A Practitioner’s Guide to Probiotics: Oral Health, Women’s Health, and Other Conditions

Probiotic supplements contain beneficial microorganisms, similar to those found in the human gastrointestinal tract. (181) When ingested, these live microorganisms confer a number of health benefits to the host. (50) Particular strains of probiotics can adhere to sites within the host, which creates an environment of competitive exclusivity. This competition limits the survival of potentially pathogenic bacteria in the gut but also in other physiological systems including the oral cavity and urogenital tract. (110)

Microbial dysbiosis may lead to the development of various oral, urogenital, and other conditions. In the oral cavity, there are over 500 different bacterial species, as well as various viruses and yeasts that live on the tongue, buccal mucosa, saliva, and supragingival and subgingival plaque. (137) Studies on the microbiome of the urogenital tract, which have focused primarily on female systems, indicate that, compared with other physiological sites, the vagina has low bacterial diversity and is primarily composed of Lactobacillus bacteria. Proportions of bacterial diversity and composition can depend on ethnicity, however. In contrast, the urinary tract has high interindividual variability and less is known about the direct physiological role of the microbial composition of the urinary tract. (95

Probiotic supplements may support a healthy composition of bacteria in the oral cavity and urogenital tract through a number of mechanisms, including: (106)(110)(178)

  • Adhesion to oral and urogenital surfaces that block pathogens from binding to host cells
  • Synthesis of anti-microbial products, such as organic acids, hydrogen peroxide, peptides, and bacteriocins, as well as anti-adhesion molecules that inhibit pathogenic bacteria
  • Co-aggregation with pathogenic bacterial species that alter the production and characteristics of biofilms, which may displace or kill pathogenic bacteria
  • Modulation of immune responses that control inflammatory responses through cytokine synthesis 

Displacement or competitive elimination of pathogenic bacteria through probiotic action can also lead to improvement of symptoms in other conditions. For instance, pathogenic bacteria may be associated with inflammation of the mammary gland as found in mastitis, (68) and in other conditions such as cystic fibrosis. (32)(113)

While probiotics are now commonly prescribed therapeutically and clinical research examining the relationship between the gut microbiome and oral (141) or urogenital health (12) is becoming increasingly available, clear guidelines for clinical application have yet to be established. This is particularly important as the effectiveness of probiotic supplementation may be dependent on the condition, strain, dosing, and duration of therapy. (181)

This guide provides an overview of the available research for the clinical application of probiotics in oral health, women’s health, and other conditions, including dosing and administration for single-strain and multi-strain probiotics.

Download the full guide to probiotics in oral health, women's health, and other conditions.

Safety Considerations & Contraindications

While probiotics are considered safe, rare short term side effects, such as gas and bloating, may occur. (30) Isolated cases of bacteremia or fungemia have been associated with probiotics, though population data also indicates that there is no widespread risk of these complications. (147)

There is some limited evidence that probiotics should not be administered in critically ill patients, as demonstrated by an increased risk of mesenteric ischemia and mortality in a trial of patients with predicted severe acute pancreatitis. (14)

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