Kushnir K.G., Bobkova S.A., Rishtakov S.F., Severinova S.K.

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

Impact of prebiotics in prosthetic pathologies treatment

Prosthodontics, also known as dental prosthetics or prosthetic dentistry is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes. 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. The two main targets of prosthetic dentistry are dental implantation and increase of dental implant survival rate. Dental implantation is the well studied process and new researches are usually targeted on processing of new materials suitable for creation of artificial teeth and dental frameworks. But processes of restoration and implant survival rate are two main factors that require specific maintains, because in case of implant acceptance failure all the treatment will be in vain. That’s why it is necessary to research new methods which may help us in processes of restoration and implant survival rate increase.

Modern science has discovered a lot of new ways to increase restoration processes in case of prosthetic treatment. Antibiotics, immunomodifier drugs, probiotics and antiseptics are the most popular medicines for increase of restoration after the prosthetic treatment. But sometimes they may have side effects and/or too strong impact on oral cavity normal microflora and biochemical processes. But we found a new, specific way to increase implant survival rate without negative changes in oral cavity. This way is the usage of prebiotics.

In the year 1995 Prof. Marcel Roberfroid discovered non-digestible food ingredients that stimulate the growth and/or activity of bacteria in the digestive system. They were named «prebiotics», what means precursors for probiotics.

. One of the main features of prebiotics is their selective action – they act mostly on normal microflora. They are represented by carbohydrates, mostly oligosaccharides. 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. Also lysozyme and pectin may be used as prebiotics, because pectin is a very good nutrient for oral cavity normal microflora and lysozyme destroys cellular walls of pathogenic microflora and in such a way it may create nutrients for normal microorganisms.

Usually for oral cavity microflora normalization prebiotics are extracted from unrefined wheat, unrefined barley and yacon, Jerusalem artichoke, jicama, and chicory root and can be used in this case, also lactulose (synthetic disaccharide) is widely used as additional component in some milk products and mouth rinses. If to say about synthetic prebiotics lactulose and other artificial saccharides may be used.

Lactulose 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. Modern biochemical researches show us that lactulose stimulate ammonia decrease and stabilize pH to low-acidic level, what creates the best environment for oral cavity normal microflora. Dental plaque analyzes shows us decrease of biofilm and redox processes inhibition, microcirculation processes in gingival and periodontal tissues become better, level of Streptococcus mutans and anaerobes such as Str. salivarius and Str. sobrinius becomes less than in case of no prebiotics using. Implant survival rate increases in 2-3 times. Mouth rinses with lactulose are the most effective medicines for prophylactics of gingival pathological processes. 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 and microorganisms multiplication.

Mouth rinses, toothpastes, mouth elixirs and food enriched with prebiotics are the best ways of prebiotics’ initiation in oral cavity biochemical processes. As the example of prebiotic containing medicines we may say about «Biotrit» ( mouth elixir made from wheat containing isoflavones which serve as strong immunomodifier and prebiotic) and «Exodent» (mouth rinse is made from soya and has effect similar to the «Biotrit» effect). Using of this medicines in case of prosthetic treatment increases processes of restoration and implant survival rate. The abnormal growth of pathogenic microflora can be stopped with the usage of some prebiotics, especially lactulose.