New probiotic formulation:
For the improvement of oral health and prevention of gingivitis
Periodontal diseases and dental caries are one of the most prevalent health problems worldwide. [1,2] Promoting a balanced microbiota in the mouth can improve oral health and thereby general health.
The mouth is one of the most heavily colonised parts of our bodies, harbouring an estimated 600+ different bacterial species. A balanced oral microbiota protects the mouth from infections and contributes to the maintenance of oral health. However, the oral microbiota can be easily disturbed by factors such as; poor oral hygiene, lifestyle choices including dietary habits and smoking, immunodeficiency, and time.[5,6,7] These disturbances can cause dental carries (dental decay) and periodontal diseases, such as gingivitis (inflammation of the gingivae) and in more severe cases periodontitis (gum disease). Furthermore, an association has been found between the composition of the oral microbiota and systemic disease, such as cardiovascular disease and pregnancy complications.[9,10]
Oral diseases start with the growth of dental plaque, a biofilm formed by the accumulation of bacteria and their toxins together with saliva  (see figure 1). Current treatment of plaque and oral diseases involve mouthwashes and professional teeth cleaning, and in more advanced cases antibiotics or surgery.  However, with ever increasing antibiotic resistance and their unwanted side effects such as antibiotic-associated diarrhoea, there is an increased need for novel therapies that do not involve conventional antimicrobial agents. Probiotics have therapeutic potential in the management of carries and periodontal diseases, since they prevent dysbiosis by inhibiting growth of periodontal pathogens and modulating disease associated inflammatory pathways. Several meta-analyses have found significant effectiveness for the use of probiotics in the management of oral health and gingivitis. [11,12]
Figure 1: Harmful bacteria assemble in a biofilm and cause inflammation of the periodontal tissue.
Winclove has developed a specific probiotic formulation for the improvement of oral health and prevention of gingivitis: Winclove SMILE. The formulation contains 9 specifically selected probiotic strains. Probiotic strains can exert health effects at different levels in the mouth (see figure 2). The bacterial strains of Winclove Smile have been selected for their capacity to inhibit the growth of oral pathogens (level 1) and influence the immune system (level 3). The strains have been screened for their capacity to:
inhibit oral pathogens associated with development of gingivitis
inhibit biofilm formation
strengthen the immune system.
Figure 2: Probiotic strains can be active on three levels in the mouth. The strains in Winclove Smile have been proven active at level 1 and 3.
Wincove SMILE: in vitro evidence
Inhibition of biofilm formation
An important virulent factor in oral health is the formation of biofilms, also known as (dental) plaque. The effects of the probiotic strains in Winclove Smile on biofilm formation were tested in vitro in a model with antibiotic vancomycin resistant Enterococcus faecium  (see figure 3). The results show that biofilm formation of E. faecium was strain-specifically modulated. Nevertheless, supernatants of all probiotic strains had a diminishing effect on biofilm formation and showed a reduction between 37% - 62%.
Inhibition of pathogens
Another selection criterion for the bacteria of Winclove Smile is their ability to inhibit pathogens associated with development of gingivitis, these include: Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi). The effect of the probiotics strains in inhibiting growth of these pathogens was tested in vitro. Figure 4 shows the inhibitory effects of the strains in Winclove Smile.
Strengthening the immune system
Besides a more direct effect of probiotics on development of biofilms, probiotic strains can also inhibit the development of gingivitis by modulating the immune system. A screening was performed for several probiotic strains in Winclove Smile for their capacity to induce IL-10, an anti-inflammatory cytokine. Almost all bacterials strains showed a stimulating effect on IL-10 production, and these effects are strain-specific (data not shown).
Figure 3: Inhibition of biofilm formation of Enterococcus faecium by bacterial strains of Winclove Smile
Figure 4: Inhibition of Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) by strains in Winclove Smile.
Read more about Winclove Smile
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10 Xiong X, et al. Periodontal disease and adverse pregnancy outcomes: a systematic review. Brit J Obstet Gynaecol 2006;113:135-43.
11 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(6):520–30.
12 Gruner D, et al. Probiotics for managing caries and periodontitis: systematic review and meta-analysis. J Dent. 2016;48:16–25.
13. Willems RJ, et al. Variant esp gene as a marker of a distinct genetic lineage of vancomycin-resistant Enterococcus faecium spreading in hospitals. Lancet 2001;357:853-5.
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