The role of probiotics in modulating cariogenic bacteria and oral health outcomes: A systematic review and risk of bias assessment.

2025-12
The Saudi dental journal 37(10-12)
- Rahayu Zulkapli
- Faezah Sabirin
- Anis Najihah Salleh
- Nurul Zurain Fatiha Zulaidi
- Iman Nabilah Abd Rahim
- Muhammad Nazirul Mubin Aziz

PubMed: 41331162
DOI: 10.1007/s44445-025-00103-1

Study Design

Type: Review
Sample size: n = 34
Population: A total of 34 RCTs were included, with the majority of the trials involving children aged 1 to 15 years, while eight studies focused on adult cohorts aged 18 to 65 years.
Methods: Systematic review of randomized clinical trials; comprehensive literature search in the Cochrane Library, PubMed, Scopus, and Web of Science until April 2025, following PRISMA 2020 guidelines; article selection and data extraction were independently conducted, with methodological quality evaluated using the Jadad Score.

This systematic review aims to evaluate the efficacy of probiotic interventions in the prevention of enamel demineralization, with a specific focus on randomized clinical trials (RCTs). A comprehensive literature search was conducted in the Cochrane Library, PubMed, Scopus, and Web of Science electronic databases, covering studies published until April 2025. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Article selection and data extraction were independently conducted, with methodological quality evaluated using the Jadad Score. A total of 34 RCTs were included, with 17 studies scoring 5 and 8 studies scoring 3 on the Jadad scale, indicating moderate to high methodological quality. The majority of the trials involved children aged 1 to 15 years, while eight studies focused on adult cohorts aged 18 to 65 years. Intervention durations varied from 6 days to 2 years. The most commonly used probiotic strains were Lactobacillus, Bifidobacterium, or a combination of both, delivered via dairy-based products, lozenges, mouth rinses, or probiotic tablets. Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001), while findings on Lactobacillus reduction, plaque index, gingival status, salivary pH, and buffering capacity were inconsistent across studies. Long-term studies (≥ 6 months) showed more sustained effects, emphasizing the need for continuous probiotic intake to maintain oral health benefits. The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.

Research Insights

Bacillus coagulans SNZ-1969→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Bacillus coagulans SNZ-1969→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Bacillus coagulans SNZ-1969→Reduced Enamel Demineralization
This systematic review aims to evaluate the efficacy of probiotic interventions in the prevention of enamel demineralization
Effect
Beneficial
Effect size
Moderate
Bifidobacterium animalis subsp. lactis BB-12→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Bifidobacterium animalis subsp. lactis BB-12→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Bifidobacterium animalis subsp. lactis BB-12→Reduced Enamel Demineralization
This systematic review aims to evaluate the efficacy of probiotic interventions in the prevention of enamel demineralization
Effect
Beneficial
Effect size
Moderate
Bifidobacterium bifidum Bb-02→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Bifidobacterium bifidum Bb-02→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Bifidobacterium breve Bb-18→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Bifidobacterium breve Bb-18→Reduced Streptococcus Mutans Levels
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Bifidobacterium lactis Bb-02→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Bifidobacterium lactis Bb-02→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Bifidobacterium lactis Bb-02→Reduced Enamel Demineralization
This systematic review aims to evaluate the efficacy of probiotic interventions in the prevention of enamel demineralization
Effect
Beneficial
Effect size
Moderate
Lactobacillus acidophilus L-92→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Lactobacillus acidophilus L-92→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Lactobacillus acidophilus L-92→Reduced Enamel Demineralization
This systematic review aims to evaluate the efficacy of probiotic interventions in the prevention of enamel demineralization
Effect
Beneficial
Effect size
Moderate
Lactobacillus acidophilus LA-02→Improved Oral Health
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization
Effect
Beneficial
Effect size
Moderate
Lactobacillus acidophilus LA-02→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Lactobacillus acidophilus LA-02→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Lactobacillus paracasei 431→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate
Lactobacillus reuteri ATCC PTA 5289→Increased Salivary pH
The findings suggest that probiotic interventions may represent a potential approach for preventing enamel demineralization, primarily through their ability to reduce cariogenic bacteria and increase salivary pH.
Effect
Beneficial
Effect size
Small
Lactobacillus reuteri ATCC PTA 5289→Reduced Cariogenic Bacteria
Twenty-seven research studies demonstrated a significant reduction in the main cariogenic pathogen, Streptococcus mutans (p < 0.05 - p < 0.001)
Effect
Beneficial
Effect size
Moderate