Title	Lactobacillus Salivarius Containing Probiotics May Have Benefits Similar to Xylitol in Decreasing Caries Risk
Clinical Question	How effective are Lactobacillus salivarius containing probiotic tablets as compared to xylitol in decreasing caries risk?
Clinical Bottom Line	Lactobacillus salivarius containing probiotic may have the added benefit of salivary buffering capacity over xylitol alone, based on one study of 64 individuals. Double blind randomized control trials should be performed before clinical recommendation of Lactobacillus salivarius to decrease caries risk.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 25178882 Nishihara/2014 1 study/64 individuals Randomized Open-Label Clinical Trial Key results While a decrease in mutans streptococci levels was seen in the L. salivarius group, it was not a statistically significant difference (p<0.05), compared to xylitol group. No significant difference was observed in salivary flow or pH between the two groups. Significant differences were observed for the salivary buffering capacity (p=.004). The xylitol group showed a decrease in salivary buffering capacity [median -0.3 (IQR -0.6 to -0.1)], while no changes were seen in the L. salivarius groups.
Evidence Search	((("lactobacillus"[MeSH Terms] OR "lactobacillus"[All Fields]) AND salivarius[All Fields]) AND ("xylitol"[MeSH Terms] OR "xylitol"[All Fields])) AND (("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) AND ("risk"[MeSH Terms] OR "risk"[All Fields]))
Comments on The Evidence	Validity: The design of this trial was open-label and not double-blinded. Also the tablets used to study the effects of L. salivarius were compounded with 280mg of xylitol, which was compared to tablets containing only the 280mg of xylitol. Study subjects were 64 healthy dental students with a mean age of 24.8. Perspective: While this trial shows that L. salivarius may contribute to caries control, a double blind randomized control trial would be required to determine the effects of L. salivarius on caries risk. Studies should be conducted comparing L. salivarius containing probiotic to no treatment and compared to xylitol alone without the xylitol present in the probiotic-containing tablet. It would be interesting and beneficial to see a comparison between L. salivarius tablets and xylitol in gum form rather than tablet. Healthy dental students are not a broad representative of a high caries risk patient seen in a general practice and studies should be done on a broader higher caries risk patient pool.
Applicability	Many patients present with a high caries risk and there is a potential benefit to finding a probiotic that will decrease the patients’ caries risk factors of the oral environment throughout the day. While there is no risk shown for the use of Lactobacillus salivarius-containing probiotic, is has not been studied enough to show benefits worth recommending to you patients.
Specialty	(General Dentistry) (Interprofessional CATs)
Keywords	Lactobacillus salivarius probiotic, xylitol, caries risk, salivary buffering capacity
ID#	2840
Date of submission	03/24/2015
E-mail	sharpar@livemail.uthscsa.edu
Author	Alexandria Gibbs
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Georgiana S. Gross, MPH
Faculty mentor e-mail	grossg@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available