International Journal of Pharma and Bio Sciences
    ISSN 0975-6299

Int J Pharm Bio Sci Volume 12 issue 4, October - December, Pages:27-34

Efficacy Of Oral Probiotic Streptococcus Salivarius K12 In The Prevention Of Halitosis (Bad Breath): A Systematic Review

Marte Eva Koelemaij, John David Francis Hale, and Rohit Jain

Halitosis (bad breath) describes the foul and repulsive odours detected in the breath of people. Oral commensal probiotic Streptococcus salivarius K12 (BLIS K12TM) has been recognised to offer potential benefit in oral health. This is due to its ability to colonise the oral cavity and ward off pathogens implicated causing oral and dental ailment such as halitosis. The aim of this systematic review was  to search and analyse 1) the published literature on orally targeted S. salivarius probiotic strain K12 and 2) its effects in conjunction with oral hygiene measures in reduction of halitosis. The research questions were formulated according to the PICO strategy. A broad search for published articles was conducted using the electronic databases such MEDLINE through PubMed, SciFinder and Web of Science by two independent reviewers. The quality of the studies was assessed using the JADAD scale and the risk of bias was assessed according to the Cochrane Collaboration assessment tool. A total of 335 articles related to S. salivarius K12 were identified. Of these articles, after manually filtering out duplicates, 157 articles were identified as unique. All unique articles were screened on their titles and abstracts and another 154 were excluded. The full text of the remaining 3 articles were reviewed with relevance to halitosis were included in this review. The overall risk of bias of the selected trials was found to be of low risk. Studies with S. salivarius K12 demonstrated a significant reduction in halitosis parameters in conjunction with routine oral hygiene practices, especially when the application of the probiotic was combined with a pre-treatment of a strong mouthwash.

Keywords: Halitosis bad breath, oral health, probiotics, Streptococcus salivarius K12, BLIS K12TM
Full HTML:


