As the oral-systemic healthcare link gains wider acceptance, and as clinicians are promoting a whole-body approach to dental treatment, the term "probiotics" pops up occasionally as a new approach to treating the entire patient. But what are probiotics, and how can they help with oral health as a gateway to overall health?

"There is a certain amount of misunderstanding about probiotics," said Michael Shahani, CEO of Nebraska Cultures and son of Khem Shahani, PhD, the company founder who discovered the DDS-1 strain of L. acidophilus in the 1950s. "Probiotics are actually live bacteria that confer some sort of benefit on the host organism that takes them or ingests them." Probiotics also is the term used for the dietary supplements containing these bacteria, such as Nebraska Cultures' Pro-FloraTM.

According to Shahani, the amount of naturally occurring probiotics in many people in this country has diminished over the past few generations for three main reasons-changes in diet, over-processing of food, and over-prescription on antibiotics-which has resulted in their need for a supplemental boost.

"The diet we eat today is the diet a very few rich people ate 100 years ago," said Shahani. Most people's diets would have consisted of more fresh fruits and vegetables in addition to more fermented food products. Traditional foods such as certain sausages, pickles and sauerkraut as well as fermented milk products like fresh cheeses and yogurt  use healthy bacteria as a means to preserve foods without refrigeration. However, today yogurts often are processed to such an extent that the healthy bacteria are killed, and the yogurt loses most of its probiotic benefits. 

Khem Shahani, PhD, began his landmark research on Lactobacillus acidophilus at the University of Nebraska in the late 1950s.

"Also, we've become quite phobic about washing and sterilizing everything," he added. "Because food wasn't quite as clean a couple generations ago, there definitely were bacteria left on these foods that came out of the garden. Now, it's too clean and sterilized."

Shahani also feels that the overuse of antibiotics has contributed to the dearth of healthy bacteria. "We're taking antibiotics for things we don't need to be taking them for,  we're taking them just as a preventive measure, and we're giving antibiotics to our food animals. There are plenty of instances where the use of antibiotics is necessary, but at the same time, there are instances where people are taking antibiotics where they don't need to. What that does is kill off all the good bacteria as well as the bad."

As a result, certain health ailments, allergies and intolerances have become more prominent and more pronounced throughout the population. The addition of a daily probiotic can help return the body to a more healthy balance.

"Any probiotic activity you can get into the body is going to improve every part of the digestive process, including the oral part," said Shahani. "Because the digestive track is such an important part of the rest of our body, it affects a lot of other areas."

Specifically, probiotics can produce enzymes that help in food digestion, including the creation of lactase that helps in the digestion of sugars in milk. Other benefits of probiotics include the production of B vitamins and folic acid, stimulation of the immune system, prevention of carcinogenesis, and keeping harmful bacteria such as E. coli from attaching to the intestinal walls.

"There is some evidence that there are probiotic bacteria that live in the mouth," said Shahani. "They're a kind of specialized group of bacteria, of which Streptococcus salivarius is one, which act as a probiotic in the mouth and can inhibit dental infections of various kinds such as dental caries and fungal infections." He adds that there has been more research into growing oral bacteria as a probiotic but that he is not aware of anything being done at a commercial level.

Shahani cautions that probiotic supplements should be considered just that: a supplement to traditional antibiotic treatment in cases involving serious disease. "I'm not sure that there's evidence that shows that taking probiotics is really going to combat periodontal disease. But it is certainly not going to hurt."

He adds that in cases where there is a legitimate prophylactic use of antibiotics to halt an infection, those antibiotics will have systemic effects on all bacteria, bad and good.

"Dentists should be as aware as any doctor of the importance of putting back those healthy bacteria in every part of the body."

