Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review

Gaurav Kumar, Sanjay Tewari, John Tagg, Michael Leonidas Chikindas, Igor V. Popov, Santosh Kumar Tiwari

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Apical periodontitis (AP) is a biofilm-associated disease initiated by the invasion of dental pulp by microorganisms from the oral cavity. Eradication of intracanal microbial infection is an important goal of endodontic treatment, and this is typically accomplished by mechanical instrumentation and application of sodium hypochlorite and chlorhexidine. However, these agents are tissue-irritating at higher concentrations and cytotoxic. Certain probiotics have been found effective in controlling marginal periodontitis, as evidenced by reduction of pathogenic bacterial loads, gains in clinical attachment levels, and reduced bleeding on probing. In vitro studies have shown inhibitory activity of some probiotics against endodontic pathogens. Similarly, in vivo studies in rats have demonstrated a positive immuno-modulatory role of probiotics in AP, as manifested by decreased levels of proinflammatory markers and increased levels of anti-inflammatory markers. A role for probiotics in effecting a reduction of bone resorption has also been reported. This review provides an outline of current research into the probiotic management of AP, with a focus on understanding the mechanisms of their direct antagonistic activity against target pathogens and of their beneficial modulation of the immune system.

Original languageEnglish (US)
Pages (from-to)299-314
Number of pages16
JournalProbiotics and Antimicrobial Proteins
Issue number2
StatePublished - Apr 2021

All Science Journal Classification (ASJC) codes

  • Microbiology
  • Molecular Medicine
  • Molecular Biology


  • Apical periodontitis
  • Candida albicans
  • Enterococcus faecalis
  • Pathogens
  • Probiotics
  • Root canal treatment


Dive into the research topics of 'Can Probiotics Emerge as Effective Therapeutic Agents in Apical Periodontitis? A Review'. Together they form a unique fingerprint.

Cite this