The use of probiotic bacteria against root canal biofilm pathogens: a scoping review

Background

Root canal biofilm is a key etiological factor in persistent endodontic infection. The biofilm form of microorganisms exhibits high resistance to standard antiseptics used in endodontics. The use of probiotic bacteria capable of inhibiting pathogen growth holds promise.

Aim

To evaluate the effectiveness of probiotic bacteria against biofilm microorganisms that cause endodontic infection. This review presents current data on the structure, properties and species-specific microbiological characteristics of biofilms in primary and secondary endodontic infections. The results of studies evaluating the antimicrobial activity of probiotic bacteria against biofilm-associated microorganisms are presented. Given their established efficacy against major root canal biofilm pathogens, probiotic bacteria hold promise for application in endodontics. Probiotics suppress pathogen growth through the production of antimicrobial metabolites, competitive adhesion, and immunomodulation. The analysis of the selected studies identified no adverse effects associated with currently used intracanal medicaments.

Conclusion

Probiotic bacteria such as L. plantarum, L. rhamnosus, L. acidophilus, L. reuteri, effectively inhibit E. faecalis (70–90%) and C. albicans (60–76%) biofilm, exceeding calcium hydroxide in efficacy and sodium hypochlorite in safety. However, clinical studies are needed to confirm the efficacy and safety of these data. The use of probiotic bacteria is a promising area of endodontics. Currently, this topic is understudied; studies have been conducted in vitro/ex vivo, protocols are heterogeneous (different strains, concentrations, carriers, exposure times), and biofilm models vary in maturity (7–21 days). These conditions limit the scope of a meta-analysis.