Articles

Probiotics: Good bacteria for good health

Periodontal disease is way too common and is something that should not be ignored. When left untreated, it can lead to very costly and painful situations. One way to help fight perio disease is to use the 

 Method™, a comprehensive method that is customized for individual patients to help manage biofilms-communities of bacteria-growing in the spaces or pockets between the teeth and gum tissue. The goal of this method is to manage oral biofilm in a minimally invasive manner and to deliver lasting oral health to the patient.


	Initially, this patient was diagnosed with advanced periodontal disease and was treated with surgical flap procedures and bone recontouring. Subsequently, the disease returned, and the patient was treated a second time with surgical periodontal procedures, removal of infected tissue, beveling of the attached gingival and bone recontouring (Fig. 1).

The patient was evaluated some years later and found to have significant periodontal pockets (Fig. 2) that had reformed in spite of his zealous home care. A third surgical procedure was recommended with extraction of the anterior teeth as there was only about 10 to 15% of the alveolar bone remaining (Fig. 3).

The patient chose the custom-formed Perio Trays to deliver doctor-selected medications to the periodontal pocket. The teeth were splinted together (Fig. 4), impressions were completed, and Perio Trays were fabricated by an FDA-registered medical lab according to the scope and magnitude of the patient’s conditions.

The patient wore the Perio Trays (Figs. 5 and 6) for multiple times a day for the first few days. As the conditions improved, he decreased his wearing to twice a day. He used a hydrogen peroxide gel to manage the oral periopathogens. Additionally, an antioxidant is used to inhibit osteoclasts and osteoclastic precursor cells as it maintained or enabled osteoblastic activity.

Progress is monitored closely at this point. The patient’s periodontal pockets went from moderate severe (5–6 mm) to normal in a matter of weeks (Figs. 7 and 8). The teeth became more stable as additional alveolar bone was discovered to form around the teeth over time. Fig. 9 illustrates a panoramic radiograph demonstrating osteogenic control and the significant bone gain in the mandibular anterior and other regions.
	
	Periodontal probing is used to chart the long-term success of the Perio Protect Method for this case. This patient has been able to control the periopathogens, regenerate lost bone and maintain his gain for more than 4 years (Fig. 10).

The patient is finally able to control the cause of disease and not suffer the ramifications of the host response to virulent pathogens.

Periodontal disease is way too common and is something that should not be ignored. When left untreated, it can lead to very costly and painful situations. One way to help fight perio disease is to use the Perio Protect Method™, a comprehensive method that is customized for individual patients to help manage biofilms-communities of bacteria-growing in the spaces or pockets between the teeth and gum tissue.

How to manage oral biofilm


	Infection control products are continually changing the way dentistry is performed. With increased attention on the spread of infectious disease in health care settings, dental teams need to be cognizant of the latest innovations that make the tedious job of infection control in a clinical setting more manageable. 

		Effective in killing microorganisms or preventing the spread of microorganisms

	The following products have been evaluated by THE DENTAL ADVISOR and were highly rated. Comments from their Consultants are included:

	With an ear-loop design well suited for users with sensitive skin, the masks are free of chemicals, inks, dyes and fragrances. They feature a fluid-resistant outer layer with a white hypoallergenic inner cellulose layer.

		“The ear loops are a little rough.”

	This highly concentrated disinfectant for alginate, polyether and silicone impressions is aldehyde-free and has a neutral odor.

		“I like the photo step by step guide; we posted it above the solution so any staff member could easily see how to use the product.”

		“I feel I am acting more responsibly to my lab.”

		“Offer a larger bath for orthodontic offices.”

		“I loved the whole system. It was very easy to use and implement into our office.”

		“I like that the impression is being thoroughly disinfected quickly.”

		“Offer a larger bath for laboratories.”

	A complete waterline cleaning system, it is indicated to provide continuous cleaning of dental waterlines associated with delivery units using independent water bottles.

		“Very easy to use, time efficient and easy to incorporate into the office procedure.”

		“Comprehensive kit-we used it daily and weekly for the past few months.”

		“Patients have complained about a bitter after-taste (but company says this does not occur when directions are properly followed).”

