Marchenko N.V., Kushnir K.G., Bobkova S.A.,

SI “Crimea State Medical University named after S. I. Georgievsky”

Using of prebiotics in prosthetic dentistry

Prosthetic dentistry is such a part of dentistry where regenerative processes after the treatment are even more important than treatment itself because in the case of adhesion failure all the results would be for nothing. Tooth implant is one of the most effective methods of treatment in dentistry because it can be destroyed only under strong physical or chemical exposure, but because implant is an alien substation for oral cavity tissues the engraftment processes are very important and should be improved by any ways possible. There are a lot of ways to improve these processes like using of antiseptic medicines, immunomodifier medicines and probiotics. One of the new ways for engraftment acceleration is usage of prebiotics, special nutrient substances for prebiotics which allow us to improve treatment without any serious changes in oral cavity biochemical balance and also useful for correction of oral cavity normal microflora.

The two main reasons for prosthetic treatment in patients are caries and parodontitis. Caries is the disease caused by demineralization of tooth enamel and the main reasons of such mineralization are pathogenic and opportunistic microorganisms such as Str. mutans, Str. sobrinius and Lactobacilli. During metabolic processes this bacteria synthesize a lot of lactic acid which destroys tooth enamel and impairs pH in oral cavity. Str. sobrinius also creates a biofilm from dextran during the metabolism of saccharose and this biofilm keeps acid near the enamel surface. Parodontitis is caused by the blood supply impairment to gingival tissues and adhesion of teeth becomes worse which causes earlier tooth loss.

Prebiotics may stop this process with the method of microbial physiological system correction. As we can see the main reasons (except of primary physical traumas) of the prosthetic treatment are connected with pathogenic and opportunistic microbes, so we have to decrease their number and increase the number of microbial physiological system useful microorganisms such as Streptococcus sanguinius. Using of prebiotics helps us to accelerate multiplication processes of useful microorganisms and to stop multiplication of pathogenic microbes because of their metabolic processes impairments.

First we need to select necessary prebiotics and their dosage band. Because we use prebiotics in oral cavity the dosage band should be either liquid (dental elixir or mouth rinse) or in pills solvable in mouth. After this we should select such prebiotics which act directly on oral cavity microflora. Prebiotics extracted from unrefined wheat, unrefined barley and yacon, Jerusalem artichoke, jicama, and chicory root can be used in this case, also lactulose (synthetic disaccharide). Because these plants contain such substances like are fructooligosaccharides (FOS), xylooligosaccharides (XOS), polydextrose and galactooligosaccharides (GOS) they are ideal for using as oral cavity prebiotics. These substances serve as a very good nutrients and catalyzers for biochemical processes in microbial cells, also they stop metabolic processes in pathogenic bacteria and are not absorbed by human organism because they have no nutrition value for it.

Mouth rinses and elixirs are widely used in modern dentistry for correction of microbe balance and prebiotical therapy. «Lizomukoid» dental elixir containing lysozyme is useful in case of pathogenic and opportunistic microorganisms massive multiplication. Lysozyme destroys cytoderm of pathogenic microbes (it destroys murein which is present in cytoderm of many gram-positive bacteria) and accelerates metabolic processes of normal microflora. «Biotrit» is an elixir made from wheat containing isoflavones which serve as strong immunomodifier and prebiotic, also it improves osteosynthesis in tooth. «Exodent» mouth rinse is made from soya and has effect similar to the «Biotrit» effect. Fructoolygosaccharides from chicory roots are effective in form of pills combined with calcium for acceleration of teeth restoration. All this medicines increase the level of Str. sanguinius in oral cavity, which stops the growth of Str. mutans and sobrinius and normalizes the level of lactic acid which also decreases level of ammonia which is formed during putrefaction of dental and periodontal tissues.

Lactulose is also one of the most effective modern prebiotical medicines. This chemical substance is an artificially synthesized disaccharide (it contains chemical residues of galactose and fructose molecules) which has no nutrient value for human cells but it is very useful for Str. sanguinius and other normal microflora microbes. It accelerates growth of Str. sanguinius and Bifidobacterium in oral cavity which normalizes pH and stops multiplication of Str. mutans and Str. sobrinius. The growth of useful bacteria also increases the process of pathogenic microflora metabolites utilization.

The results of many investigations have shown that the usage of prebiotics after the prosthetic treatment helps to increase implant survival rate in case of pathologies primary connected with bacterial invasion and complications connected with dysbiosis after the implant installation. The abnormal growth of pathogenic microflora can be stopped with the usage of some prebiotics, especially lactulose. So that’s why we can say that usage of prebiotics in prosthetic dentistry is grounded because of the results achieved y this method of therapy.