How To Determine What Probiotic Your Dental Patient Needs

Taking probiotics indiscriminately without proper direction can cause systemic problems. Here are steps you can take to determine which probiotic your dental patient needs and avoid unnecessary risks.

Probiotic Overuse

The overuse and indiscriminate administration of probiotics have reached epidemic proportions. The global probiotic market size has reached $57.1 billion in 2023 and is assessed to grow at a compounded annual growth rate of 8.7% from 2024 to 2032. By the end of 2032, the probiotic consumer market is expected to exceed $91.4 billion.⁴

The adage too much of a good thing is a bad thing holds true with probiotic use. Unfortunately, simply taking a probiotic without direction or without knowing what bacteria you are deficient in can cause systemic problems.

For example, one type of bacteria commonly found in over-the-counter probiotics, Lactobacillus, has been associated with an increase in D-lactic acid and has caused SIBO (small intestinal bowel overgrowth) in certain patients.

Other studies have shown that overreliance on probiotics can cause brain fog, poor concentration, short-term memory problems, and metabolic acidosis.⁵ The authors of this study concluded that probiotics should contain strains of bacteria that are patient-specific and should be treated like a medication, not a supplement.

Although there are numerous brands of probiotic supplements (figure 1), many contain a limited number of bacterial strains, primarily from the groups Lactobacillus, Bifidobacterium, and a few others. Patients who take probiotics without knowing which strains they need can do more harm than good.

For instance, concentrated doses of a few strains of bacteria (e.g., Lactobacillus casei) can upset the balance in the gut inadvertently by creating a form of dysbiosis that comes from having too much of a good bacterium, which decreases the more important factor of microbiome diversity.

Directed probiotic use should include oral saliva and stool testing. This will determine the patient’s oral and gut microbiome and ascertain what bacteria strains are or are not needed (figure 2). Based on this information, the clinician can then determine what, if any, probiotic is needed and how it needs to change over time to support the evolving microbial flora. In other words, one type of probiotic should not be taken ad infinitum, and focus should be placed on increasing the diversity of microbial flora.