SHORT COMMUNICATION

The effects of short-term consumption of

commercial yogurt on salivary mutans streptococci
and lactobacilli counts: an in vivo investigation
GF Ferrazzano, T Cantile, G Sangianantoni, I Amato and A Ingenito
Department of Paediatric Dentistry, School of Dentistry, University of Naples Federico II, Naples, Italy
The aim of this study was to evaluate in vivo whether short-term consumption of commercial yogurt modifies the levels of
salivary mutans streptococci and lactobacilli in young subjects. A total of 84 volunteers were selected and divided into two
groups (test and control). Subjects from the test group were asked to eat a pot of commercial yogurt twice a day for 2 weeks. No
dietary restrictions, except a prohibition on eating yogurt and other fermented dairy products, were required to the subjects
from the control group. The salivary colonisation of mutans streptococci and lactobacilli was investigated by chair-side kits at
baseline, and after 1 and 2 weeks. Data were statistically processed. A statistically significant reduction in mutans streptococci
counts was observed in the test group compared with the control group. No effects on the levels of lactobacilli were noted.
Daily consumption of yogurt for 2 weeks may decrease the salivary levels of mutans streptococci.
European Journal of Clinical Nutrition (2011) 65, 11701172; doi:10.1038/ejcn.2011.54; published online 11 May 2011
Keywords: yogurt; dental caries; Streptococcus mutans; lactobacilli; salivary counts
Introduction
It has been suggested that mutans streptococci and
lactobacilli have a leading role in the aetiology of dental
caries (Loesche, 1986).
Given that these bacteria are responsible for dental caries
development (Hardie et al., 1977), the use of antibacterial
substances to reduce their numbers and pathogenicity seems
to be helpful.
Yogurt is considered to be a probiotic carrier food with
health-promoting effects (Elli et al., 2006).
As there is evidence that yogurt can restore the physiolo-
gical microbial equilibrium in the digestive tract, it is
possible that it has a similar role in restoring microbial
homeostasis in dental plaque that has been disrupted
by frequent intake of fermentable carbohydrates. The
mechanisms by which yogurt could exert this beneficial
effect on oral health are largely unknown, but they may
involve competitive activity by the yogurt microorganisms
and production of substances with antimicrobial activity
(Petti et al., 2001; Aimutis, 2004).
Recent studies have reported that consumption of yogurt,
probiotic-containing milk and cheese is associated with a
decrease in mutans streptococci in dental plaque and/or
saliva (Petti et al., 2001; Ahola et al., 2002; Caglar et al.,
2005).
Therefore, the aim of this study was to assess whether
short-term consumption of commercial plain yogurt affects
mutans streptococci and lactobacilli salivary levels in young
patients.
Subjects and methods
The study was performed at the Department of Paediatric
Dentistry of the University of Naples Federico II, Italy.
A total of 84 subjects (aged 12 to 18 years) were recruited.
The inclusion criteria were good general health and good
oral hygiene habits (tooth brushing twice a day). The
exclusion criteria were milk protein allergies, the use of
antibiotics and probiotics and consumption of fermented
dairy products within the 2-week-washout period before
the study.
Received 10 September 2010; revised 14 March 2011; accepted 15 March
2011; published online 11 May 2011
Correspondence: Dr GF Ferrazzano, Department of Paediatric Dentistry,
School of Dentistry, University of Naples Federico II, Via S. Pansini 5, Naples
80121, Italy.
E-mail: gianmariafabrizio@yahoo.it
European Journal of Clinical Nutrition (2011) 65, 11701172
& 2011 Macmillan Publishers Limited All rights reserved 0954-3007/11
www.nature.com/ejcn
The written informed consent was signed by the parents.
Permission was received from the appropriate authorities.
The study protocol was in accord with the Helsinki
Declaration of Human Rights. The subjects were randomly
assigned to a test and a control group.
The subjects were submitted to a clinical examination
performed by two trained professionals. The presence of tooth
decay was assessed using the DMFT index (the number of
decayed, missing and filled teeth; test group mean DMFT
3.25

