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Bağırsak Florasının Genel Sağlık ve Ağız Sağlığı Üzerine Olan Etkilerinin Değerlendirilmesi

Yıl 2023, Cilt: 13 Sayı: 2, 268 - 275, 10.05.2023
https://doi.org/10.33631/sabd.1118898

Öz

Bağırsak mikrobiyotası olarak da bilinen bağırsak florası; bakteri ve virüslerden, arkeler, protozoalar ve mantarlara kadar geniş bir yelpazede mikroorganizmaya ev sahipliği yapmaktadır. İnsan vücudunda 100 trilyondan fazla simbiyotik mikroorganizma ağız boşluğu, deri ve gastrointestinal sistemde kolonileşmektedir. Mikrobiyotanın %70'inden fazlası konak ile simbiyotik bir ilişki içinde gastrointestinal kanalda yaşamaktadır. Ağız boşluğu, insan vücuduna açılan birincil kapıdır ve 770'ten fazla bakteri türünü barındıran, bağırsaktan sonraki en büyük ve çeşitli mikrobiyotaya sahip vücut bölümüdür. İnsan bağırsağı mikrobiyotası; bağışıklık sisteminin gelişmesi, besin sindirimi, patojen mikroorganizmaların kolonizasyonuna karşı savunma ve nörodavranışsal işlevi etkileme dahil olmak üzere konak gelişimine ve konağın fizyolojik fonksiyonlarını sürdürmesine katkıda bulunmaktadır. Yaşamın erken dönemlerindeki mikrobiyota ve konak arasındaki etkileşimler ilerleyen dönemde sağlığı etkileyecek fizyolojik değişikliklerden sorumludur. Bağırsağın ve ağızdaki mikrobiyal toplulukların disbiyozisi otizm, astım, obezite, inflamatuar bağırsak hastalıkları gibi birçok otoimmün ve enflamatuar hastalık ile ilişkilidir ve immün sistemi, bilişsel fonksiyonları ve metabolizmayı etkileyebilmektedir. Mikrobiyotanın önemi göz önünde bulundurularak fekal ve oral mikrobiyota transplantasyonu bir tedavi seçeneği olarak değerlendirilmiştir. Bu derleme, ağız ve bağırsak florasının oluşumunu, oral mikrobiyota ve bağırsak mikrobiyotası arasındaki etkileşimi ve sistemik hastalıklar ile mikrobiyota arasındaki çift yönlü ilişkiyi ele almaktadır.

