Probiotics for caries prevention: A narrative review

Dental caries, a widespread global health problem, results from oral microbiome dysbiosis dominated by acidogenic pathogens like Streptococcus mutans. Conventional preventive methods, such as fluoride and antimicrobial rinses, often lack specificity and can disrupt beneficial microbes. Probiotics are live, health-promoting bacteria or yeasts commonly found in foods such as yogurt or in dietary supplements. They help restore microbial balance and have emerged as a promising strategy for caries management. This review explores the mechanisms, efficacy, and clinical applications of probiotics in caries prevention. Specific strains such as Lactobacillus reuteri, Lactobacillus rhamnosus, and Streptococcus salivarius inhibit cariogenic bacteria through competitive exclusion, acidity modulation via arginine metabolism, and production of antimicrobial compounds like reuterin and bacteriocins. Clinical trials show that probiotic lozenges, gums, and dairy products reduce Streptococcus mutans counts and caries incidence in both children and adults. Challenges remain in optimizing strain selection, delivery methods, and ensuring long-term efficacy. Innovations include engineered probiotics with enhanced antimicrobial activity and synbiotics that combine probiotics with prebiotic fibers to improve colonization. While probiotics provide a safe, non-invasive adjunct to traditional approaches, further large-scale, well-designed longitudinal studies are essential to standardize protocols and understand their ecological effects on the oral microbiome. In summary, integrating probiotics into personalized oral care has the potential to revolutionize caries prevention by addressing microbial dysbiosis directly, shifting the focus from pathogen elimination to promoting a balanced microbiome. This highlights the significance of probiotics in supporting oral and dental health and potentially reducing the prevalence of caries worldwide.