Biofilm Control Strategies in Dental Health - Antibiofilm Agents: From Diagnosis to Treatment and Prevention - page 307

this microorganism. IgG responses to fimbriae antigen elicited by the initial contact
with A. actinomycetemcomitans may play an important role for eliminating organ-
isms from the periodontal pockets of patients harboring high IgG antibody against
these antigens (Ishikawa et al. 1997 ). However, relatively few studies have been
conducted on developing vaccines against A. actinomycetemcomitans .
7.2 Probiotics
Total elimination of the oral biofilm is neither desirable nor possible, and therefore
replacement strategies with “probiotics” have been the subject of extensive
research. Recently, probiotics have been gaining interest for alleviating oral and
other health disorders. The Food and Agriculture Organization of the United
Nations has defined probiotics as “live microorganisms administered in adequate
amounts conferring beneficial health effect on the host”. Probiotics are naturally
found in food products such as yogurt and milk and have yet to cause the serious
side effects that are associated with currently available antimicrobials.
Lactobacillus and Bifidobacterium are the most commonly used genus of bac-
teria in probiotic formulations and they have been used with positive results for a
large number of different health disorders (Girardin and Seidman 2011 ; Kruis 2012 ;
Travers et al. 2011 ; Twetman and Stecks ´ n-Blicks 2008 ; Uccello et al. 2012 ).
The balance between beneficial and pathogenic bacteria is essential in order to
maintain oral health. Therefore, the oral cavity has recently been suggested as a
relevant target for probiotic applications. Although it is a promising concept, there
is still not conclusive evidence that current probiotics have any beneficial effect on
oral diseases and further studies are needed to assess its value as a therapy.
One can conclude that there are three main goals that probiotics should achieve
to prove successful as therapeutics for gingivitis and periodontitis. The first goal
involves the modulation of the host's inflammatory processes. The second goal
involves the reduction of plaque formation. Finally, the third goal is to reduce the
presence and numbers of disease promoting microorganisms. Given our focus on
biofilm control we are going to skip modulation of the host's inflammatory response
and focus on the two latter goals.
One of the problems of probiotic therapy is colonization of the biofilm by the
probiotic bacterium. Long-term establishment of probiotics in the oral biofilm is
difficult, and detectable levels are commonly only found at the beginning of the
treatment (Twetman and Stecks´n-Blicks 2008 ). Probably, the most successful
example of the use of probiotics in treating a disease is using “fecal transplantation”
for treating recurrent Clostridium difficile infections (Aroniadis and Brandt 2013 ).
Fecal microbiota transplantation (FMT) has been used as a treatment to reconstitute
the normal microbial homeostasis after the gastrointestinal microbiota has been
eliminated by antibiotic treatments, allowing for the over growth of C. difficile .It
may be possible that for the effective action of probiotics, the normal microbiota
has first to be reduced allowing for the establishment of the desired bacteria.