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

Abstract

The aim of this study was to evaluate the effect of milk supplemented with probiotic bacteria and fluoride on caries development and general health in preschool children. Children 1–5 years of age (n = 248) attending 14 day care centres with 27 units in northern Sweden entered the study. The centres were randomly assigned to two parallel groups: children in the intervention group were served 150 ml milk supplemented with Lactobacillus rhamnosus LB21 (10⁷ CFU/ml) and 2.5 mg fluoride per litre for lunch while the control group received standard milk. The double-blind intervention lasted for 21 months (weekdays) and data were collected through clinical examinations and questionnaires. The primary outcome was caries increment and secondary outcomes were measures of general health. The dropout rate was 25%. The mean baseline caries experience was 0.5 dmfs in the intervention units and 0.6 in the control units and after 21 months 0.9 and 2.2 (p < 0.05). The number of days with sick leave was similar in both groups but the children of the intervention units displayed 60% fewer days with antibiotic therapy (mean 1.9 vs. 4.7 days) and 50% less days with otitis media (0.5 vs. 1.0) (p > 0.05). In children who had participated during the whole 21-month intervention, fewer days with otitis media were reported (0.4 vs. 1.3 days, p < 0.05). No serious side effects were reported. It is concluded that daily consumption of milk containing probiotic bacteria and fluoride reduced caries in preschool children with a prevented fraction of 75%. Additional beneficial health effects were evident.

Antimicrobial and anti-biofilm activities of Lactobacillus kefiranofaciens DD2 against oral pathogens

“…Various clinical studies have shown that L. rhamnosus and L. paracasei consumption could reduce S. mutans biofilm formation in the oral cavity [15,30]. Despite the extensive research effort devoted to determining the effects of LAB supplementation on cariogenic bacteria, there are still large knowledge gaps related to understanding the mechanism of the bacterial behavior in response to supplementation.…”

Oral Administration of <b><i>Lactobacillus reuteri</i></b> during the First Year of Life Reduces Caries Prevalence in the Primary Dentition at 9 Years of Age

“…Several studies have shown positive effects of probiotic lactobacilli: reduction in the number of mutans streptococci, dental plaque and gingival inflammation [Nikawa et al, 2004;Krasse et al, 2006;Calgar et al, 2008;Marttinen et al, 2012]. To date, however, only five studies have been published with caries as the endpoint [Näse et al, 2002;Stecksén-Blicks et al, 2009;Petersson et al, 2011;Hasslöf et al, 2013;Taipale et al, 2013], three of which report lower caries increment after exposure to probiotic bacteria compared to control groups. In the study by Näse et al [2002], preschool children were exposed to milk with L. rhamnosus five days a week over seven months at 1-6 years of age.…”

Are we ready for caries prevention through bacteriotherapy?

“…31,32 Both studies found improvements in general health, along with reductions in caries risk and caries incidence, but the most important findings were probably those related to the use of less prescribed antibiotics. 32,34 In fact, the findings may support a "metabolic domino effect" in which probiotic therapy is a link between oral and general health; the oral cavity influences and is influenced by general health. Future research will reveal if orally derived probiotic candidates optimized for oral diseases may have a similar dual impact.…”

“…[31][32][33] The first of these studies investigated the effects of probiotic bacteria given to 594 preschool children aged 1-6 years, and showed a significant reduction in caries increment in the probiotic milk group after 7 months, compared to the control group, but only in the subgroup of the 3-4 year-olds. 31 It was claimed that the 5-day-aweek intake of probiotic milk reduced the risk of caries significantly (OR = 0.56).…”

“…31 It was claimed that the 5-day-aweek intake of probiotic milk reduced the risk of caries significantly (OR = 0.56). The second study was a cluster-randomized trial by Stecksén-Blicks et al 32 that lasted over 21 months. The results suggested a dramatic reduction in early childhood caries after daily consumption of milk supplemented with L. rhamnosus and 2.5 ppm fluoride, but the effect of the two supplements could not be individualized.…”