More re­search needed in or­der to es­tab­lish a de­fin­i­tive con­nec­tion

Calgary Herald - - YOU - DR. EDDY LANG AND RE­BECCA LANG Dr. Eddy Lang is a pro­fes­sor and depart­ment head for emer­gency medicine at the Cum­ming School of Medicine, Univer­sity of Calgary. Re­becca Lang is a grad­u­ate stu­dent in Com­mu­nity Health Sciences at the Univer­sity of Calgary.

Two cav­i­ties. The last words Sasha, a mother of three chil­dren, wanted to hear at the den­tist’s of­fice as her son Spencer was get­ting a checkup.

Spencer, who re­cently turned four, has now col­lected five cav­i­ties over the course of his young life. These cav­i­ties oc­curred de­spite Sasha’s dili­gent ef­forts to brush and floss Spencer’s teeth twice a day, and min­i­mize how much snacking he does. With den­tal care be­ing so ex­pen­sive in Calgary, Sasha feels frus­trated and hope­less. Is there any way to re­duce the num­ber of cav­i­ties Spencer gets in his life­time?

A cav­ity de­vel­ops when a tooth de­cays, or breaks down. It is a rel­a­tively large hole in the tooth that can grow larger over time. Cav­i­ties de­velop be­cause of mi­crobe­in­fested plaques made up of harm­ful bac­te­ria that stick to the tooth and cause it to de­cay. It is one of the many dis­eases that can com­pro­mise your oral health. Oth­ers in­clude den­tal in­fec­tions and sores, gum dis­eases such as gin­givi­tis, and any other con­di­tion that may limit an in­di­vid­ual’s abil­ity to bite, chew, smile or speak.

Oral health is a very im­por­tant part of over­all health, and a smile is also of­ten re­ferred to as a win­dow to the soul. Miss­ing, stained or dam­aged teeth can af­fect em­ploy­ment and men­tal health, and toothaches and den­tal in­fec­tions can be ex­tremely painful.

The mouth is home to 250 to 300 dif­fer­ent types of bac­te­ria at any given time. Though we usu­ally think of bac­te­ria as a cause of dis­eases, the hu­man body is full of both “good” and “bad” bac­te­ria. While the good bac­te­ria in the mouth are im­por­tant to help with di­ges­tion, stim­u­lat­ing saliva pro­duc­tion and fight­ing bad breath, the bad bac­te­ria can lead to cav­i­ties and gum dis­ease; strep mu­tans is a par­tic­u­larly vil­lain­ous species. Many have sug­gested that one of the fac­tors con­tribut­ing to oral health is the care­ful bal­ance be­tween the help­ful and non-help­ful guests in your mouth.

Pro­bi­otics have been a re­cent hot topic in the me­dia for their role in im­prov­ing di­ges­tive health in the hu­man body. How­ever, the per­ceived ben­e­fits of these health­pro­mot­ing bac­te­ria are not so new. The 1908 No­bel Prize for Medicine went to Dr. Elie Metch­nikoff, who claimed that Bul­gar­i­ans lived longer than other Euro­peans be­cause they ate lots of fer­mented prod­ucts like yo­gurt, which con­tained help­ful bac­te­ria such as lac­to­bacilli and aci­dophilus.

Pro­bi­otics have been shown to be ben­e­fi­cial in cer­tain con­di­tions such as ir­ri­ta­ble bowel syn­drome, in­flam­ma­tory bowel dis­ease, and an­tibi­otic-trig­gered di­ar­rhea. Pro­bi­otics work well for these con­di­tions be­cause they re­place some of the harm­ful bac­te­ria in your di­ges­tive tract, which is home to hun­dreds of species of bac­te­ria.

Pro­bi­otics can be taken as sup­ple­ments, or through di­ets that help pro­mote the good bac­te­ria in your sys­tem. Ex­am­ples of pro­bi­otic-con­tain­ing foods in­clude yo­gurt, ke­fir and, lit­tle-known to most, sauer­kraut and kim­chi. What most peo­ple don’t of­ten hear about is the po­ten­tial role pro­bi­otics may play in im­prov­ing oral health. When there are more harm­ful bac­te­ria than help­ful bac­te­ria in the oral cav­ity, symp­toms of in­flam­ma­tion set in, lead­ing to den­tal pain and in­fec­tion and bleed­ing and sen­si­tive gums.

This all sounds great, but just like Sasha, you may won­der if any of this is true. A re­cent sys­tem­atic re­view has sought to an­swer that ques­tion. Pub­lished last sum­mer in a Span­ish jour­nal of oral health, re­searchers in Barcelona col­lected all the pub­lished re­search ev­i­dence they could find on the con­nec­tion be­tween pro­bi­otics and oral health. Their re­view iden­ti­fied 12 ran­dom­ized tri­als where sub­jects were given ei­ther some form of pro­bi­otics, or a placebo. Next, af­ter a pe­riod of two months, re­searchers looked for the amount of the un­friendly bac­te­ria (strep mu­tans) grow­ing in sub­jects’ mouths. They also looked at how likely gums were to bleed as a re­sult of pok­ing with a metal den­tal probe, a sign of gum in­flam­ma­tion. Only a few stud­ies fol­lowed pa­tients long enough to look at cav­i­ties and gin­givi­tis.

In these col­umns, we try to fo­cus on re­search that is sound and con­vinc­ing enough to al­low some­one to se­ri­ously con­sider fol­low­ing the study con­clu­sions and rec­om­men­da­tions. How­ever, the same can­not be said for this topic. Al­though there were a few stud­ies that showed pos­i­tive re­sults and thus a ben­e­fit in oral health to tak­ing sup­ple­ments of pro­bi­otics, oth­ers failed to show im­prove­ment.

In a nutshell, the use of pro­bi­otics to im­prove oral health is in­trigu­ing, maybe even promis­ing, but cer­tainly not proven to be ben­e­fi­cial at this time. Two things are clear, how­ever: pro­bi­otics are al­most cer­tainly safe and bet­ter re­search is ur­gently needed. Es­pe­cially lack­ing are stud­ies that fol­low study sub­jects for ex­tended pe­ri­ods of time to de­ter­mine if pro­bi­otics have a last­ing ef­fect on things that mat­ter to pa­tients, such as cav­i­ties and den­tal pain; bac­te­rial colony counts won’t cut it.

Most im­por­tant to keep in mind is that dis­eases of teeth and gums are caused by a com­plex in­ter­play of many fac­tors un­re­lated to pro­bi­otic in­take. Brush­ing and floss­ing, fol­low­ing a healthy diet, and vis­it­ing the den­tist reg­u­larly are all part of on­go­ing oral care for healthy teeth and gums. April is oral health month, a time to think about how much you are do­ing to look af­ter your teeth and gums.

Many have sug­gested that one of the fac­tors con­tribut­ing to oral health is the care­ful bal­ance be­tween the help­ful and non­help­ful guests in your mouth.


Sauer­kraut, kim­chi and yo­gurt are pop­u­lar pro­bi­otic fer­mented foods, but do they help pro­mote oral health?

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