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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists

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Year : 2022  |  Volume : 26  |  Issue : 4  |  Page : 597

Awareness of probiotics among dental practitioners of Puducherry—A cross-sectional questionnaire study

1 Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Pondicherry, India
2 Department of Oral and Maxillofacial Pathology and Oral Microbiology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
3 Department of Oral and Maxillofacial Pathology and Oral Microbiology, SRM Dental College and Hospital, SRM University, Kattankulathur, Chennai, Tamil Nadu, India
4 Department of Oral and Maxillofacial Pathology and Oral Microbiology, Sree Balaji Dental College and Hospital, Bharath University, Chennai, Tamil Nadu, India

Date of Submission05-Dec-2021
Date of Decision22-Feb-2022
Date of Acceptance26-Feb-2022
Date of Web Publication22-Dec-2022

Correspondence Address:
Vidyalakshmi Santhanam
Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Pondicherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jomfp.jomfp_422_21

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Background: The efficiency of probiotics in prevention and also treatment of oral infections including dental caries, periodontitis, halitosis is found to be appealing in the recent literature. Their antagonistic role in oral infections is mainly through formation of biofilm which needs documentation. Though the emergence and practice of oral probiotics is visualized for the past two decades, the consumption and knowledge level is found to be less among the community. Stronger source to spread scientific evidence to the community would be health professionals.
Aim: The current study is aimed at assessing the level of awareness of probiotics among dental practitioners of Puducherry thereby aid and assist in the beneficial practice of the same in the community.
Methods: The knowledge level was assessed through a cross sectional survey using closed ended questionnaire. Involves practicing dentists of Puducherry (n-173). A prevalidated questionnaire with 17 closed ended and one open ended question was employed as the research tool .
Results: The results revealed an acceptable knowledge in 77.4% and a greater level of knowledge in 20.8% of dentists. More number of studies are expected to fulfill the lacunae in the field of safety of usage and long term effects of probiotics.
Conclusion: Responses of the current study which was focused on dental practitioners revealed that the knowledge level is well above the acceptable level. There is no profound difference in the awareness level noticed among BDS and MDS practitioners..

Keywords: Awareness of dentists, oral probiotics, probiotics

How to cite this article:
Santhanam V, Devi M, Aravindan R, Suganya R, Aroumugam S, Babu M A. Awareness of probiotics among dental practitioners of Puducherry—A cross-sectional questionnaire study. J Oral Maxillofac Pathol 2022;26:597

How to cite this URL:
Santhanam V, Devi M, Aravindan R, Suganya R, Aroumugam S, Babu M A. Awareness of probiotics among dental practitioners of Puducherry—A cross-sectional questionnaire study. J Oral Maxillofac Pathol [serial online] 2022 [cited 2023 Jan 27];26:597. Available from: https://www.jomfp.in/text.asp?2022/26/4/597/364811

   Introduction Top

Probiotics are defined as 'living microorganisms, principally bacteria, that are safe for human consumption and, when ingested in sufficient quantity, have a beneficial effect on human health beyond basic nutrition' has been approved by the United Nations Food and Agriculture Organization and World Health Organization. They are also referred to as 'good bacteria' or 'supporting bacteria.'[1],[2]

The idea behind probiotics emerged in the early 20th century. Nobel prize winner Ellie Metchnikoff was popularly referred to as the 'father of probiotics' proposed in The Prolongation of Life. Probiotic therapy is used in oral treatment after the emergence of antibiotic-resistant bacteria.[3] As suggested by Dr Daniel Grenier, the mechanism of action of probiotics is related to their ability to compete with pathogenic microorganisms for adhesion sites.[2]

Probiotics are available to consumers not only in the form of drugs like suppositories and creams but also in dietary supplements like milk, yoghurt, cheese, etc. The efficiency of probiotics in the prevention and treatment of oral infections, including dental caries, periodontitis, and halitosis, is found to be appealing through few studies.[4] Their antagonistic role in oral infections is mainly through forming a biofilm, which has also been documented. The introduction of genetically modified microbes has given a newer facelift in the field of probiotics. The hub of modified microbes reduces the harmful properties of pathogenic strains among the commensals of the oral cavity. The modified strain beneficially would replace the original strain.[5]

Probiotics generally refer to bacteria, yeasts, and moulds. The most common bacterial strains are of the genera  Lactobacillus acidophilus Scientific Name Search  Bifidobacterium.