	Dr. John Molinari is the Director of Infection Control at THE DENTAL ADVISOR. Submit your questions to him online at: dentaladvisor.com. 

	No matter what the product, some questions can be applied to assess its suitability for the job, acceptability to staff and cost-effectiveness. In making product selection decisions about infection control products, consider the product’s:

		Compatibility with patients, staff and materials in the practice

		Consistency with public health recommendations

	Final purchasing considerations should take into account user satisfaction and cost. Because even features such as odor, method of delivery or dispensing, and packaging or color can influence compliance, practices should not discount the value of some of these more subjective considerations.

	Objective organizations such as the non-profit Organization for Safety, Asepsis and Prevention (OSAP) can help practitioners understand how to read labels, interpret regulations and guidelines and make informed decisions about the products they select.  For more information on OSAP, visit 

   Cavex ImpreSafe        Crosstex Int'l       Team Vista  The Dental Advisor's Top Choices

The Benchmark: Infection Control

This second article in a series about behavioral change looks at how you can use Motivational Interviewing to help your staff members look at their goals and the changes they need to make to reach them.

	In the last installment of this series, we were introduced to Sharon, a dental team member who is habitually late to work. This meant the rest of the team had to “cover” for her, which got the daily schedule off to a bad start-something we all know is difficult to recover from. Punitive measures, such as scowls and other subtle expressions of anger from team members, didn’t motivate Sharon to arrive earlier. Looks like it’s time for a different approach!

	Could the office manager use the “Motivational Interviewing” technique to motivate Sharon to make a behavior change? This technique is designed to help team members express their goals and then examine whether their current behaviors are likely to help them achieve those goals.

	When asked, Sharon told her office manager that her goal is to work in an environment where she feels respected and is viewed as a valuable team member. Sharon also mentioned that she sure doesn’t feel that way at work now, giving the office manager a chance to help her see that her chronic late arrival at work negatively impacts the other team members and affects the way they treat her. Here’s how the conversation could go from there:

  “I wonder how you are going to earn their respect and feel like part of the team with your pattern of arriving late nearly every day?”

 “Maybe you are right. I hadn’t thought of it that way. I guess if I am going to be a team player I’d better figure out how to get to work on time.”

 “What will need to change so you can be here sooner?”

 “I guess I can ask the babysitter to arrive 15 minutes earlier than she has been.”

 “You’ve come up with a great remedy for this situation. I bet the other team members will react differently to you when you are at work on time. How soon can you arrange for this change that you’ve suggested?”

	In this scenario, the office manager has helped Sharon see that something she wants-an amicable work environment-won’t be obtained unless she changes her behavior. And, most importantly, she came up with the solution to the problem. This approach is much more of a ‘win-win’ exchange than an angry confrontation where demands for punctuality are made, accompanied by an ‘or-else’ threat. Confrontation, threats and inciting guilt do not result in meaningful behavior changes and usually elicit defensiveness, resistance and additional anger.

	In the next installment of this series, we’ll look at how to effectively motivate patients toward behavior change. The differences between using the traditional patient education approach (often with unsuccessful outcomes) and using Motivational Interviewing skills for effective change will be explained.

	This demonstration of the Motivational Interviewing technique can be used to facilitate a variety of behavior changes. This approach uses the compelling concept that people will do what they want to do. The first step is to help them realize what outcome they are seeking. Then guide them to look at current practices that prevent the desired outcome. Because the person who needs to make the behavior change is really the “expert” about his or her life, it is essential that he or she decides whether to and how to change a behavior to get the desired outcome. This is sometimes referred to as “verbalized intention.” It is much more powerful to hear yourself commit to something than it is to merely agree with someone’s advice.

