs. Arugula contains 4,677 parts per million (ppm) of nitrates, celery 1,103 ppm, beets 1,279 ppm and hotdogs and processed meats 10 ppm.

As soon as nitrate-rich vegetables enter your mouth, beneficial bacteria that reside on the surface of your tongue reduce them to nitrites. These nitrites are swallowed and then either reduced to nitric oxide (NO) in the acidic environment of the stomach, or absorbed via the gastrointestinal tract and placed into the circulatory system as nitrites. This describes the nitrate-nitrite-nitric oxide pathway, one of the ways the body produces NO.

The other way the body generates NO involves the oxidation of L-arginine by endothelial cells, which line the interior surface of blood and lymphatic vessels. This process requires oxygen and numerous cofactors, but still follows the nitrate-nitrite-NO pathway.

You Can’t Beat Beets

You may have heard or read about the excitement surrounding beetroot juice. NFL and college football teams, bodybuilders, endurance athletes, runners, and cyclists are excited about it because it has one of the highest nitrate concentrations of any vegetable. And studies have shown that by enhancing vasodilation, beetroot juice can have some profound performance enhancing effects.

In simple terms, after ingesting beetroot juice, muscles use less oxygen for the same amount of work that is used without the juice. Some studies indicate as much as 17 percent longer, which is nothing short of amazing.

Not Just for Athletes

You don’t have to be an athlete to benefit from beetroot juice.

After three days, not only were plasma nitrite levels significantly higher among those drinking the beetroot juice, their systolic blood pressure (the top number) was dramatically lower (8 mmHg). Plasma nitrite levels doubled and reached a peak at three hours, which correlated with the drops in blood pressure.

This same study showed that beetroot juice can prevent the normal cascading damage that typically occurs when blood supply is totally shut off to an area. The ramifications of this could be huge in preventing the injuries caused by stroke or heart attack.

In yet another study, 1/2 liter of beetroot juice was given to patients suffering from peripheral artery disease, a form of cardiovascular disease where arterial plaques block blood flow to the lower extremities and cause intermittent severe pain during walking due to poor circulation. Three hours after ingesting the juice, the participants were able to walk 17 percent longer compared to those who did not drink it. Exercise tolerance increased by 20 percent. Beetroot juice could be extremely valuable to people who suffer from this problem.

Nitrate Consumption Has Suffered

In spite of all the recent research and excitement about beetroot juice, I can’t help but wonder if, over the last several decades, changes in our diet and habits have actually lowered our levels of nitrates and NO.

For one, we’ve had countless warnings about the potential dangers of nitrates and nitrites. Totally bogus, lots of people still believe them and intentionally avoid those natural preservatives.

Remember that our primary source of nitrates is vegetables. On average, 87 percent of the total nitrites we get every day come from the conversion of nitrates in the vegetables we eat.

French fries contain only 23 percent of the nitrates and 2.49 percent of the nitrites of those found in the raw vegetable. Potato chips aren’t any better, with 24 percent of the nitrates and 0.59 percent of the nitrites found in the raw potato.

Nitrate and nitrite amounts in tomatoes are also low, sometimes undetectable, in both raw form and in processed products.

It’s reasonable to conclude that some of today’s most common health complaints (cardiovascular disease, poor circulation, dementia, erectile dysfunction, etc.) are a direct result of the reduction of nitrates in our diet. At the very least, it’s a major contributing factor.

NO is formed in the stomach acid after nitrates are converted to nitrites in the mouth. These nitrite compounds are necessary in raising the pH levels in the stomach to a point that the environment becomes bactericidal against foodborne pathogens.

Even if you are getting adequate amounts of nitrates, they have to be converted to nitrites by the bacteria in your mouth, which are essential to the production of NO in the body.

One study evaluated the effect of spitting out saliva during and after beetroot juice consumption on blood pressure and plasma nitrite concentration. The spitting disrupted the entire pathway and prevented nitrite-rich saliva from reaching the stomach. This resulted in no reduction in platelet stickiness, no rise in plasma nitrite levels, and no decrease in blood pressure.

Get the Most Benefit from Beets

If you have a juicer, making beetroot juice is easy and far less expensive than the prepackaged products starting to hit the market.

Most of the studies used 1/2 liter of fresh beetroot juice a day. There are commercial concentrated products like Beet It, which had also been used in numerous studies. The cost of drinking a commercial concentrate jumps considerably when compared to juicing your own beets, using beetroot powder, or simply including more vegetables in your diet.

There’s no perfect formula for determining the exact dosage required to improve athletic performance, lower blood pressure, and achieve the other health benefits. In the studies I mentioned, however, the beetroot juice or concentrates contained 300 – 500 mg of nitrates.