Saccharomyces boulardii is a yeast that satisfies the criteria of probiotics.[6] In vitro studies have demonstrated the competency of the lactobacillus strain over the  Streptococcus mutans Scientific Name Search solated from oral fluid. L. rhamnosus, L. paracaesi, and L. plantarum were the strains that proved their effect on decreasing the existence of the streptococcus strain.[7]

The Bifidobacterium strain targets the pathogenic strains by producing antimicrobial substances. L. rhamnosus strains modulate immunity by boosting the activity levels of natural killer cells and leukocytes. Natural killer cells identify and destroy tumour cells. Lactobacilli have an indirect effect on the killing of tumour cells. Studies conducted that went a duration of nine months to one year proved that when the probiotics were administered orally, they presented a great tolerance level and a better safety profile.[8]

Despite the immense action of probiotics, data is still deficient on the role of probiotics in oral health. The concept of probiotics prompts a new horizon in the relationship between diet and oral health. Very few clinical studies have been conducted till now. The current study is aimed at assessing the awareness of dental practitioners of Puducherry. Awareness of products like probiotics with more benefits would be the need of the hour. Since the inception of probiotics, their implications in dentistry have not been widely described. The outcome of this study would aid in attempting preliminary studies to find the effect of the same in the field of dentistry. Also, the accelerated growth in market and consumer focus and consumption has withdrawn scientific research on the safety and effectiveness of probiotics for specified health issues, including dentistry.

Aims and objectives

To evaluate the level of awareness of probiotics among dental practitioners of Puducherry, thereby aiding and assisting in the beneficial practice of the same in the community.

   Materials and Methods Top

Study area

The study was set in Puducherry with dental practitioners of Puducherry as the study population.

Study design

A cross-sectional questionnaire study was conducted among the dentists practising in Puducherry.

Sample size

Involves total population of dentists (n = 173), both Indian Dental Association (IDA) registrants and non-registrants. The previously proposed sampling method (convenient sampling: IDA list) was modified since more than half of the dentists were not IDA registrants. The dentists' list of practising in Puducherry was generated by pooling both Indian Dental Association registrants and dentists' list with the dental material dealers.

Type of study

A questionnaire with 17 closed-ended and one open-ended questions was designed to probe the basic aspects of probiotics based on the current literature. Validation of the questionnaire was done, and the content was validated by experts in the field of general microbiology, dietetics, and oral pathology. The suggestions were accepted positively and incorporated into the questionnaire. The study then proceeded after the approval of the proposal by the IRB & IEC of Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry.

The study was conducted for a period of two months (August–September). With the help of the newly generated list and after getting consent from the participants, the questionnaire was distributed to 173 participants, and the filled-in questionnaires were collected and organised.

Statistical analysis

Data analysis was carried out using SPSS software version 11. Frequency distribution was done, and results were interpreted in percentages.

   Results Top

Of the 173 dentists, 27% were BDS, and 73% were MDS. 75% of the n = 173 participants were practising above four years, and 25% were practising for less than four years. The scoring of the correct responses was classified and made to fall within three class intervals 0–5 as poor, 6–11 as acceptable, and 12–17 as good. The responses for the 17 questions, irrespective of the degree, are given in [Table 1]. [Figure 1] represents the knowledge level, where the awareness was good in 20.8% of them, 77.4% of them had fallen into an acceptable category, and only 1.7% of them had poor knowledge about probiotics. [Table 2] and [Table 3] show the awareness level of the BDS and MDS practitioners.
Table 1: Distribution of responses to questions related to knowledge, safety, and availability of probiotics

