This study assessed whether the persistence of Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 in saliva could delay the regrowth of mutans streptococci (MS) after a full-mouth disinfection with chlorhexidine (CHX). A randomised, double-blind, placebo-controlled study with a 6-week intervention period and 3- and 6-month follow-up was performed. 62 healthy subjects with moderate to high counts of MS were randomly assigned to a test group (n = 32) or a placebo group (n = 30). Before onset of the intervention, subjects received two sessions of professional cleaning, flossing, and application of CHX varnish and rinsed their mouth with a CHX solution between the sessions (2 days). Thereafter, the test group used probiotic lozenges (2/day) containing L. reuteri (DSM 17938 and ATCC PTA 5289; 1 × 108 CFU of each strain), and the placebo group used identical lozenges lacking the lactobacilli. Saliva samples were collected and cultured onto selective media, and isolates of L. reuteri as well as DNA directly extracted from saliva were tested by polymerase chain reaction (PCR) with specific primers. Presence of salivary MS was analysed with a chair-side test. L. reuteri was frequently detected by culture during the intervention period but in only 3 test group subjects at follow-ups. Regrowth of MS statistically significantly differed depending on the presence or absence of L. reuteri DSM 17938 detected by PCR. We conclude that cultivable L. reuteri strains may only sporadically be confirmed after termination of the intervention, but subjects with PCR-detected L. reuteri demonstrated slower regrowth of MS.

1.
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.
2.
Caglar E, Topcuoglu N, Cildir SK, Sandalli N, Kulekci G: Oral colonization by Lactobacillus reuteri ATCC 55730 after exposure to probiotics. Int J Paediatr Dent 2009;19:377-381.
3.
Doron S, Gorbach SL: Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther 2006;4:261-275.
4.
Egervarn M, Danielsen M, Roos S, Lindmark H, Lindgren S: Antibiotic susceptibility profiles of Lactobacillus reuteri and Lactobacillus fermentum. J Food Prot 2007;70:412-418.
5.
Glavina D, Gorseta K, Skrinjaric I, Negovetic Vranic D, Mehulic K, Kozul K: Effect of LGG yoghurt on Streptococcus mutans and Lactobacillus spp. salivary counts in children. Coll Antropol 2012;36:129-132.
6.
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.
7.
Haukioja A: Probiotics and oral health. Eur J Dent 2010;4:348-355.
8.
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.
9.
Jones SE, Versalovic J: Probiotic Lactobacillus reuteri biofilms produce antimicrobial and anti-inflammatory factors. BMC Microbiol 2009;9:35.
10.
Juárez Tomás MS, Ocaña VS, Nader-Macías ME: Viability of vaginal probiotic lactobacilli during refrigerated and frozen storage. Anaerobe 2004;10:1-5.
11.
Keller MK, Hasslöf P, Dahlén G, Stecksén-Blicks C, Twetman S: Probiotic supplements (Lactobacillus reuteri DSM 17938 and ATCC PTA 5289) do not affect regrowth of mutans streptococci after full-mouth disinfection with chlorhexidine: a randomized controlled multicenter trial. Caries Res 2012;46:140-146.
12.
Keller MK, Hasslöf P, Stecksén-Blicks C, 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.
13.
Klein G: Antibiotic resistance and molecular characterization of probiotic and clinical Lactobacillus strains in relation to safety aspects of probiotics. Foodborne Pathog Dis 2011;8:267-281.
14.
Mackenzie DA, Jeffers F, Parker ML, Vibert-Vallet A, Bongaerts RJ, Roos S, Walter J, Juge N: Strain-specific diversity of mucus-binding proteins in the adhesion and aggregation properties of Lactobacillus reuteri. Microbiology 2010;156:3368-3378.
15.
Madhwani T, McBain AJ: Bacteriological effects of a Lactobacillus reuteri probiotic on in vitro oral biofilms. Arch Oral Biol 2011;56:1264-1273.
16.
Moussavi M, Adams MC: An in vitro study on bacterial growth interactions and intestinal epithelial cell adhesion characteristics of probiotic combinations. Curr Microbiol 2010;60:327-335.
17.
Ravn I, Dige I, Meyer RL, Nyvad B: Colonization of the oral cavity by probiotic bacteria. Caries Res 2012;46:107-112.
18.
Reuter G: The Lactobacillus and Bifidobacterium microflora of the human intestine: composition and succession. Curr Issues Intest Microbiol 2001;2:43-53.
19.
Rogosa M, Mitchell JA, Wiseman RF: A selective medium for the isolation and enumeration of oral and fecal lactobacilli. J Bacteriol 1951;62:132-133.
20.
Rosander A, Connolly E, Roos S: Removal of antibiotic resistance gene-carrying plasmids from Lactobacillus reuteri ATCC 55730 and characterization of the resulting daughter strain, L. reuteri DSM 17938. Appl Environ Microbiol 2008;74:6032-6040.
21.
Simark-Mattsson C, Emilson CG, Hakansson EG, Jacobsson C, Roos K, Holm S: Lactobacillus-mediated interference of mutans streptococci in caries-free vs. caries-active subjects. Eur J Oral Sci 2007;115:308-314.
22.
Söderling EM, Marttinen AM, Haukioja AL: Probiotic lactobacilli interfere with Streptococcus mutans biofilm formation in vitro. Curr Microbiol 2011;62:618-622.
23.
Tanzer JM, Thompson A, Lang C, Cooper B, Hareng L, Gamer A, Reindl A, Pompejus M: Caries inhibition by and safety of Lactobacillus paracasei DSMZ16671. J Dent Res 2010;89:921-926.
24.
Taverniti V, Guglielmetti S: The immunomodulatory properties of probiotic microorganisms beyond their viability (ghost probiotics: proposal of paraprobiotic concept). Genes Nutr 2011;6:261-274.
25.
Twetman S, Frostner N: Salivary mutans streptococci and caries prevalence in 8-year-old Swedish schoolchildren. Swed Dent J 1991;15:145-151.
26.
Twetman S, Keller MK: Probiotics for caries prevention and control. Adv Dent Res 2012;24:98-102.
27.
Twetman S, Petersson L, Axelsson S, Dahlgren H, Holm AK, Kallestal C, Lagerlof F, Lingstrom P, Mejare I, Nordenram G, Norlund A, Soder B: Caries-preventive effect of sodium fluoride mouthrinses: a systematic review of controlled clinical trials. Acta Odontol Scand 2004;62:223-230.
28.
Twetman S, Stecksén-Blicks C: Probiotics and oral health effects in children. Int J Paediatr Dent 2008;18:3-10.
29.
Usman, Hosono A: Viability of Lactobacillus gasseri and its cholesterol-binding and antimutagenic activities during subsequent refrigerated storage in nonfermented milk. J Dairy Sci 1999;82:2536-2542.
30.
Walter J, Britton RA, Roos S: Host-microbial symbiosis in the vertebrate gastrointestinal tract and the Lactobacillus reuteri paradigm. Proc Natl Acad Sci USA 2011;108(suppl 1):4645-4652.
31.
Yang R, Argimon S, Li Y, Gu H, Zhou X, Caufield PW: Determining the genetic diversity of lactobacilli from the oral cavity. J Microbiol Methods 2010;82:163-169.
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