Oral microbiome products are moving from a niche dental supplement category into a broader oral wellness one. The market is growing and is projected to reach $3.6bn by 2033, with a CAGR of 13.1%, driven by rising demand for preventive dental care and increased consumer awareness of microbiome balance and systemic health.
Tooth decay and gum disease are widespread in the US, affecting more than 90% and 50% of the population, respectively. Consumers are already familiar with probiotics for gut health and are now exploring new avenues to support mouth health.
This is creating a new target for functional products, with probiotics currently leading the way.
However, oral probiotics cannot simply be gut ones in a different format — which creates new challenges for formulators and R&D teams. Selecting the right probiotic strain is crucial, which is pushing the category towards more strain-specific, clinically substantiated and targeted approaches. Dr Jessica Neilands, Senior Science Manager at Probi, spoke to Emily Letton at Nutraceutical Business Review to explain more.
Why oral probiotics need different science
“The oral cavity presents a very different environment to the gastrointestinal tract,” said Dr Neilands. An oral probiotic must be designed for the mouth’s oxygen-rich environment, which has constant salivary flow, a fluctuating pH and multiple surfaces, including the tongue, teeth, gums and oral mucosa. A probiotic designed for the gut, however, will be selected to survive stomach acid and bile and then interact with the intestinal lining.
Thus, the two different locations will need different types of probiotic strains, making strain selection particularly important.
Probi looks to start their development process with commensal bacteria — microorganisms that live on or inside the host — that have evolved naturally to function within the oral cavity. The company aims to crowd out more harmful microbes with its own, deliberately chosen strains.
Mechanism of action is equally important, with strains having to demonstrate characteristics such as adhesion, competitive exclusion and the production of beneficial metabolites.
“Oral probiotics are typically transient rather than permanent colonisers,” explained Dr Neilands.
Hence, they need to be able to adhere effectively to oral surfaces, establish themselves long enough to exert a beneficial effect and compete with less desirable organisms.
Probi says that its BLIS K12 and M18 were specifically chosen as they exhibit this combination of desirable properties: “BLIS M18 … combines strong adhesion with bacteriocin production and pH-buffering activity, which contribute to its clinically documented ability to support plaque control and gum health.”
Good vs bad
Traditional oral care has focused on removing plaque and suppressing bacteria — but this is changing.
"Rather than viewing oral bacteria as something to eliminate, research now supports the importance of maintaining a balanced microbial ecosystem," said Dr Neilands.
This has resulted in the introduction of precision microbiome management in oral healthcare, where different health goals may require different strains, mechanisms and formulations.
Formulation challenges
Delivery format is also crucial to ensure the efficacy of oral health probiotics. “Unlike traditional probiotic capsules that are designed to deliver bacteria to the gastrointestinal tract, oral probiotics need sufficient contact time within the mouth to interact with oral tissues and establish temporary colonisation,” Dr Neilands explained.
Because of this, rather than fast-clearing delivery formats such as liquids, standard swallowed tablets, or quick-dissolving strips, lozenges are the preferred format for oral probiotics.
Lozenges are well suited because they dissolve slowly, increasing exposure to the tongue, saliva, gums and throat, thereby allowing the probiotic to exert its intended effect before being swallowed.
Additionally, oral probiotic formulation isn't simply about getting enough CFUs into a capsule; manufacturers must ensure the strain remains viable and reaches the end of shelf life at a clinically relevant dose.
Beyond probiotics
Probi also sees potential for postbiotics in oral health, partly because their greater stability could allow microbiome-modulating ingredients to move into formats such as toothpaste, chewing gum and dental floss.
“Postbiotics are very promising,” Dr Neilands added. “Novel delivery technologies and bacteriophage-based approaches are [also] attracting interest in selectively modulating the oral microbiome.”
There is also growing research around associations between the oral microbiome and immune function, cardiovascular and metabolic health. As Dr Neilands puts it: “The oral cavity represents one part of a highly interconnected microbial ecosystem.”
However, association does not equal causation and Probi believes the next stage requires long-term human clinical studies plus mechanistic research to establish whether — and how — changes in the oral microbiome influence health beyond the mouth.
“Innovation should always be driven by scientific evidence,” concluded Dr Neilands.
The greatest opportunity lies in combining robust science with products that fit naturally into consumers’ existing oral care routine, improving convenience and ensuring they receive clinically relevant dosages to achieve meaningful health outcomes.
