Herasimenko F.I., Rishtakov S.F., Kushnir K.G., Bobkova S.A.,

Kolbasina L.P.

Using of prebiotics in patients with chronic

nicotine intoxication

Over the last century the amount of smokers has catastrophically increased. Modern researches has shown that nicotine and other components of tobacco smoke impact on all the systems of human body, predominantly on respiratory system, cardiovascular system and oral cavity.

If to say about the oral cavity nicotine has long-term effect on the oral mucosa, it causes bad breath because nicotine stays on the teeth and lips for a long time causing its smell to stay on it and leads to discoloration of teeth. But one of the worst effects of nicotine is connected with odontoclasis and agomphiasis. Odontoclasis (tooth decay) is the main reason of visits to dentists and may be caused by many reasons. Nicotine intoxication leads to tooth decay by two ways – the first one is the parodontitis and the second one is caries. Parodontitis is connected with deterioration of blood supply to gums and periodontium so teeth have no fixation. Caries is the process of tooth demineralization caused by bacteria, most commonly responsible for dental cavities are Streptococcus mutans, Streptococcus sobrinius and Lactobacillus. This bacteria crowd out oral cavity normal microflora and teeth lose their protection. The main nutrient for this bacteria are sugars which are fermented to lactic acid. Lactic acid destroys tooth enamel and causes its decay.

There are a lot of methods of tooth decay correction. One of the most effective methods in patients with chronic nicotine intoxication is the using of prebiotics. Prebiotics are non-digestible food ingredients that stimulate the growth and/or activity of bacteria in the digestive system in ways claimed to be beneficial to health and because the oral cavity is the part of digestive system prebiotics are very effective for treatment of tooth decay.

Using of prebiotics can solve 2 main problems connected with smoking in such patients – increase of pathogenic microorganisms level and tooth decay connected with their impact. All the prebiotics used in dentistry has one primary target, they are nutrients for oral cavity normal microflora. Lactobacillus and Streptococcus (peptococcus) are main microorganisms of oral cavity normal microflora and they require special condition and nutrients for their normal existing. Using of prebiotics is the most effective way to provide bacteria with such nutrients. Nicotine intoxication is the complication factor and it is necessary to neutralize its impact. Neutralization of nicotine by chemical agents or prebiotics is impossible because metabolites are also very harmful for an organism but we can reduce its impact by modern methods.

Prebiotic therapy causes restoration of streptococcus and lactobacillus level in oral cavity and they replace pathogenic and opportunistic bacteria, mostly Str. mutans, Str. sobrinius and some other pathogenic microorganisms. Also we should mention that high level of Str. mutans causes rapid increase of dental plaque, which is connected with metabolic processes of this bacteria. Str. mutans uses sugars as the main nutrients, but if it uses only saccharose for its metabolic processes it is metabolized in dextran, high molecular glucose polymer which creates tight plaque. This plaque together with lactic acid rapidly destroy the tooth enamel and this leads to tooth decay and agomphiasis. Str. salivarius, the main protective microbe in oral cavity can stop this process but for its good reproduction we should use specific nutrients and prebiotics are ideal substances for this.

There are two main ways of prebiotic therapy – using of prebiotic medicines and addition to the diet some products containing prebiotics. Food containing prebiotics include soybeans, inulin sources (such as Jerusalem artichoke, jicama, and chicory root), raw oats, unrefined wheat, unrefined barley and yacon. Some of the oligosaccharides that naturally occur in breast milk are believed to play an important role in the development of a healthy immune system in infants. Prebiotic oligosaccharides are increasingly added to foods for their health benefits. Some oligosaccharides that are used in this manner are fructooligosaccharides (FOS), xylooligosaccharides (XOS), polydextrose and galactooligosaccharides (GOS). Moreover disaccharids like lactulose or some monosaccharides such as tagatose are also used sometimes as prebiotics.

Lactulose is the main prebiotic which is used in the form of medicine. Lactulose is considered a prebiotic because it modulates the beneficial bacterial flora of the mouth and is considered a digestive aid. Modulation of oral cavity flora presumably works by reducing potential pathogenic bacteria such as and Staphylococcal species in oral cavity, with increase in non-urease producing Lactobacillus limiting ammonia production. Moreover, lactulose is converted to lactic and acetic acid which results in acidification (but the level of lactic acid is much lower than its level produced by Str. mutans and it leads to normalization of oral cavity pH). Furthermore, with its prebiotic potential, lactulose also encourages growth of probiotic bacteria such as Bifidobacterium species that are known to have health-promoting effects.

Mouth rinses with lactulose are the most effective medicines for prophylactics and treatment of oral cavity dysbiosis. Adding of lactulose in food (yoghurts, drink yoghurts, multi-juice drinks and bakery products) in combination with mouth rinse is one of the most effective methods to prevent tooth decay caused by nicotine. Also it is useful in prosthetics patients because it improves implant survival rate.

As the result of clinical investigations and monitoring processes in dental patients who also have chronic nicotine intoxication we can say that using of prebiotics helps to prevent agomphiasis and tooth decay, accelerates engraftment of the implant and normalizes mouth microflora, that’s why it’s possible to say that prebiotic therapy is very effective, simple and non-harmful method of dental pathologies treatment.