1.84; control group mean DMFT3.07

1.78).
In the 2-weeks washout period before the start of the study,
subjects were approached by trained professionals, and gave
them oral hygiene advice. The volunteers were requested not
to eat yogurt and other fermented dairy products.
The 42 subjects from the test group were instructed to eat a
pot (125gr) of commercial plain yogurt, containing living
Lactobacillus bulgaricus and Streptococcus thermophilus but with-
out probiotic species, twice a day (at breakfast and dinner) for 2
weeks. No tooth brushing was allowed for at least 1h after
eating the yogurt. The subjects from the test group were
requested not to eat other fermented dairy products.
No special dietary restrictions, other than the prohibition
on eating yogurt and other fermented dairy products, were
imposed on the subjects from the control group, and no
tooth brushing was allowed for at least 1h after having
breakfast and dinner in that group.
In the morning of the first day of the study (t0), samples of
stimulated saliva were collected to calculate the colony-
forming unit (CFU) densities (CFU/ml) of the mutans
streptococci and lactobacilli at baseline.
The CFU densities of mutans streptococci and lactobacilli
were calculated using a chair-side test (Ivoclar Vivadent AG,
Liechtenstein) according to the manufacturers instructions.
Saliva samples were again collected and assessed after 1
week (t1) and 2 weeks (t2). The samples were collected in the
morning, at least 1h after the first ingestion of yogurt in the
case of the test group.
The data were analysed using SPSS 10.0 (SPSS Inc., Chicago,
IL, USA). A binary logistic regression model was made.
Results and discussion
Statistical analysis within the test group
The differences in mutans streptococci CFU density between
t0 and t1 and between t0 and t2 were statistically significant
(both at Po0.001), but those between t1 and t2 were not
statistically significant (Figure 1).
The differences in lactobacilli CFU density between t0 and
t1, t0 and t2, t1 and t2 were not statistically significant
(Figure 2).
Statistical analysis within the control group
The differences in CFU density between t0 and t1, t0 and t2,
t1 and t2 were not statistically significant for either mutans
streptococci or lactobacilli (Figures 1 and 2).
Statistical analysis between the test and control groups
At t0, the difference in mutans streptococci CFU density
between the test and control groups was not statistically
significant, whereas the differences were statistically signifi-
cant (odds ratio6.60 (confidence interval 2.5017.42) for
t1 and odds ratio4.89 (confidence interval 1.8812.74)
for t2) at t1 and t2.
At t0, t1 and t2, the differences in lactobacilli CFU density
between the test and control groups were not statistically
significant.
Comments on the results
The observed reduction in mutans streptococci counts in
the test group compared with the control group are
consistent with those of Petti et al. (2001), who reported
an indiscriminate activity of yogurt against mutans
streptococci after 8 weeks of consumption. The reduction
may be explained by the ability of casein and casein
derivatives to inhibit bacterial adherence and/or the bacter-
icidal activity of bacteriocins with selective activity against
Streptococcus mutans that are present in dairy products (Petti
et al., 2008).
In our study, no statistically significant effects on the
lactobacilli levels were noted following 2 weeks of yogurt
90
80
70
60
50
40
30
P
a
t
i
e
n
t
s

(
%
)
20
10
0
t0 t1
p < 0.0001 p < 0.001
10
5
test group
10
5
control group
<10
5
test group
<10
5
control group
t2
Figure 1 The variation in the streptococci mutans CFU density
(CFU/ml) at t0, t1 and t2 for the test and control groups.
100
90
80
70
60
P
a
t
i
e
n
t
s

(
%
)
50
40
30
20
10
0
t0 t1 t2
>10
5
test group
<10
5
test group
>10
5
control group
<10
5
control group
Figure 2 The variation in the lactobacilli CFU density (CFU/ml) at
t0, t1 and t2 for the test and control groups.
The role of yogurt against cariogenic micro-flora
GF Ferrazzano et al
1171
European Journal of Clinical Nutrition
consumption. Our lactobacilli results are in contrast with
those of Petti et al. (2001), who found a decrease in salivary
lactobacilli counts in participants with high values at
baseline after consuming yogurt for 8 weeks.
The explanation for this difference may lie in lactobacilli
being sequestered in retention niches in limited contact with
the ingested yogurt (Cildir et al., 2009); therefore, the yogurt
may take a longer time to exert an antibacterial effect against
lactobacilli.
In conclusions, the daily consumption of commercial
yogurt for 2 weeks may have beneficial effects on oral health
through reducing the salivary levels of mutans streptococci.
Conflict of interest
The authors declare no conflict of interest.
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