Clinical Innovation

Bugs with benefits: Digging into the oral microbiome’s DSO moment

A lozenge that cools inflamed gums, a rinse that “feeds” good bacteria, and a saliva test that flags trouble before it bleeds: vendors promise a prevention flywheel and a fresh retail line at checkout. But how much can dental practices really leverage emerging science on the oral microbiome today? Time to map where the science stands and how DSOs can dip their toes in the water without buying snake oil.

What’s on the market: Dental practices now have a dizzying array of products to choose from that pitch themselves as oral microbiome boosters, including: 

• Probiotic lozenges, tablets, and mints that promise to freshen breath and support gum health

• Probiotic and prebiotic toothpastes that claim to improve oral microbiome health

• Rinses and mouthwashes that promise to support microbiome balance

• Candies that claim to strengthen tooth enamel

• A range of salivary diagnostic tests, including direct-to-consumer options that promise a personalized care plan

The state of play: Treatments and tests targeting the oral microbiome are showing some promising early benefits, but the evidence is uneven and practices looking to incorporate them will need to stay inside the regulatory lines.

• Periodontal therapy: Recent meta‑analyses show modest, strain‑specific benefits when probiotics are added to non‑surgical periodontal therapy, but effects are inconsistent and often small. Several analyses favor Lactobacillus reuteri among tested strains, while others find non‑significant changes versus placebo. Translation: promise, not panacea.
  

• Halitosis: Some studies show promise for using probiotics to treat halitosis by reducing VSC levels and improving saliva quality, particularly when combined with tongue scraping.
  

• Diagnostics: Salivary and oral‑microbiome tests are moving fast, but clinical utility for caries or periodontitis risk stratification is not yet established in guidelines. That doesn’t mean practices aren’t incorporating these tests into their offerings. Smile Source recently announced salivary screening deployment in 800+ practices, a sign that chairside or send‑out testing will keep showing up in your referral network and patient expectations.
  

• Regulations: When it comes to oral-microbiome tests, the ADA says there are no FDA‑approved saliva tests to evaluate patient risk for periodontal disease, caries, or head‑and‑neck cancer. Instead, most tests on the market are regulated by the Clinical Laboratory Improvement Amendments (CLIA) and marketed as wellness products.

What this means for you: Practices can credibly pilot targeted oral probiotics as adjuncts in narrow indications where the risk–benefit calculation makes sense, namely periodontal maintenance and halitosis programs. “Microbiome” diagnostics could be considered as decision support, but not as a diagnostic replacement.