Pseudomonas clearance from the oropharyngeal cavity and healing of mouth ulcers using a selenium-enriched Lactobacillus brevis Lse mouthwash: a randomized, double-blind, controlled clinical trial
-
Zohreh Amirheidari
,
Farshid Ataollahi
,
Bagher Amirheidari
,
Hamid Forootanfar
,
Mojtaba Shakibaie
,
Mehdi Ahmadinejad
,
Zahra Khoshnam
,
Maryam Nooshadokht
,
Mohammad Shabani
,
Maryam Ramezani Nejad
,
Zahra Amirheidari
Abstract
Background and Objectives: A selenium (Se) enriched Lactobacillus brevis was applied as mouthwash to relieve mouth ulcers and regulate oral pathogens. The persistence of four frequent oral pathogens (Pseudomonas, Klebsiella, Proteus, and Enterobacter) and the quantity of mouth lesions were to be measured after exposure to the above probiotic. Susceptibility of the pathogens was also examined.
Materials and Methods: In this randomized double-blind controlled clinical trial, 60 ICU patients were allocated into three groups equally (to receive normal saline, chlorhexidine, and Se-probiotic) every 6 hours for 1 week. The utilized Lactobacillus brevis was previously separated from a traditional dairy product and its enrichment was accomplished through streaking on MRS plates supplemented with sodium selenite.
Results: Klebsiella and Pseudomonas were the most frequent initial pathogens, from which Pseudomonas were totally omitted from the probiotic group. The Se-probiotic existed in the mouth cavity of the test group six hours after the last dose. In the probiotic group, the number of oral lesions were significantly reduced.
Conclusion: Clearance of Pseudomonas from mouth cavity and significant decrease in the quantity of mouth ulcers are considerable achievements. Hence, the applied Se-supplemented mouthwash exhibited promising capability to be considered as a potential oral hygiene formulation.
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8. Brookes Z, Teoh L, Cieplik F, Kumar P. Mouthwash Effects on the Oral Microbiome: Are They Good, Bad, or Balanced? Int Dent J 2023; 73 Suppl 2(Suppl 2):S74-S81.
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11. A Castiblanco G, Yucel-Lindberg T, Roos S, Twetman S. Effect of Lactobacillus reuteri on Cell Viability and PGE(2) Production in Human Gingival Fibroblasts. Probiotics Antimicrob Proteins 2017; 9: 278-283.
12. Lee GH, McGrath C, Yiu CK. Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital. BMC Oral Health 2016; 16: 58.
13. Duane B, Yap T, Neelakantan P, Anthonappa R, Bescos R, McGrath C, et al. Mouthwashes: Alternatives and Future Directions. Int Dent J 2023; 73 Suppl 2(Suppl 2): S89-S97.
14. Henrique Soares K, Firoozi P, Maria de Souza G, Beatriz Lopes Martins O, Gabriel Moreira Falci S, Rocha Dos Santos CR. Efficacy of Probiotics Compared to Chlorhexidine Mouthwash in Improving Periodontal Status: A Systematic Review and Meta-Analysis. Int J Dent 2023; 2023: 4013004.
15. Bollero P, Di Renzo L, Franco R, Rampello T, Pujia A, Merra G, et al. Effects of new probiotic mouthwash in patients with diabetes mellitus and cardiovascular diseases. Eur Rev Med Pharmacol Sci 2017; 21: 5827-5836.
16. Jun MK, Ku JK, Kim IH, Park SY, Hong J, Kim JY, et al. Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review. J Clin Med 2021; 10: 3681.
17. Shakibaie M, Mohammadi-Khorsand T, Adeli-Sardou M, Jafari M, Amirpour-Rostami S, Ameri A, et al. Probiotic and antioxidant properties of selenium-enriched Lactobacillus brevis LSe isolated from an Iranian traditional dairy product. J Trace Elem Med Biol 2017; 40: 1-9.
18. Ataollahi F, Amirheidari B, Ahmadinejad M, Khoshnam Z, Shakibaie M, Forootanfar H, et al. Bedsore Healing Using Selenium-Enriched Lactobacillus brevis LSe: A Randomized, Double-Blind, Controlled Clinical Trial. Biol Trace Elem Res 2025; 203: 766-774.
19. Camacho C, Coulouris G, Avagyan V, Ma N, Papadopoulos J, Bealer K, et al. BLAST+: architecture and applications. BMC Bioinformatics 2009; 10: 421.
