The increasing interest in plant-based alternatives to milk and the simultaneous strengthening of the role of evidence-based medicine are shaping new clinical and scientific priorities in dentistry.
The key problem remains the incomplete validation of the influence of food substitutes on the oral microbiota and on the risks of caries and periodontitis; in this regard a critical appraisal of the methodology of in vitro‑studies and of the translatability of the obtained data to the clinic is necessary.
When assessing the effects of dairy and plant-based beverages on dental tissues and biofilms a comprehensive analysis is required — not only the quantitative profile of carbohydrates and proteins, but also a qualitative assessment of buffering capacity, the content of calcium and phosphate ions, as well as the presence of biologically active components capable of modifying demineralization and remineralization of enamel.
The presence of casein in bovine milk is considered a key protective factor due to its ability to form calcium‑phosphate complexes, increase the saturation of saliva with calcium and inhibit demineralization — this has direct clinical significance for the prevention of initial caries and remineralization therapy.
The content of fermentable carbohydrates in a beverage determines the substrate potential for microbial acidogenesis — the authors of the study emphasize that unsweetened plant-based beverages with a low proportion of readily fermentable sugars are likely to have low cariogenic potential, however standardized measurements of pH, lactate production and biofilm acidogenicity are necessary.
The buffering capacity of beverages, the concentration of calcium and phosphate ions, as well as the presence of mechano‑biochemical factors (for example, milk enzymes) influence the dynamics of remineralization — these parameters should be included in the analytical panel in comparative studies.
The study from the University of Bern used models including individual strains and multi‑species biofilms — it is necessary to understand that the resulting effects depend on the composition of the microbial consortium, cultivation conditions and the chosen activity markers (colonies, metabolic activity, biofilm mass, exopolysaccharide production, inflammatory cytokine profile).
The authors tested the effects on Streptococcus gordonii, Streptococcus mutans and Porphyromonas gingivalis — differences in response underscore that interpretation must take into account species specificity, the metabolic status of the cell and interspecies interactions; for clinical relevance it is necessary to compare with exudates and salivary biomarker profiles of patients.
In the experiment almond beverage reduced the number of colony-forming units in the cariogenic model, whereas bovine milk and soy beverage reduced biofilm volume and its metabolic activity — these data demonstrate that the same beverage can exhibit multifaceted effects depending on the endpoint; furthermore, the reported immunomodulatory effect of the soy beverage requires confirmation in vivo with study of inflammatory markers — IL‑1β, IL‑6, TNF‑α — and clinical outcomes in periodontitis.
Conducting such studies at the University of Bern underscores the importance of protocol standardization, multicenter validations and transnational cooperation — only with harmonized methodologies is integration of data and formulation of substantiated clinical recommendations possible.
Clinical translation requires predefined endpoints — demineralization tests with control of calcium saturation, quantitative assessment of EPS and biomass, standardized measurements of metabolic activity (for example, bioluminescent assays, lactate), as well as inclusion of biological markers of inflammation and clinical indices (plaque index, bleeding index, probing depth) to link laboratory results with patient outcomes.
[The in‑vitro effect of bovine milk, and plant‑based alternatives on oral microorganisms and biofilms] demonstrates that modern dentistry is developing as an integrated ecosystem, where experimental data must be interconnected with clinical outcomes and standardized methodologies; for practical application of the results randomized clinical trials, systematic reviews and meta-analytic syntheses are necessary.
From a practical point of view it is advisable for dentists to recommend that patients opt for unsweetened varieties of plant-based beverages when a milk substitute is needed, while also taking into account individual risk factors — the state of remineralization potential, salivary secretion, microbiota composition and concomitant therapy; in the research agenda the priorities are standardization of biofilm models, unified analytical endpoints and interdisciplinary clinical trials.
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