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Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review

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Abstract

Apical periodontitis (AP) is a biofilm-associated disease initiated by the invasion of dental pulp by microorganisms from the oral cavity. Eradication of intracanal microbial infection is an important goal of endodontic treatment, and this is typically accomplished by mechanical instrumentation and application of sodium hypochlorite and chlorhexidine. However, these agents are tissue-irritating at higher concentrations and cytotoxic. Certain probiotics have been found effective in controlling marginal periodontitis, as evidenced by reduction of pathogenic bacterial loads, gains in clinical attachment levels, and reduced bleeding on probing. In vitro studies have shown inhibitory activity of some probiotics against endodontic pathogens. Similarly, in vivo studies in rats have demonstrated a positive immuno-modulatory role of probiotics in AP, as manifested by decreased levels of proinflammatory markers and increased levels of anti-inflammatory markers. A role for probiotics in effecting a reduction of bone resorption has also been reported. This review provides an outline of current research into the probiotic management of AP, with a focus on understanding the mechanisms of their direct antagonistic activity against target pathogens and of their beneficial modulation of the immune system.

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Funding

MLC and IVP were supported by the Ministry of Science and Higher Education of the Russian Federation (Project Number 075-15-2019-1880). SKT received financial supports from the Department of Biotechnology (BT/PR8306/PID/6/738/2013) and Indian Council of Medical Research (5/9/1117/2013-NUT), New Delhi, India.

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  1. Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India

    Gaurav Kumar & Sanjay Tewari

  2. BLIS Technologies Ltd, Dunedin, New Zealand

    John Tagg

  3. Health Promoting Naturals Laboratory, School of Environmental and Biological Sciences, Rutgers State University, 65 Dudley Road, New Brunswick, NJ, 08901, USA

    Michael Leonidas Chikindas

  4. Center for Agrobiotechnology, Don State Technical University, Gagarin Square 1, Rostov-on-Don, 344002, Russia

    Michael Leonidas Chikindas & Igor V Popov

  5. I.M. Sechenov First Moscow State Medical University, Bol’shaya Pirogovskaya Str., 19c1, Moscow, 119146, Russia

    Michael Leonidas Chikindas

  6. Department of Genetics, Maharshi Dayanand University, Rohtak, India

    Santosh Kumar Tiwari

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Kumar, G., Tewari, S., Tagg, J. et al. Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review. Probiotics & Antimicro. Prot. 13, 299–314 (2021). https://doi.org/10.1007/s12602-021-09750-2

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