Almost daily in my current practice, I encounter a pathology that is far from being carious in its nature, but it obviously represents an important aesthetic discomfort: extrinsic black stains (photo1). They do indeed (engl;BS: Black Stain) clinically affect both temporary and permanent teeth with a high incidence in early childhood and a decreased one in adolescence and young adulthood, in a reported range of about 1-20%  (1). The anamnesis conducted either in the office or online  (see attached questionnaire) of the diet, hygiene and medical history, surprisingly and usually does not reveal disruptive or non-sanogenic behaviors but on the contrary, a balanced diet, correct hygiene, parents with good dental health, lack of associated caries, etc.  And even if the prognosis of this disease is not likely to alarm us, as on the one hand it does not cause damage to the tooth enamel and on the other,  it disappears by itself in time, parents don’t get easily encouraged and ask for itsmechanical removal, directly in the office, as well as for recommendations for their daily brushing at home.

However, the current therapeutic orientation of mechanical removal doesn’t offer immediate or stable results in time because:

-on the one hand, for the pediatric patient, the removal procedure is difficult to control given the psychological stage of pre or non-cooperative development in which dyschromia is intercepted;

-on the other hand, the black stains relapse in a short time (2).

The composition of these extrinsic black stains is a deposition of Fe, Ca or phosphate salts, accompanied by chromogenic bacteria (predominantly Aggregatibacter actinomycetemcomitans and Actinomyces naesludii).

While looking for a reliable treatment solution, a new trend of Probiotics is being researched and optimistically recommended as an option not to be neglected. Indeed, Meurman (2005), Twetman and Steeksen-Blicks (2008), Allaker and Stephen (2017)  initially investigated the benefits of probiotics in caries prevention, periodontal disease and halitosis. Generally, the beneficial probiotic action is based on the observation that they are able to influence the balance between bacterial species associated with BS dyschromia (extrinsic black stains) through the effect of competition and thus reducing their level of colonization.

Among Probiotics, Streptococcus salivarius has an excellent potential as an oral probiotic (3). To be more specific Streptococcus salivarius M18 has proven its abilities to be colonizing and persistent in the human oral cavity, producing bacteriocins- some ribosomal synthesized natural antibiotics. Another studied probiotic is Lactobacillus reuteri Prodentis. Both compete with chromogenic bacteria and may implicitly reduce their unsightly chromogenic excretory effect.

As such, the practical implementation is encouraging for obtaining better aesthetic results while using less invasive methods than mechanical brushing and their procurement from the Romanian market would not be an insurmountable problem. However, future research on their mechanisms of action and/or possible adverse effects, route and form of administration for the pediatric population are necessary.

 

  1. E Gobbi, M.A. De Francesco.In vitro inhibitory effect of two commercial probiotics on chromogenic actinomycetes. European Archives of Paediatric Dentistry (2020) 21: 673-677
  2. Hattab FN, Qudeimat MA, Dental discoloration:an overwiew, J Esthet Restor Dent. 1999;11: 291-310.
  3. Tagg JR, Dierksen KP Bacterial replacement therapy adapting germ warfare in infection prevention. Trends Biotechnol. 2003; 21: 217-23.

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