Reasons to add L. reuteri to your dental patient recommendations
I first heard about the magical microbiome Lactobacillus reuteri at a dental conference. It was one of those CEs where I take a picture of every slide on the Power Point, then let it sit untouched in my photos. But this was different. I was enthralled with what this bacteria could do in the oral microbiome, to the point it’s almost unreal.
How could something so tiny and utterly minuscule outperform our beloved dental devices that we tell our patients about day in and day out? Don’t get me wrong; we still need devices to disrupt biofilm on tooth surfaces and interproximal successfully but adding this little step can make a huge difference in our patients’ oral health.
A little L. reuteri history
Where did L. reuteri originate? German microbiologist Dr. Gerhard Reuter isolated L. reuteri from the gastrointestinal tract of a healthy patient in 1962, where it was noted to be an antimicrobial substance benefitting the gut microbiome and supporting the immune system. When the anti-inflammatory properties were noted, studies discovered possible uses throughout the body’s system. The excitement these scientists must have felt was probably astounding!
Initially studied for its role in gastrointestinal conditions such as irritable bowel syndrome, chronic constipation, and Helicobacter pylori infections, this bacterial strain gained widespread recognition for its effectiveness in soothing colicky babies.1 For exhausted and desperate parents, the promise of a simple drop that could bring relief to their little one, and some much-needed rest for everyone, was an easy sell.
Recognizing its potential, the medical community expanded research into L. reuteri, exploring its benefits in immune support, dermatitis, obesity, type II diabetes, anxiety, depression, urinary tract infections, and more. As clinical trials gained momentum, the strain became a global topic of interest.2 Naturally, it was only a matter of time before the dental community embraced the excitement surrounding this promising probiotic.
Clinical trials investigating the use of L. reuteri in the treatment of periodontal disease and gingivitis began in 2009 and have provided promising results. These studies aimed to evaluate the effects of L. reuteri on periodontal disease in a randomized, placebo-controlled clinical trial.3 Thirty selectively chosen patients with chronic periodontitis received either L. reuteri lozenges or a placebo, along with nonsurgical periodontal therapy.
The results showed significant improvements in plaque index, gingival index, and gingival bleeding index, with the SRP plus L. reuteri treatment showing the best outcomes. Additionally, L. reuteri significantly reduced harmful pathogens such as Aggregibacter actinomycetemcomitans and Porphyromonas gingivalis.4 The study concluded that L. reuteri is a beneficial adjunct in periodontal therapy. While long-term research is always needed, I think we can all agree that this is promising information.
How L. reuteri helps in dental treatment
We all have patients who, regardless of our tireless home care guidance, just cannot seem to grasp the techniques, or they simply lack the motivation to perform adequate oral hygiene at home. While we wrack our brains trying to find a way to get them to understand, we may have a secret weapon.
We all have preferred tools to help perio patients, such as an electric toothbrush and water flosser. But now we can add an oral probiotic for extra support for these patients. Medically compromised patients, such as those with arthritis, Parkinson’s, cerebral palsy, and others, need something beyond an electric brush and water flosser, which can be difficult to navigate.
How about the teens with gingivitis? The kids with sensory processing disorders? All of these difficulties make standard oral care difficult and allow those sneaky yet dangerous bacteria to throw a party in the mouth.
I understand that introducing an oral probiotic can be intimidating for some hygienists. Asking your patients to buy a bottle of what looks like a mint and advertise it as a cure-all may be far reaching, but it’s all about the delivery. Start with a hook such as, “Hey, I have an easier way to reduce the bacteria in your mouth so you can have less bleeding and discomfort in your gums. It’s inexpensive and fast to use.” I mean, that would get me interested!
Discussing the use of this oral probiotic is all about educating patients in terms they understand, such as low cost, ease, and efficiency. L. reuteri is available in drops and tablets. I suggest that patients leave this product by their nightstands and make it the last thing they have at night after brushing and flossing.
Another interesting thing I find is asking whether patients struggle with morning breath. We all know it—that rank smell we have upon waking, and when we realize it’s coming from our mouth we rush to brush. This is something everyone can relate to and likely would like to change. This was the biggest change I saw when I used this product as a patient with no gingivitis or periodontal disease. With a healthy mouth, I still suffered with morning breath, and the only way I was able to change this was with an oral probiotic. While we see this as a beneficial adjunct for periodontal patients, healthy patients can also reap the rewards.
Introducing L. reuteri to patients is not about replacing the fundamentals—it’s about enhancing them. As dental professionals, we aim to provide science-based solutions that fit into patients’ everyday lives. With its antimicrobial, anti-inflammatory, and probiotic benefits, L. reuteri offers a powerful adjunct to traditional oral home care methods, making it an excellent option for those struggling with compliance, physical limitations, or persistent oral health challenges.
Whether supporting periodontal therapy, reducing morning breath, or offering an accessible solution for hard-to-reach patients, this tiny but mighty bacteria has earned its place in the conversation. By staying informed and open to innovation, we can empower patients with new tools that make a real difference, one microscopic ally at a time.
References
1. Reuter G. Lactobacillus reuteri sp. nov. and other Lactobacilli isolated from the human intestine. Int J System Bact. 1962;12(3):202-207.
2. Slot DE, Van der Weijden FA, Krom BP. Clinical efficacy of Lactobacillus reuteri probiotics in the management of periodontal disease and gingivitis: A systematic review. J Clin Periodont. 2014;41(4):327-334.
3. Vivekananda MR, Vandana KL, Bhat KG. Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. J Oral Microbiol. 2010;2:2. doi:10.3402/jom.v2i0
4. Berg G, Smid EJ. Probiotic strains of Lactobacillus reuteri as potential treatments for periodontal disease and gingivitis. J Oral Microbiol. 2017;9(1):1-10.