  1. Tessier JF, Kulkarni GV. Bad breath: etiology, diagnosis and treatment. Oral Health. 1991;81(10). PMID: 1824429
  2. Jamali Z, Aminabadi NA, Samiei M, Deljavan AS, Shokravi M, Shirazi S. Impact of chlorhexidine pretreatment followed by probiotic streptococcus salivarius strain K12 on halitosis in children: A randomised controlled clinical trial. Oral Health Prev Dent [Internet]. 2016 [cited 2021 May 11];14(4):305–13. Available from: doi: 10.3290/j.ohpd.a36521; PMID: 27508274
  3. Kazor CE, Mitchell PM, Lee AM, Stokes LN, Loesche WJ, Dewhirst FE, et al. Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients. J Clin Microbiol [Internet]. 2003 Feb 1 [cited 2021 May 11];41(2):558–63. Available from: doi: 10.1128/JCM.41.2.558-563.2003; PMID: 12574246
  4. Amou T, Hinode D, Yoshioka M, Grenier D. Relationship between halitosis and periodontal disease - associated oral bacteria in tongue coatings. Int J Dent Hyg. 2014. 12(2):145-51. doi: 10.1111/idh.12046. PMID: 23890391.
  5. Karbalaei M, Keikha M, Kobyliak NM, Khatib Zadeh Z, Yousefi B, Eslami M. Alleviation of halitosis by use of probiotics and their protective mechanisms in the oral cavity. New Microbes New Infect. 2021. 42:100887. doi: 10.1016/j.nmni.2021.100887. PMID: 34123388.
  6. Allaker RP, Stephen AS. Use of Probiotics and Oral Health. Curr Oral Health Rep. 2017;4(4):309-318. doi: 10.1007/s40496-017-0159-6. PMID: 29201598.
  7. Guglielmetti S, Taverniti V, Minuzzo M, Arioli S, Stuknyte M, Karp M, et al. Oral bacteria as potential probiotics for the pharyngeal mucosa. Appl Environ Microbiol [Internet]. 2010 Jun [cited 2021 May 11];76(12):3948–58. Available from: /pmc/articles/PMC2893495/ doi: 10.1128/AEM.00109-10; PMID: 20418429
  8. FAO/WHO. Guidelines for the evaluation of probiotics in food (Working Group on Drafting Guidelines for the Evaluation of Probiotics in Food). Food Agric Organ United Nations World Health Organ. 2002;21(214).
  9. Meurman JH. Probiotics: Do they have a role in oral medicine and dentistry? [Internet]. Vol. 113, European Journal of Oral Sciences. Eur J Oral Sci; 2005 [cited 2021 May 11]. p. 188–96. Available from: doi: 10.1111/j.1600-0722.2005.00191.x ; PMID: 15953242
  10. Wescombe PA, Heng NCK, Burton JP, Chilcott CN, Tagg JR. Streptococcal bacteriocins and the case for Streptococcus salivarius as model oral probiotics [Internet]. Vol. 4, Future Microbiology. Future Microbiol; 2009. p. 819–35. Available from: doi: 10.2217/fmb.09.61; PMID: 19722837
  11. Chatterjee A, Bhattacharya H, Kandwal A. Probiotics in periodontal health and disease [Internet]. Vol. 15, Journal of Indian Society of Periodontology. Wolters Kluwer -- Medknow Publications; 2011 [cited 2021 May 11]. p. 23–8. Available from: /pmc/articles/PMC3134041/ doi: 10.4103/0972-124X.82260; PMID: 21772717
  12. Hegde S, Munshi AK. Influence of the maternal vaginal microbiota on the oral microbiota of the newborn. J Clin Pediatr Dent. 1998;22(4):317–21. PMID: 9796502
  13. Barbour A, Philip K. Variable characteristics of bacteriocin-producing Streptococcus salivarius strains isolated from Malaysian subjects. PLoS One [Internet]. 2014 Jun 18 [cited 2021 May 11];9(6). Available from: /pmc/articles/PMC4062538/ doi: 10.1371/journal.pone.0100541; PMID: 2941127
  14. Burton JP, Wescombe PA, Macklaim JM, Chai MHC, MacDonald K, Hale JDF, et al. Persistence of the Oral Probiotic Streptococcus salivarius M18 Is Dose Dependent and Megaplasmid Transfer Can Augment Their Bacteriocin Production and Adhesion Characteristics. PLoS One. 2013; doi: 10.1371/journal.pone.0065991 PMID: 23785463
  15. Tagg JR. Streptococcal Bacteriocin-Like Inhibitory Substances: Some Personal Insights into the Bacteriocin-Like Activities Produced by Streptococci Good and Bad. Probiotics Antimicrob Proteins [Internet]. 2009 Jun [cited 2021 May 11];1(1):60–6. Available from: doi: 10.1007/s12602-008-9002-7  PMID: 26783132
  16. Burton JP, Chilcott CN, Wescombe PA, Tagg JR. Extended Safety Data for the Oral Cavity Probiotic Streptococcus salivarius K12. Probiotics Antimicrob Proteins. 2010; doi: 10.1007/s12602-010-9045-4; PMID: 26781236