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Figure 1: Knowledge of probiotics among dental practioners

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Table 2: Scoring of BDS practitioners' responses in %

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Table 3: Scoring of MDS practitioners' responses in %

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   Discussion Top

Living in harmony with nature improves the well-being of an individual. Naturally occurring products help in restoring good health. Such products are derived from sources like water, plants, animals, and microorganisms, categorised under the division complementary and alternative medicine. 'Complementary and alternative medicine' is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.[1]

Complementary medicine includes probiotics, which are nothing but naturally occurring microorganisms, principally bacteria, and also yeasts and mould.[2] It has been categorised as 'generally regarded as safe' by the United States Food and Drug Administration.[3] A PubMed search revealed 13,138 number of literature published about probiotics from 1954 to 2015, of which 1,713 publications were on oral probiotics from 1991 to 2015. Despite accumulating evidence in connection to probiotics, the product is still less successfully integrated in practice. Healthcare providers are the effective source in the delivery of scientific evidence to the benefit of consumers. The current study is aimed to gauge the level of awareness of probiotics among dental practitioners.

Our questionnaire was constructed to judge the familiarity and knowledge of effective strains, dosage, availability, and their long-term effects. The responses are given in [Table 1]. Our study revealed an acceptable level of awareness in 77.4%, and 20.8% had a good level of knowledge. A similar survey was conducted in Chennai with n = 300 involving dentists, medical professionals, and health care providers to analyse the knowledge of probiotics, wherein 69% of the participants were aware of the terms and their contents.[9]

An identical study was conducted in Iran with 296 participants, where the level of awareness was acceptable at 43% and good at 51%.[10] In par with ours a survey conducted in Canada among 62 Nigerian physicians, only 4.8% were familiar with the term, and none of them 0% have ever recommended probiotics.[11] Comparable to ours, a survey was conducted in New Delhi, India, among 300 chemist shops, where only 10% of the shops had 75% of the probiotic products. The author concludes by saying this status is due to the lack of awareness among the chemists regarding the product.[12] Correspondingly, a survey conducted among 33 caregivers in South Africa displayed the critical level of knowledge acquired by caregivers from sources other than healthcare providers.[13]

Another study conducted in Alberta, Canada, among 413 mothers revealed that 99.3% had heard of probiotics, and 87% were aware that they contained live bacteria. Despite a better level of awareness, the respondents were not sure about the safety of the products on their infants (36.6%).[14] A cross-sectional study conducted in Iran was closely associated with our study, where 332 students were the knowledge, attitude, and practice of food labelling was evaluated. 89.2% of the students agreed with the fact that appropriate labelling had a greater effect on the awareness of the food product.[15]

A study was conducted in Pennsylvania, USA, among 162 patients who visited the community department. The patients were assessed for their knowledge and usage of probiotics as supplements. 65% of them were aware, and 29.9% of them were taking probiotics as supplements. 59% of them had not reported their regular consumption of probiotics to their health care providers.[16] The quality and efficacy of probiotics rely on the strain and the number of live bacteria. A daily dosage of a minimum of '10 billion colony-forming units (CFU)' is recommended. Fourteen billion CFU is more favourable.[8]

Literature suggests that probiotics can be used in association with antibiotics, in the case of antibiotic-resistant bacteria, tolerated to a better extent in the place of critically ill individuals associated with nosocomial infections, pneumonia etc.[17] Probiotics adhere well with the oral epithelial, rendering localisation of the microorganisms for a longer duration. This mechanism in oral tissues advocates the application of probiotics in treating dental caries, periodontal diseases, and halitosis.[18]

