The aim of this study was to investigate the effectiveness of tablets containing two probiotic Lactobacillus reuteri strains in inhibiting regrowth of salivary mutans streptococci (MS) after full-mouth disinfection (FMD) with chlorhexidine. The null hypothesis was that the levels of MS would not differ in comparison with a placebo protocol. The study population was comprised of 62 young adults (mean age 23 years) with moderate or high counts of salivary MS who volunteered after informed consent. The study was a double-blinded randomized controlled trial with two parallel groups. After a 3-day chlorhexidine regimen, the subjects were randomly assigned to a test group (n = 32) with probiotic lozenges (2/day) or a placebo group (n = 30). The intervention period was 6 weeks, and stimulated whole saliva was collected at baseline and after 1, 6, and 12 weeks. The samples were processed for MS by a chair-side test and DNA-DNA hybridization as an estimate of 19 bacterial strains associated with oral health and disease. There was no significant difference between the groups at inclusion, and FMD reduced the salivary MS levels significantly in both groups. The MS suppression lasted less than 6 weeks and there were no statistical differences in salivary MS regrowth between the test and control groups at any of the follow-ups. Likewise, there were no major differences in the regrowth patterns of the checkerboard panel between the two groups. We conclude that daily oral administration of L. reuteri did not seem to affect or delay the regrowth of salivary MS after FMD with chlorhexidine.

Aminabadi NA, Erfanparast L, Ebrahimi A, Oskouei SG: Effect of chlorhexidine pretreatment on the stability of salivary lactobacilli probiotic in six- to twelve-year-old children: a randomized controlled trial. Caries Res 2011;45:148–154.
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;64:314–318.
Eberhard J, Jepsen S, Jervoe-Storm PM, Needleman I, Worthington HV: Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database Syst Rev 2008;CD004622.
Emilson CG: Effect of chlorhexidine gel treatment on Streptococcus mutans population in human saliva and dental plaque. Scand J Dent Res 1981;89:239–246.
Hasslöf P, Hedberg M, Twetman S, Stecksén-Blicks C: Growth inhibition of oral mutans streptococci and candida by commercial probiotic lactobacilli – an in vitro study. BMC Oral Health 2010;10:18.
Haukioja A, Loimaranta V, Tenovuo J: Probiotic bacteria affect the composition of salivary pellicle and streptococcal adhesion in vitro. Oral Microbiol Immunol 2008;23:336–343.
Haukioja A, Yli-Knuuttila H, Loimaranta V, Kari K, Ouwehand AC, Meurman JH, Tenovuo J: Oral adhesion and survival of probiotic and other lactobacilli and bifidobacteria in vitro. Oral Microbiol Immunol 2006;21:326–332.
Hintao J, Teanpaisan R, Chongsuvivatwong V, Ratarasan C, Dahlén G: The microbiological profiles of saliva, supragingival and subgingival plaque and dental caries in adults with and without type 2 diabetes mellitus. Oral Microbiol Immunol 2007;22:175–181.
James P, Parnell C, Whelton H: The caries-preventive effect of chlorhexidine varnish in children and adolescents: a systematic review. Caries Res 2010;44:333–340.
Keller MK, Hasslöf P, Stecksén-Blicks, Twetman S: Co-aggregation and growth inhibition of probiotic lactobacilli and clinical isolates of mutans streptococci: an in vitro study. Acta Odontol Scand 2011;69:263–268.
Lexner MO, Blomqvist S, Dahlén G, Twetman S: Microbiological profiles in saliva and supragingival plaque from caries-active adolescents before and after a short-term daily intake of milk supplemented with probiotic bacteria – a pilot study. Oral Health Prev Dent 2010;8:383–388.
Maltz M, Zickert I, Krasse B: Effect of intensive treatment with chlorhexidine on number of Streptococcus mutans in saliva. Scand J Dent Res 1981;89:445–449.
Marsh PD: Are dental diseases examples of ecological catastrophes? Microbiology 2003;149:279–294.
Marsh PD: Microbiology of dental plaque biofilms and their role in oral health and caries. Dent Clin North Am 2010;54:441–454.
Näse L, Hatakka K, Savilahti E, Saxelin M, Ponka A, Poussa T, Korpela R, Meurman JH: Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res 2001;35:412–420.
Nigatu A: Evaluation of numerical analyses of RAPD and API 50 CH patterns to differentiate Lactobacillus plantarum, Lact. fermentum, Lact. rhamnosus, Lact. sake, Lact. parabuchneri, Lact. gallinarum, Lact. casei, Weissella minor and related taxa isolated from kocho and tef. J Appl Microbiol 2000;89:969–978.
Söderling EM, Marttinen AM, Haukioja AL: Probiotic lactobacilli interfere with Streptococcus mutans biofilm formation in vitro. Curr Microbiol 2011;62:618–622.
Stamatova I, Meurman JH: Probiotics: health benefits in the mouth. Am J Dent 2009;22:329–338.
Stecksén-Blicks C, Sjöström I, Twetman S: Effect of long-term consumption of milk supplemented with probiotic lactobacilli and fluoride on dental caries and general health in preschool children: a cluster-randomized study. Caries Res 2009;43:374–381.
Teughels W, Newman MG, Coucke W, Haffajee AD, Van Der Mei HC, Haake SK, Schepers E, Cassiman JJ, Van EJ, van SD, Quirynen M: Guiding periodontal pocket recolonization: a proof of concept. J Dent Res 2007;86:1078–1082.
Teughels W, Van EM, Sliepen I, Quirynen M: Probiotics and oral healthcare. Periodontol 2000 2008;48:111–147.
Twetman S: Antimicrobials in future caries control? A review with special reference to chlorhexidine treatment. Caries Res 2004;38:223–229.
Twetman S, Frostner N: Salivary mutans streptococci and caries prevalence in 8-year-old Swedish schoolchildren. Swed Dent J 1991;15:145–151.
Twetman L, Larsen U, Fiehn NE, Stecksén-Blicks C, Twetman S: Coaggregation between probiotic bacteria and caries-associated strains: an in vitro study. Acta Odontol Scand 2009;67:284–288.
Vivekananda MR, Vandana KL, Bhat KG: Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. J Oral Microbiol 2010;2:5344.
Wall-Manning GM, Sissons CH, Anderson SA, Lee M: Checkerboard DNA-DNA hybridisation technology focused on the analysis of Gram-positive cariogenic bacteria. J Microbiol Methods 2002;51:301–311.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.