20. El-Ghazely MH, Mahmoud WH, Atia MA, Eldip EM. Effect of probiotic administration in the therapy of pediatric thermal burn. Ann Burns Fire Disasters 2016; 29: 268-272.
21. Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology 2003; 124: 1202-1209.
22. Pallotto C, Fiorio M, De Angelis V, Ripoli A, Franciosini E, Quondam Girolamo L, et al. Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial. Clin Microbiol Infect 2019; 25: 705-710.
23. Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura M. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 2006; 32: 230-236.
24. Rivas Caldas R, Le Gall F, Revert K, Rault G, Virmaux M, Gouriou S, et al. Pseudomonas aeruginosa and Periodontal Pathogens in the Oral Cavity and Lungs of Cystic Fibrosis Patients: a Case-Control Study. J Clin Microbiol 2015; 53: 1898-1907.
25. Subramanian A. Molecular Characterization of Cariogenic, Biofilm-forming, Multi-drug-resistant Pseudomonas aeruginosa and Detection of NDM-1 and blaVIM-1 Genes. Indian J Microbiol 2026; 66: 782-792.
26. Wu X, Al Farraj DA, Rajaselvam J, Alkufeidy RM, Vijayaraghavan P, Alkubaisi NA, et al. Characterization of biofilm formed by multidrug resistant Pseudomonas aeruginosa DC-17 isolated from dental caries. Saudi J Biol Sci 2020; 27: 2955-2960.
27. Harini PM, Anegundi RT. Efficacy of a probiotic and chlorhexidine mouth rinses: a short-term clinical study. J Indian Soc Pedod Prev Dent 2010; 28: 179-182.
28. Kamble A, Jabin Z, Agarwal N, Anand A. Effectiveness of Oral Probiotics in Reducing S. Mutans Count in Caries-active Children: A Comparison with Chlorhexidine and Herbal Mouthrinse (Hiora((R))). Int J Clin Pediatr Dent 2022; 15(Suppl 2): S207-S211.
29. Allaker RP, Stephen AS. Use of Probiotics and Oral Health. Curr Oral Health Rep 2017; 4: 309-318.
30. Meurman JH, Stamatova I. Probiotics: contributions to oral health. Oral Dis 2007;13: 443-451.
31. Invernici MM, Salvador SL, Silva PHF, Soares MSM, Casarin R, Palioto DB, et al. Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol 2018; 45: 1198-1210.
32. Tapashetti RP, Ansari MW, Fatima G, Bhutani N, Sameen N, Hm P. Effects of Probiotics Mouthwash on Levels of Red Complex Bacteria in Chronic Periodontitis Patients: A Clinico-microbiological Study. J Contemp Dent Pract 2022; 23: 320-326.
33. Alam H, Khatoon N, Khan MA, Husain SA, Saravanan M, Sardar M. Synthesis of selenium nanoparticles using probiotic bacteria Lactobacillus acidophilus and their enhanced antimicrobial activity against resistant bacteria. J Clust Sci 2020; 31: 1003-1011.
34. Samiraninezhad N, Kazemi H, Rezaee M, Gholami A. Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial. BMC Oral Health 2023; 23: 1019.
35. Nirmala M, Smitha SG, Kamath GJ. A Study to Assess The Efficacy of Local Application of Oral Probiotic in Treating Recurrent Aphthous Ulcer and Oral Candidiasis. Indian J Otolaryngol Head Neck Surg 2019; 71(Suppl 1): 113-117.
36. Dou X, Li G, Wang S, Shao D, Wang D, Deng X, et al. Probiotic-loaded calcium alginate/fucoidan hydrogels for promoting oral ulcer healing. Int J Biol Macromol 2023; 244: 125273.
37. Prasad M, Patthi B, Singla A, Gupta R, Jankiram C, Kumar JK, et al. The clinical effectiveness of post-brushing rinsing in reducing plaque and gingivitis: a systematic review. J Clin Diagn Res 2016; 10(5): ZE01-7.
38. Mahasneh SA, Mahasneh AM. Probiotics: a promising role in dental health. Dent J (Basel) 2017; 5: 26.
2. Oliveira LC, Carneiro PP, Fischer RG, Tinoco EM. A presença de patógenos respiratórios no biofilme bucal de pacientes com pneumonia nosocomial. Rev Bras Ter Intensiva 2007; 19: 428-433.