  17. Cosseau C, Devine DA, Dullaghan E, Gardy JL, Chikatamarla A, Gellatly S, et al. The commensal Streptococcus salivarius K12 downregulates the innate immune responses of human epithelial cells and promotes host-microbe homeostasis. Infect Immun [Internet]. 2008 Sep;76(9):4163–75. Available from: doi: 10.1128/IAI.00188-08; PMID: 18625732
  18. Ishijima SA, Hayama K, Burton JP, Reid G, Okada M, Matsushita Y, et al. Effect of Streptococcus salivarius K12 on the In vitro growth of Candida albicans and its protective effect in an oral candidiasis model. Appl Environ Microbiol. 2012 Apr;78(7):2190–9. doi: 10.1128/AEM.07055-11; PMID:22267663
  19. Masdea L, Kulik EM, Hauser-Gerspach I, Ramseier AM, Filippi A, Waltimo T. Antimicrobial activity of Streptococcus salivarius K12 on bacteria involved in oral malodour. Arch Oral Biol [Internet]. 2012 Aug;57(8):1041–7. Available from: 10.1016/j.archoralbio.2012.02.011; PMID: 22405584
  20. Yoo HJ, Jwa SK, Kim DH, Ji YJ. Inhibitory effect of Streptococcus salivarius K12 and M18 on halitosis in vitro. Clin Exp Dent Res [Internet]. 2020 Apr 1 [cited 2021 May 11];6(2):207–14. Available from: /pmc/articles/PMC7133729/ doi: 10.1002/cre2.269; PMID: 32250565
  21. Wescombe PA, Hale JDF, Heng NCK, Tagg JR. Developing oral probiotics from Streptococcus salivarius [Internet]. Vol. 7, Future Microbiology. Future Microbiol; 2012. p. 1355–71. Available from:  doi: 10.2217/fmb.12.113;  PMID: 23231486
  22. O’Shea EF, Cotter PD, Stanton C, Ross RP, Hill C. Production of bioactive substances by intestinal bacteria as a basis for explaining probiotic mechanisms: Bacteriocins and conjugated linoleic acid. Int J Food Microbiol [Internet]. 2012 Jan 16 [cited 2021 May 11];152(3):189–205. Available from: doi: 10.1016/j.ijfoodmicro.2011.05.025; PMID: 21742394
  23. Zupancic K, Kriksic V, Kovacevic I, Kovacevic D. Influence of Oral Probiotic Streptococcus salivarius K12 on Ear and Oral Cavity Health in Humans: Systematic Review. Probiotics Antimicrob Proteins [Internet]. 2017 Jun 1 [cited 2021 May 11];9(2):102–10. Available from: doi: 10.1007/s12602-017-9261-2; PMID: 28236205
  24. Yoo J Il, Shin IS, Jeon JG, Yang YM, Kim JG, Lee DW. The Effect of Probiotics on Halitosis: a Systematic Review and Meta-analysis [Internet]. Vol. 11, Probiotics and Antimicrobial Proteins. Springer New York LLC; 2019 [cited 2021 May 11]. p. 150–7. Available from: doi: 10.1007/s12602-017-9351-1: PMID: 29168154
  25. Wilcox CR, Stuart B, Leaver H, Lown M, Willcox M, Moore M, et al. Effectiveness of the probiotic Streptococcus salivarius K12 for the treatment and/or prevention of sore throat: a systematic review [Internet]. Vol. 25, Clinical Microbiology and Infection. Elsevier B.V.; 2019 [cited 2021 May 11]. p. 673–80. Available from: doi: 10.1016/j.cmi.2018.12.031: PMID: 30616011
  26. Burton JP, Chilcott CN, Moore CJ, Speiser G, Tagg JR. A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters. J Appl Microbiol [Internet]. 2006 Apr [cited 2021 May 11];100(4):754–64. Available from: doi: 10.1111/j.1365-2672.2006.02837.x  PMID: 16553730
  27. He L, Yang H, Chen Z, Ouyang X. The Effect of Streptococcus salivarius K12 on Halitosis: a Double-Blind, Randomized, Placebo-Controlled Trial. Probiotics Antimicrob Proteins [Internet]. 2020 Dec 1 [cited 2021 May 11];12(4):1321–9. Available from: doi: 10.1007/s12602-020-09646-7;  PMID: 32227309
  28. Santos CMDC, Pimenta CADM, Nobre MRC. The PICO strategy for the construction of the research question and the search for evidence [Internet]. Vol. 15, Rev. Latino-Am. Nursing; 2007 [cited 2021 May 14]. p. 508–11. Available from:
    1. 2
  29. PW S. Popping the (PICO) question in research and evidence-based practice [Internet]. Vol. 15, Applied Nursing Research. W.B. Saunders; 2002 [cited 2021 May 14]. p. 197–8. Available from: doi: 10.1053/apnr.2002.34181; PMID: 1217317