   Conclusion Top

Responses of the current study, which was focused on dental practitioners, revealed that the knowledge level is well above the acceptable level. There is no profound difference in the awareness level noticed among BDS and MDS practitioners. Much more studies in the field of probiotics are the need of the hour to ascertain its benefits and to spell out the safety issues. Combination therapies with antibiotics and prebiotics would be contenting, and more randomised control trials in connection to them are invited.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Meena K. Probiotics and oral health in Indian scenario- A systematic review. J Adv Med Dent Scie Res 2015;3:83-7.  Back to cited text no. 1
Bonifait L, Chandad F, Greneir D. Probiotics for oral health: Myth or reality? J Can Dent Assoc 2009;75:585-90.  Back to cited text no. 2
Reddy JJ, Sampathkumar N, Aradhya S. Probiotics in dentistry: Review of the current status. Rev Clín Pesq Odontol 2010;6:261-7.  Back to cited text no. 3
Flichy-Fernández AJ, Domingo TA, Oltra DP, Diago MP. Probiotic treatment in the oral cavity: An update. Med Oral Patol Oral Cir Bucal 2010;15:77-80.  Back to cited text no. 4
Sareen M, Roy S, Singh SK, Gupta A. A review on probiotics and their implications in dentistry. J Dent Sci 2012;1:7-10.  Back to cited text no. 5
Anilkumar K, Monisha ALS. Role of friendly bacteria in oral health-A short review. Oral Health Prev Dent 2012;10:3-8.  Back to cited text no. 6
Mattsson SC, Emilson CG, Håkansson EG, Jacobsson C, Roos K, Hom S. Lactobacilus-mediated interference of mutans streptococci in caries-free vs. caries-active subjects. Eur J Oral Sci 2007;115:308-14.  Back to cited text no. 7
Bruno G. Probiotics. Smart Supplementation:Huntington College of Health Sciences; Washington D.C.2009. p. 1-5.  Back to cited text no. 8
Sunayana M, Alekhiya K, Preethi A, Kumar S, Prabu D. Awareness of probiotics among dental and medical professionals and health care providers. Unique j. med. dent. Sci 2013;1:36-40.  Back to cited text no. 9
Payahoo L, Nikniaz Z, Mahdavi R, Abadi AJM. Perceptions of medical sciences students towards probiotics. Health Promot Perspect 2012;2:96-102.  Back to cited text no. 10
Anukam KC, Osazuwa EO, Reid G. Knowledge of probiotics by Nigerian clinicians. Int J Probiotics Prebiotics 2006;1:57-62.  Back to cited text no. 11
Shetty SM, Shah DS, Goyal G, Kathuria NS, Abraham J, Bhatia V. A study to find the status of probiotics in New Delhi, India and review of strains of bacteria used as probiotics. J Int Soc Prevent Communit Dent 2014;4(Suppl 1):S18-22.  Back to cited text no. 12
Chelule PK, Mokgatle MM, Zungu LI, Chaponda A. Caregivers' Knowledge and use of fermented food for infants and young children feeding in a community of Odi, Gauteng province, South Africa. Health Promot Perspect 2014;4:54-60.  Back to cited text no. 13
Bridgman SL, Azad MB, Field CJ, Letourneau N, Johnston DW, Kaplan BJ, et al. Maternal perspectives on the use of probiotics in infants: A cross-sectional survey. BMC Complement Altern Med 2014;14:366.  Back to cited text no. 14
Mahdavi AM, Abdolahi P, Mahdavi R. Knowledge, attitude and practice between medical and non-medical sciences students about food labeling. Health Promot Perspect 2012;2:173-9.  Back to cited text no. 15
Lee BC, Curry WJ, Fetterman J, Graybill MA, Karpa K. Patient experience and use of probiotics in community-based health care settings. Patient Prefer Adherence 2014;8:1513-20.  Back to cited text no. 16
Moghaddham OM. Probiotics in critically ill patients. Anesth Pain 2011;1:58-60.  Back to cited text no. 17
Reddy RS, Swapna LA, Ramesh T, Singh TR, Vijayalaxmi N, Lavanya R. Bacteria in oral health-Probiotics and prebiotics a review. Int J Biol Med Res 2011;2:1226-33.  Back to cited text no. 18


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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