3. Tuon FF, Gavrilko O, Almeida S, Sumi ER, Alberto T, Rocha JL, et al. Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. J Glob Antimicrob Resist 2017; 8: 159-163.
4. Messika J, La Combe B, Ricard JD. Oropharyngeal colonization: epidemiology, treatment and ventilator-associated pneumonia prevention. Ann Transl Med 2018; 6: 426.
5. Vilela MC, Ferreira GZ, Santos PS, Rezende NP. Oral care and nosocomial pneumonia: a systematic review. Einstein (Sao Paulo) 2015;13: 290-296.
6. Poppolo Deus F, Ouanounou A. Chlorhexidine in dentistry: pharmacology, uses, and adverse effects. Int Dent J 2022; 72: 269-277.
7. Brookes Z, McGrath C, McCullough M. Antimicrobial Mouthwashes: An Overview of Mechanisms-What Do We Still Need to Know? Int Dent J 2023; 73 Suppl 2(Suppl 2): S64-S68.
8. Brookes Z, Teoh L, Cieplik F, Kumar P. Mouthwash Effects on the Oral Microbiome: Are They Good, Bad, or Balanced? Int Dent J 2023; 73 Suppl 2(Suppl 2):S74-S81.
9. Meurman JH. Probiotics: do they have a role in oral medicine and dentistry? Eur J Oral Sci 2005; 113: 188-196.
10. Sajedinejad N, Paknejad M, Houshmand B, Sharafi H, Jelodar R, Shahbani Zahiri H, et al. Lactobacillus salivarius NK02: a Potent Probiotic for Clinical Application in Mouthwash. Probiotics Antimicrob Proteins 2018; 10: 485-495.
11. A Castiblanco G, Yucel-Lindberg T, Roos S, Twetman S. Effect of Lactobacillus reuteri on Cell Viability and PGE(2) Production in Human Gingival Fibroblasts. Probiotics Antimicrob Proteins 2017; 9: 278-283.
12. Lee GH, McGrath C, Yiu CK. Evaluating the impact of caries prevention and management by caries risk assessment guidelines on clinical practice in a dental teaching hospital. BMC Oral Health 2016; 16: 58.
13. Duane B, Yap T, Neelakantan P, Anthonappa R, Bescos R, McGrath C, et al. Mouthwashes: Alternatives and Future Directions. Int Dent J 2023; 73 Suppl 2(Suppl 2): S89-S97.
14. Henrique Soares K, Firoozi P, Maria de Souza G, Beatriz Lopes Martins O, Gabriel Moreira Falci S, Rocha Dos Santos CR. Efficacy of Probiotics Compared to Chlorhexidine Mouthwash in Improving Periodontal Status: A Systematic Review and Meta-Analysis. Int J Dent 2023; 2023: 4013004.
15. Bollero P, Di Renzo L, Franco R, Rampello T, Pujia A, Merra G, et al. Effects of new probiotic mouthwash in patients with diabetes mellitus and cardiovascular diseases. Eur Rev Med Pharmacol Sci 2017; 21: 5827-5836.
16. Jun MK, Ku JK, Kim IH, Park SY, Hong J, Kim JY, et al. Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review. J Clin Med 2021; 10: 3681.
17. Shakibaie M, Mohammadi-Khorsand T, Adeli-Sardou M, Jafari M, Amirpour-Rostami S, Ameri A, et al. Probiotic and antioxidant properties of selenium-enriched Lactobacillus brevis LSe isolated from an Iranian traditional dairy product. J Trace Elem Med Biol 2017; 40: 1-9.
18. Ataollahi F, Amirheidari B, Ahmadinejad M, Khoshnam Z, Shakibaie M, Forootanfar H, et al. Bedsore Healing Using Selenium-Enriched Lactobacillus brevis LSe: A Randomized, Double-Blind, Controlled Clinical Trial. Biol Trace Elem Res 2025; 203: 766-774.
19. Camacho C, Coulouris G, Avagyan V, Ma N, Papadopoulos J, Bealer K, et al. BLAST+: architecture and applications. BMC Bioinformatics 2009; 10: 421.
20. El-Ghazely MH, Mahmoud WH, Atia MA, Eldip EM. Effect of probiotic administration in the therapy of pediatric thermal burn. Ann Burns Fire Disasters 2016; 29: 268-272.
21. Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology 2003; 124: 1202-1209.
