Tooth infections can be agonising and frustrating. Sometimes, it seems like an extraction is the best way to get rid of the problem once and for all.
A Human reader recently asked a question on Human about a tooth infection on her upper molar and wanted to know if oral probiotics are able to help treat the current infection or prevent future infections from happening.
Experienced dentists from the human.com.sgmunity responded to her question and here's what they had to share.
First, you have to find out the cause of the tooth infection
Dr Asha Karunakaran, an experienced dentist, explained that before you jump into the treatment method, the cause of your tooth infection must first be understood.
If your infection is caused by a deep tooth decay has already infected the pulp or nerve in the centre of the tooth, probiotics will have no effect.
In such a situation, root canal treatment would be the appropriate treatment.
"What, probiotics are bacteria?!"
Yes, that's right. Probiotics are microorganisms, mainly bacteria, that are actually beneficial for your health if used appropriately. They have successfully been used to control intestinal diseases.
Currently, clinical trials are being done to confirm if oral probiotics have the potential to prevent or treat diseases of the oral cavity. 
Dietary probiotics won't prevent tooth decay
There are currently no reports that state dietary probiotics like yoghurt, kefir, or kombucha will prevent tooth decay or periodontal disease.
However, oral probiotics are also not first-line treatments for tooth infection
According to Dr Jaclyn Toh, oral probiotics (orally ingested probiotics or probiotics "optimised" for the maintenance of oral health and prevention of oral diseases such as tooth decay and gum disease) are not used as first-line treatments or for first-line prevention.
Why? Because there isn't enough evidence
Studies suggest that using probiotics could be beneficial for the maintenance of oral health, due to its ability to decrease the colony forming units (CFU) counts of the oral pathogens.
However, further clinical trials are needed to confirm their efficacy in reducing the chances of infectious oral diseases occurring. 
Dr Jaclyn explained that there are many aspects of the oral and even gut microbiome that we still don't know yet, such as:
What is the composition of an "ideal" healthy oral microbiome?
Are there certain beneficial bacteria that should be present, and in what proportions?
Is it possible to reorganize the oral microbiome to eliminate harmful bacterial species?
How will the probiotic bacteria be kept alive in the oral cavity to have sustained effects?
Therefore, there is insufficient evidence to routinely recommend oral probiotics at this point.
We don't know if oral probiotics safe for compromised immune systems
Another thing that research has yet to discover: are oral probiotics are safe for patients with compromised immune systems?
This could include young children, the elderly, or patients undergoing immunosuppression like organ transplantation. Thus, it's imperative that you consult a doctor before taking any probiotics.
There is a specific type of probiotic lozenges that might help
Dr Asha stated that there is a particular kind of probiotic designed specifically for dental use.
It's helpful in the management of periodontal infections (gum disease) and comes in the form of a chewable lozenge that needs to be consumed twice a day for 3 months.
Essentially, this probiotic changes the bacterial population in your mouth so "good" bacteria overwhelms disease-causing bacteria. 
However, these probiotic lozenges might not be so effective on their own
Here's the catch: these probiotic lozenges need to be used together with procedures like scaling and root planing. These procedures physically remove the calculus and plaque which is the cause of gum infections and periodontal disease.
If you're suffering from severe gum infections, you may also require antibiotics and antiseptic mouthwashes.
Green vegetables will do you a lot of good
Dr Jaclyn reminds us to eat our greens! There's actually evidence that green vegetables are essential for the maintenance of beneficial gut bacteria. 
Without prebiotics (foods that nourish the good bacteria such as green leafy vegetables, asparagus, garlic, onion, leek etc) taking a probiotic on its own will not produce lasting effects.
She also added that the consumption of green vegetables allows for salivary secretion of nitrate that is converted to nitric acid and nitrous oxide in an acidic environment.
These compounds are able to kill harmful bacteria (such as E.Coli that can cause food poisoning) and suppress the growth of decay-causing oral bacteria.
Stick to the basics of oral hygiene if you want real results
Dr Jaclyn Toh mentioned that the basic principles of oral health that have stood the test of time are what you should be focusing on.
Extensive research has backed maintaining healthy oral hygiene as one of the best ways for healthier teeth.
Maintain meticulous oral hygiene to prevent tooth decay
These are all steps that can stop tooth infection before it begins:
- Brushing your teeth twice a day
- Daily interdental cleaning (flossing, use of interdental brushes)
- Maintaining a balanced diet high in green vegetables
- Reducing the consumption of refined sugars
Until there are more definitive findings for the efficacy of oral probiotics, conventional dental treatment and prevention is still the way to go.
Always remember to consult your dentist or doctor before starting any probiotic and supplement courses.
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