Joanna Cosgrove01.01.09
A Gum for Gums
GUM Periobalance reduces gingivitis with the probiotic Lactobacillus reuteri.
By Joanna Cosgrove
Online Editor
The mint flavored, sugar-free gum is called GUM Periobalance and its keystone ingredient is the lactic acid bacterium Lactobacillus reuteri Prodentis (L. reuteri, or “Prodentis”).
According to BioGaia, the human mouth typically contains more than 500 different microflora species, the balance of which can occasionally be overthrown by pathogenic bacteria. In response, the human immune defense will then react, resulting in some form of inflammation. Recent data from the U.S. indicates that inflamed gums are very common, affecting approximately 50% of all adults over age 30. A hallmark of gingivitis is inflamed gums that tend to bleed easily, something dentists tend to observe when teeth are professionally cleaned. Another sign is a swollen tooth pocket, which results when the inflammation forces excess fluid out into the tooth pocket.
Just as there are bad bacteria in the gut, there are bad bacteria in the mouth. According to the study, published by Acta Odontologica Scandinavica, and performed by Professor Svante Twetman and his team in the Department of Cardiology and Endodontics at the University of Copenhagen in Denmark, L. reuteri has been proven to balance the oral flora and reduce the levels of bad bacteria associated with oral problems, such as bleeding gums and tooth decay.
In the study, 42 subjects with moderate gingivitis were randomly assigned to receive either chewing gum containing Lactobacillus reuteri Prodentis (either one or two chewing gums per day) or placebo (non-active) chewing gums during a two-week period. The number of bleeding sites was reduced in both groups taking Prodentis chewing gums, by 85% for those taking one Prodentis chewing gum per day and by 86% for those taking two. Both decreases were statistically significant.
In the Prodentis groups, the amount of fluid in the teeth pockets decreased by 43% for those taking one chewing gum per day, and by 53% for those taking two chewing gums per day.
In the group that took two Prodentis chewing gums per day, researchers found a significant decrease of some important inflammatory mediators, TNF-alpha and IL-8, which pointed toward a possible mechanism of action for Prodentis. Researchers said this was the first time that such changes caused by oral health probiotics were recorded in a clinical setting. In the placebo group, there were no statistically significant changes for any of the studied parameters.
“The importance of this study is not only that it supports earlier findings that L. reuteri Prodentis can be effective in the treatment of gingivitis, but also that it points towards an extended mechanism of action beyond the ability of fighting off pathogens,” commented Professor Twetman. “Our immune system involves mediators that promote inflammation when they are ‘turned on.’ Our results suggest that these mediators can be down-regulated by L. reuteri Prodentis.”
Serendipitous Study
The Prodentis gum is part of a family of products BioGaia formulates with L. reuteri. In fact, the triggering event behind the gingivitis study was an intriguing testimonial. “A man in his early fifties had been fighting his gingivitis for several years,” recounted BioGaia’s Anders Zachrisson, vice president, R&D Oral Health. “His oral hygiene was otherwise excellent and he went to the dentist twice a year for check-ups. Except for the gingivitis, he was in good health. At one visit some years ago his dentist asked him what he had done since the gingivitis was all of a sudden completely gone. After pondering the question for a couple of days he realized that the only change he could think of was that he had taken tablets with L. reuteri for the last few months.
“In parallel, we at BioGaia had started researching reuteri’s effects on Strep mutans, the bacterium that is implicated in causing dental caries. The testimonial led us to hypothesize that L. reuteri could have more of a general effect on oral health, and thus we started the first clinical study.”
Given BioGaia’s rich experience with L. reuteri in products, including lozenges, liquid drops and tablets, Mr. Zachrisson said the company extrapolated its line of probiotic reasoning to focus on the bacterial atmosphere of the mouth. Just as the natural microflora in the gut can be adversely disturbed by injury, disease, stress and medication, so too can the microflora of the oral cavity. “Opportunistic pathogenic bacteria may ‘take over’ and tip the ecology towards a pathological state (dental caries, gingivitis, periodontitis, oral candidiasis, etc.),” he said. “Restoration of the well-balanced micro-ecology should consequently have the ability to either treat these conditions or at least stop disease progression. Therefore we are really interested in pursuing all oral diseases that are caused by pathogenic micro-organisms.”
GUM Periobalance contains 30 pieces per pack and is currently available in Sweden, France, Germany, Poland, U.K., Spain, Italy, U.S., Portugal, Ireland, Bulgaria, Slovakia, Slovenia and Romania. The products also sold in Finland, South Africa and Indonesia and distributed by local partners to BioGaia. Mr. Zachrisson said retail prices vary between 13-17€, depending on the local market.
Products containing Lactobacillus reuteri Prodentis are covered by several global patents and are exclusive to BioGaia and its licensees. BioGaia began marketing Prodentis-based products in Sweden in 2006 and within the last two years, entered into a partnership with Sunstar, which markets the company’s chewing gum and long-lasting tablet products in several markets. A larger, global marketing effort is forthcoming.
In the meantime, the company plans to continue its research endeavors as they pertain to gingivitis and L. reuteri’s effects on periodontitis disease progression.
If the restoration of a well-balanced mouth ecology continues to prove beneficial, which the company’s research results indicate thus far, then its probiotic approach could open up a substantial new approach in the treatment of oral diseases. “Until now, the treatment rationale for oral infectious diseases has been to eliminate all micro-organisms, good and bad alike. This approach has its consequences,” said Mr. Zachrisson. “For instance, oral candidiasis is not an uncommon event following antibiotic therapy and the number of pathogens resistant to antibiotics are on the rise. We do not think that treatment with Lactobacillus reuteri Prodentis will replace current treatment regimes, but will offer an alternative first-line treatment. However, the most important rationale for using L. reuteri Prodentis is to prevent the potential deleterious effects of a disrupted oral ecology.”