Periodontal diseases are common and irreversible diseases that may eventually lead to loosening of teeth. Their onset is associated with an imbalance in the flora of the dental plaque.
Severe periodontal diseases affect 15 to 20% of middle-aged adults (ages 35-44)1. Along with cavities, they are the primary cause of tooth loss. According to the WHO, almost 30% of people aged 65-74 have no natural teeth remaining1.
An irreversible disease
Periodontal diseases are infectious diseases of the tooth-supporting structures (gums, root, alveolar bone). They cause inflammation, bloody gums, and the irreversible formation of gingival and periodontal pockets.
Several contributing factors, including the oral microbiota
These diseases are multifactorial: genetic factors, age, smoking, alcohol, diabetes mellitus, HIV, certain medications, menopause, pregnancy, and especially poor oral hygiene2. The presence of deep periodontal pockets and clinical attachment loss are related to the presence of dental plaque and tartar. This disease is also associated with the transition, within that plaque, from healthy to pathological bacterial flora3,4, including pathogenic anaerobic strains like Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum2,3.
Eliminate dental plaque
First-line treatment consists of halting the progression of periodontal disease: supragingival tartar removal and from the surface of the teeth, along with antiseptic or antibiotic treatments2. Sometimes surgical treatment may be necessary. In all cases, education on oral hygiene is fundamental2.
Potential use of probiotics
Imbalances in the oral flora associated with periodontal diseases may justify the use of probiotics to attempt to limit their appearance. Individuals presenting with large quantities of P. gingivalis may, for example, find some benefit in using probiotics before the appearance of a periodontal disease3. Several clinical studies have demonstrated the effectiveness of probiotics like L. reuteri and L. salivarius in reducing bleeding gums and the formation of gingival and periodontal pockets4-8.
1- OMS Santé bucco-dentaire. http://www.who.int/mediacentre/factsheets/fs318/fr/
2- Haute Autorité de santé. Parodontopathies : diagnostic et traitements, mai 2002. https://www.has-sante.fr/portail/upload/docs/application/pdf/Parodontopathies_rap.pdf
3- Zarco MF et al. The oral microbiome in health and disease and the potential impact on personalized dental medicine. Oral Diseases (2012) 18, 109–120
4- Martin-Cabezas R et al. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2016;43:520-30. https://www.ncbi.nlm.nih.gov/pubmed/26970230
5- Iwamoto T et al.. Effects of probioticLactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 ;110:201-8. https://www.ncbi.nlm.nih.gov/pubmed/20659698
6- İnce G et al.. Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis. J Periodontol. 2015 ;86:746-54 https://www.ncbi.nlm.nih.gov/pubmed/25741580
7- Cocco F, Lingström P, Campus G. The use of probiotic strains in caries prevention: a systematic review. Nutrients. 2013 ;5:2530-50. https://www.ncbi.nlm.nih.gov/pubmed/23857225
8- Twetman S, Keller MK. Probiotics for caries prevention and control. Adv Dent Res. 2012 ;24:98-102. https://www.ncbi.nlm.nih.gov/pubmed/22899689