	As an example, the individual who says, “I guess if I want to prevent gum disease, I’ll need to floss,” is much more likely to comply than the person who was led into agreement by a dental hygienist saying, “ You will start flossing every day, won’t you?” Once the “change talk,” such as ‘I’ll need to floss” occurs, the clinician will need to consolidate that intent and elicit a verbalized intention to change. The patient’s autonomy is respected, which is an impressive attribute of Motivational Interviewing.

 This second article in a series about behavioral change looks at how you can use Motivational Interviewing to help your staff members look at their goals and the changes they need to make to reach them.

Learn how to get your "yes"

	SAINT LOUIS, MO (July 20, 2010) – MediNiche, Inc., a St. Louis, Mo., pharmaceutical company, has announced that due to a significant increase in Dentaplex® interest among dental professionals, the company is offering practitioners in the U.S. their choice of a free Dentaplex product display for office use and/or patient coupons each good for a free bottle of Dentaplex in order to increase awareness, office trial, and patient usage.

	Dentaplex, vitamin mineral supplement for teeth and gums, helps repair, protect and?maintain healthy teeth and gums. It is the #1 recommended supplement brand of? periodontists, general dentists, and hygienists for perio, surgical, implant, canker sore and orthodontic patients. Since market introduction in 2001, Dentaplex has become an integral part of homecare for thousands of patients. According to Samuel Alioto, MediNiche President and CEO, Dentaplex product and information requests have escalated to a point where additional support is warranted, “We have patiently sat back and watch Dentaplex grow. Dental professionals and patients have provided extremely positive feedback on their Dentaplex® experiences. It is now time to give dental professionals everywhere an opportunity to evaluate the product”. Through the end of 2010, MediNiche is offering dental professionals a free attractive counter display containing six (6) bottles of Dentaplex, a patient brochure easel, starter samples and staff training materials all for the cost of shipping and handling only --- a $200 value for just $19.99.

on the internet to access the free display program or call, toll-free, 1-888-325-2395. The offer is valid for new customers only and good while supplies last.

	In addition to the free office counter display kit offer, MediNiche is also offering dental?practitioners a complimentary supply of “Free Bottle of Dentaplex” coupons for distribution to patients. The coupon allows patients to receive a free bottle of Dentaplex for a small shipping and handling fee. Patients can take advantage of the free offer by going to www.dentaplex.com or www.mediniche.com/freedentaplex.html on the internet or by calling, toll-free, 1-866-Dentaplex (1-866-336-8275).

	To compliment featuring new Dentaplex marketing programs that will feature a message that highlights the product formula. The Dentaplex formulation is built on a "C-complex" of calcium, vitamin C and carotene, and high potency levels of B-complex vitamins; all key nutrients known to be helpful in maintaining healthy gums and strong teeth.

	MediNiche has also prepared for the increased Dentaplex activity by adding customer?service support. A toll-free telephone number, 1-866-DENTAPLEX, a dedicated email?address dentaplex@mediniche.com, and an extensive update of Dentaplex information on the company’s website, www.mediniche.com, have been added to help improve dental professional and patient communication.

	MediNiche, Inc. is a St. Louis based pharmaceutical company that develops, markets and distributes dermatologic, orthopedic, ophthalmic, urologic and dental products.

	All orders, inquiries or correspondence relating to Dentaplex® should be directed to:

	MediNiche, Inc.,167 Lamp & Lantern Village, #300?Chesterfield, MO 63017, 

 SAINT LOUIS, MO (July 20, 2010) – MediNiche, Inc., a St. Louis, Mo., pharmaceutical company, has announced that due to a significant increase in Dentaplex® interest among dental professionals, the company is offering practitioners in the U.S. their choice of a free Dentaplex product display for office use and/or patient coupons each good for a free bottle of Dentaplex in order to increase awareness, office trial, and patient usage.  

Dental Products Report-2010-07-01

Probiotics: Good bacteria for good health

How to manage oral biofilm

The Benchmark: Infection Control

Learn how to get your "yes"

MediNiche offers dentists free Dentaplex offer