22. Pallotto C, Fiorio M, De Angelis V, Ripoli A, Franciosini E, Quondam Girolamo L, et al. Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial. Clin Microbiol Infect 2019; 25: 705-710.
23. Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura M. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 2006; 32: 230-236.
24. Rivas Caldas R, Le Gall F, Revert K, Rault G, Virmaux M, Gouriou S, et al. Pseudomonas aeruginosa and Periodontal Pathogens in the Oral Cavity and Lungs of Cystic Fibrosis Patients: a Case-Control Study. J Clin Microbiol 2015; 53: 1898-1907.
25. Subramanian A. Molecular Characterization of Cariogenic, Biofilm-forming, Multi-drug-resistant Pseudomonas aeruginosa and Detection of NDM-1 and blaVIM-1 Genes. Indian J Microbiol 2026; 66: 782-792.
26. Wu X, Al Farraj DA, Rajaselvam J, Alkufeidy RM, Vijayaraghavan P, Alkubaisi NA, et al. Characterization of biofilm formed by multidrug resistant Pseudomonas aeruginosa DC-17 isolated from dental caries. Saudi J Biol Sci 2020; 27: 2955-2960.
27. Harini PM, Anegundi RT. Efficacy of a probiotic and chlorhexidine mouth rinses: a short-term clinical study. J Indian Soc Pedod Prev Dent 2010; 28: 179-182.
28. Kamble A, Jabin Z, Agarwal N, Anand A. Effectiveness of Oral Probiotics in Reducing S. Mutans Count in Caries-active Children: A Comparison with Chlorhexidine and Herbal Mouthrinse (Hiora((R))). Int J Clin Pediatr Dent 2022; 15(Suppl 2): S207-S211.
29. Allaker RP, Stephen AS. Use of Probiotics and Oral Health. Curr Oral Health Rep 2017; 4: 309-318.
30. Meurman JH, Stamatova I. Probiotics: contributions to oral health. Oral Dis 2007;13: 443-451.
31. Invernici MM, Salvador SL, Silva PHF, Soares MSM, Casarin R, Palioto DB, et al. Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol 2018; 45: 1198-1210.
32. Tapashetti RP, Ansari MW, Fatima G, Bhutani N, Sameen N, Hm P. Effects of Probiotics Mouthwash on Levels of Red Complex Bacteria in Chronic Periodontitis Patients: A Clinico-microbiological Study. J Contemp Dent Pract 2022; 23: 320-326.
33. Alam H, Khatoon N, Khan MA, Husain SA, Saravanan M, Sardar M. Synthesis of selenium nanoparticles using probiotic bacteria Lactobacillus acidophilus and their enhanced antimicrobial activity against resistant bacteria. J Clust Sci 2020; 31: 1003-1011.
34. Samiraninezhad N, Kazemi H, Rezaee M, Gholami A. Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial. BMC Oral Health 2023; 23: 1019.
35. Nirmala M, Smitha SG, Kamath GJ. A Study to Assess The Efficacy of Local Application of Oral Probiotic in Treating Recurrent Aphthous Ulcer and Oral Candidiasis. Indian J Otolaryngol Head Neck Surg 2019; 71(Suppl 1): 113-117.
36. Dou X, Li G, Wang S, Shao D, Wang D, Deng X, et al. Probiotic-loaded calcium alginate/fucoidan hydrogels for promoting oral ulcer healing. Int J Biol Macromol 2023; 244: 125273.
37. Prasad M, Patthi B, Singla A, Gupta R, Jankiram C, Kumar JK, et al. The clinical effectiveness of post-brushing rinsing in reducing plaque and gingivitis: a systematic review. J Clin Diagn Res 2016; 10(5): ZE01-7.
38. Mahasneh SA, Mahasneh AM. Probiotics: a promising role in dental health. Dent J (Basel) 2017; 5: 26.
| Files | ||
| Issue | Vol 18 No 4 (2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Selenium Probiotics Lactobacillus Ulcer Pseudomonas | ||
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How to Cite
1.
Amirheidari Z, Ataollahi F, Amirheidari B, Forootanfar H, Shakibaie M, Ahmadinejad M, Khoshnam Z, Nooshadokht M, Shabani M, Ramezani Nejad M, Amirheidari Z. Pseudomonas clearance from the oropharyngeal cavity and healing of mouth ulcers using a selenium-enriched Lactobacillus brevis Lse mouthwash: a randomized, double-blind, controlled clinical trial. Iran J Microbiol. 2026;18(4):509-517.