  30. Nobre MRC, Bernardo WM, Jatene FB. Evidence based clinical practice. Part 1--well-structured clinical questions. Rev Assoc Med Bras [Internet]. 2003 [cited 2021 May 13];49(4):445–9. Available from:; doi: 10.1590/s0104-42302003000400039; PMID: 14963600
  31. Bergin S, Wraight P. Silver based wound dressings and topical agents for treating diabetic foot ulcers. Cochrane Database Syst Rev [Internet]. 2006 Jan 25 [cited 2021 May 14];(1). Available from: doi: 10.1002/14651858.CD005082.pub2; PMID: 16437516
  32. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation [Internet]. Vol. 349, BMJ (Online). BMJ Publishing Group; 2015 [cited 2021 May 14]. Available from: doi: 10.1186/2046-4053-4-1; PMID: 25554246
  33. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials [Internet]. 1996 [cited 2021 May 11];17(1):1–12. Available from: doi: 10.1016/0197-2456(95)00134-4; PMID: 8721797
  34. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Cochrane Handbook for Systematic Reviews of Interventions Version 510. 2011.
  35. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ [Internet]. 2011 Oct 29 [cited 2021 May 14];343(7829). Available from: doi: 10.1136/bmj.d5928; PMID: 22008217
  36. Messora M R, Silva PHF, Maia LM, Salvador S, Ouwehand AC, Furlaneto F. Chapter 4 - Probiotics and Prebiotic in Oral Health. Probiotics and Prebiotics in Foods 2021, 59-80
  37. Zhang Y, Wang X,Li H, Ni C, Du Z, Yan F. Human oral microbiota and its modulation for oral health. Biomedicine & Pharmacotherapy 2018: 99:883-893. Available from:; PMID:29710488.
  38. Lamont R J,  Koo H,  Hajishengallis G. The oral microbiota: dynamic communities and host interactions. Nat. Rev. Microbiol. 2018, 16:745-759, Available from: 10.1038/s41579-018-0089-x; PMID:30301974.
  39. Sampaio-Maia B. ,  Caldas IM,  Pereira ML,  Pérez-Mongiovi D,  Araujo R. The oral microbiome in health and its implication in oral and systemic diseases. Adv. Appl. Microbiol. 2016 97:171-210. Available from:; PMID27926431.
  40. Zaura E,  Twetman S. Critical appraisal of oral pre- and probiotics for caries prevention and care. Caries Research, 2019 (53):514-526, Available from: 10.1159/000499037; PMID:30947169.
  41. Brignardello-Petersen R. Probiotics seem to decrease organoleptic scores in patients with halitosis, but there is uncertainty about their effect on volatile sulfur compounds. J Evid Based Dent Pract. 2017.17(4):381-388. Available from; PMID:29395011.
  42. Schemel-Suárez M,  Chimenos-Küstner E,  Estrugo-Devesa A, Jané-Salas E, López-López J. Halitosis Assessment and Changes in Volatile Sulfur Compounds After Chewing Gum: A Study Performed on Dentistry Students.J Evid Based Dent Pract.2017. 17(4):381-388. Available from doi: 10.1016/j.jebdp.2017.06.001; PMID:29197439.
  43. Alp S, Baka ZM. Effects of probiotics on salivary Streptecoccus mutans and Lactobacillus levels in orthodontic patients. Amer. J. Orthodontics and Dentofacial Orthopedics. 2018. 154(4): 517-523. Available from; PMID:30268262.
  44. Chugha P, Dutta R, Sharma A, Bhagat N, Dhara MS. A critical appraisal of the effects of probiotics on oral health. J. of Functional Foods. 2020.70:103985. Available from doi:10.1016/j.jff.2020.103985.
  45. Li X, Fields RF,  Ho M, Marshall-Hudson A, Gross R, Casser ME,  Naito M. Safety assessment of Streptococcus salivarius DB-B5 as a probiotic candidate for oral health. Food and Chemical Toxicology.2021. 153:112277. Available from; PMID:34004226.



[Download PDF]
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy
Pharmaceutical Fields
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Pharmaceutics
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Novel drug delivery system
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Nanotechnology
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Pharmacology
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Pharmacognosy
© Copyright 2009-2015 IJPBS, India. All rights reserved. Specialized online journals by ubijournal. Website by Ubitech Solutions
         Home I Contact I Terms & Conditions