Below you’ll see some estimates of the nitrate content of various vegetables and foods. Amounts can vary depending on the soil conditions in which they grew, storage, transport, and other factors:

■  Two cups of fresh beetroot juice contain around 400 mg of nitrates. This amount has been shown to lower blood pressure by about 10 points, which is more efficient than many prescription drugs. In one study, blood pressure dropped one hour following consumption, reached its lowest point two-and-a-half to three hours after ingestion, and continued to be effective for 24 hours.

■ One teaspoon (about 1/3 of an ounce or 10 grams) of beetroot powder normally equates to one beet. Two teaspoons provide 300 – 500 mg of nitrates.

■ 1 cup of raw spinach contains about 900 mg of nitrates; 1/2 cup of cooked collard greens approximately 200 mg; and 1/2 cup of vegetable juice about 40 mg.

Don’t make the mistake of sidestepping vegetables altogether and taking a nitrite supplement. Nitrite salts are available online and athletes have used them to enhance performance, but the results can be dangerous and life threatening.

Consuming beetroot juice, powder, and/or other vegetables rich in nitrates, on the other hand, is totally safe. When you consume nitrates, for example from vegetables, only a minor part of the nitrate is converted to nitrite.

The Best Environment for NO Production

While researchers are finally becoming more open-minded about the need for nourishing beneficial bacteria in gut, the oral cavity seems to be a totally different matter and is often overlooked.

Still operating under the premise that “the only good bacterium is a dead bacterium,” toothpastes, mouthwashes, breath sprays, and even some mints contain antibacterial compounds. If you read the labels on these products, some of the antibacterials you’ll find include triclosan, chlorhexidine, and zinc chloride. They wipe out odor-causing bacteria and provide “24-hour protection” from halitosis, they may also be reducing your ability to produce lifesaving NO.

Guess what happens when a disruption or decrease in the number of beneficial bacteria occurs in your mouth?

This past October, researchers found that gargling with a mouthwash that destroys the bacteria in your mouth also happens to increase blood pressure. Fifteen men and women (average age 65) undergoing treatment for high blood pressure were recruited for this study.

During three days of using the antibacterial mouthwash, their nitrate to nitrite conversion, nitrite and nitrate plasma levels, and blood pressure were compared to a separate period of time when they used a water wash. After just three days, the conversion of nitrates to nitrites dropped considerably and their systolic blood pressure rose 2.3 mmHg.

Not surprisingly, several other studies have found that people with high blood pressure tend to have lower levels of nitrates and nitrites.

NO’s ability to safely boost blood flow is so profound that some doctors now recommend infusing critical patients with nitrite. Nitrite infusions can safely and effectively increase blood flow by 175 percent. This practice could be a lifesaver for many by quickly getting blood to regions of the body with low oxygen, such as the kidneys, heart, brain, and muscles.

Don’t Believe the Negative Hype

Despite what you’ve been told, no studies indicate that nitrites or nitrates cause cancer. Dozens of studies have found no association between nitrates, cancer, and human mortality.

Scientific data has confirmed that nitrates and nitrites benefit rather than endanger health. If they were harmful, we would have to stop eating vegetables and swallowing our own spit, which accounts for 70 – 97 percent of our total nitrite and nitrate exposure.

Don’t be afraid of the nitrate or nitrite content of processed meats. The sodium nitrite or nitrate in cured meat is exactly the same compound naturally found in sea salt, celery, beets, and other vegetables.

Circling back to oral probiotics, they are essential for practically everyone. Research indicates that cavity-causing bacteria can’t live in a high-nitrite environment. The widespread use of oral probiotics, especially among children, would probably put a lot of pediatric dentists out of business.

And for adults, along with providing all of the benefits just covered, oral probiotics routinely improve gum health, reduce the buildup of plaque and tartar, and help extend the time between cleanings. They are not a substitute for brushing, flossing, and other dental hygiene, but do provide another layer of protection for optimum oral (and overall) health.

 Legal CMA Disclaimer:

Although this article may contain factual information, the information contained in this article has probably not been evaluated by the FDA nor is it in any way intended to be medical advice.

Unfortunately I must recommend that for any change in medical or health behavior or for any change in the way you use prescribed drugs by your healthcare providers or before acting upon any of the advice given in this or any other article, that you consult with your licensed healthcare provider or physician.

Dr. Locker and his friendly, knowledgeable staff invite you to call Gentle Family Dentistry in Duncansville, PA for the greatest, most advanced, painless dental experience you have ever had.

You can call us at: 814-693-6777 or just click the link to
go to our webpage for more information.
Click here now: www.gfdentistry.com

And remember, You only have to floss daily the ones you want to keep.