A Systematic Review on Modulation of Oral Biofilm and Immune Response Associated to Mucosa with Probiotic Bacteria as a Potential Approach in the Prevention of Dental Caries

Background: A variety of approaches have been developed for the control of dental caries, a pathology with high incidence and prevalence worldwide. The use of probiotic strains for the modulation of dental biofilm in the prevention of caries has been studied, but the available evidence shows varied methodologies; and the strains tested differ from one study to another. Objective: To analyze the efficacy of using probiotic strains to prevent caries through the modulation of biofilm and immune response associated to oral mucosa. Methods: A search was made in the scientific bases PubMed, Cochrane and Science Direct, prioritizing randomized double and triple-blind clinical trials from 2010 to 2020, including a total of 20 studies to be analyzed. The selection criteria were consistent with the Preferred Reporting Items for Systematic Reviews protocol. Results: Within the studies, different types of probiotic bacteria were analyzed, dominating Lactobacillus paracasei. While most clinical trials show a favorable response in terms of a significant reduction of Streptococcus mutans in the oral microbiota, very few studies evaluated salivary pH and sIgA levels. Conclusions: The heterogeneity of the studies analyzed and the multifactorial nature of dental caries do not allow us to ensure that probiotic therapy is completely effective in preventing this pathology. Although probiotic therapy can help by regulating the microbiological factor, there are other determinants that can favor the development of caries and that are barely approached in their relationship with bacteriotherapy. Future studies that homogeneously evaluate the use of probiotics could give us a clearer idea of their effectiveness.