Kaynakça

  • Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature. 2010; 464(7285): 59-65. https://doi.org/10.1038/nature08821.
  • Gomez A, Nelson KE. The oral microbiome of children: Development, disease, and implications beyond oral health. Microb Ecol. 2017; 73(2): 492-503. https://doi.org/ 10.1007/s00248-016-0854-1.
  • Xiao J, Fiscella KA, Gill SR. Oral microbiome: possible harbinger for children's health. Int J Oral Sci. 2020; 12(1): 12. https://doi.org/10.1038/s41368-020-0082-x.
  • Poddighe D, Kushugulova A. Salivary microbiome in pediatric and adult celiac disease. Front Cell Infect Microbiol. 2021; 17; 11: 625162. https://doi.org/10.3389/fcimb.2021.625162
  • D'Agostino S, Ferrara E, Valentini G, Stoica SA, Dolci M. Exploring oral microbiome in healthy infants and children: A systematic review. Int J Environ Res Public Health. 2022; 19(18): 11403. https://doi.org/10.3390/ijerph191811403.
  • Walker WA. The importance of appropriate initial bacterial colonization of the intestine in newborn, child, and adult health. Pediatr Res. 2017; 82(3): 387-95. https://doi.org/ 10.1038/pr.2017.111.
  • De Filippo C, Di Paola M, Giani T, Tirelli F, Cimaz R. Gut microbiota in children and altered profiles in juvenile idiopathic arthritis. J Autoimmun. 2019; 98: 1-12. https://doi.org/10.1016/j.jaut.2019.01.00
  • Kundu P, Blacher E, Elinav E, Pettersson S. Our gut microbiome: the evolving inner self. Cell. 2017; 171(7): 1481-93. https://doi.org/10.1016/j.cell.2017.11.024.
  • Carding S, Verbeke K, Vipond DT, Corfe BM, Owen LJ. Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis. 2015; 26(0): 26191. https://doi.org/10.3402/mehd.v26.26191.
  • Shishniashvili T, Suladze T, Makhviladze M, Kalandaze M, Margvelashvili V. Dental diseases and intestinal dysbiosis among children. J Clin Pediatr Dent. 2018; 42(3): 217-20. https://doi.org/10.17796/1053-4628-42.3.9.
  • Duran-Pinedo AE, Frias-Lopez J. Beyond microbial community composition: Functional activities of the oral microbiome in health and disease. Microbes Infect. 2015; 17(7): 505-16. https://doi.org/10.1016/j.micinf.2015.03.014.
  • Lu M, Xuan S, Wang Z. Oral microbiota: A new view of body health. Food Sci. Hum. Wellness. 2019; 8(1): 8-15. https://doi.org/10.1016/j.fshw.2018.12.001
  • Schirmer M, Denson L, Vlamakis H, Franzosa EA, Thomas S, Gotman NM, et al. Compositional and temporal changes in the gut microbiome of pediatric ulcerative colitis patients are linked to disease course. Cell Host Microbe. 2018; 24(4): 600-10. https://doi.org/10.1016/j.chom.2018.09.009.
  • Elmaghrawy K, Hussey S, Moran GP. The oral microbiome in pediatric IBD: A source of pathobionts or biomarkers?. Front Pediatr. 2021; 8: 928. https://doi.org/ 10.3389/fped.2020.620254.
  • Docktor MJ, Paster BJ, Abramowicz S, Ingram J, Wang YE, Correll M, et al. Alterations in diversity of the oral microbiome in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2012; 18(5): 935-42. https://doi.org/10.1002/ibd.21874.
  • Lucafo M, Franzin M, Lagatolla C, Franca R, Bramuzzo M, Stocco G, et al. Emerging insights on the interaction between anticancer and immunosuppressant drugs and intestinal microbiota in pediatric patients. Clin Transl Sci. 2020; 13(2): 238-59. https://doi.org/10.1111/cts.12722.
  • Olsen I, Hicks SD. Oral microbiota and autism spectrum disorder (ASD). J Oral Microbiol. 2020; 12(1): 1702806. https://doi.org/10.1080/20002297.2019.1702806.
  • Ogbonnaya ES, Clarke G, Shanahan F, Dinan TG, Cryan JF, O’Leary OF. Adult hippocampal neurogenesis is regulated by the microbiome. Biol Psychiatry. 2015; 78(4): 7-9. https://doi.org/10.1016/j.biopsych.2014.12.023.
  • Braniste V, Al-Asmakh M, Kowal C, Anuar F, Abbaspour A, Toth M, et al. The gut microbiota influences blood-brain barrier permeability in mice. Sci Transl Med. 2014; 6(263): 158. https://doi.org/10.1126/scitranslmed.3009759.
  • Ley RE. Obesity and the human microbiome. Curr Opin Gastroenterol. 2010; 26(1): 5-11. https://doi.org/10.1097/MOG.0b013e328333d751.
  • Thorsen J, Mccauley K, Fadrosh D, Lynch K, Barnes KL, Bendixsen CG, et al. Evaluating the effects of farm exposure on infant gut microbiome. J Allergy Clin Immunol. 2019; 143(2). https://doi.org/10.1016/j.jaci.2018.12.911
  • Abrahamsson TR, Jakobsson HE, Andersson AF, Björksten B, Engstrand L, Jenmalm MC. Low gut microbiota diversity in early infancy precedes asthma at school age. Clin Exp Allergy. 2014; 44(6): 842-50. https://doi.org/10.1111/cea.12253.
  • Saulnier DM, Ringel Y, Heyman MB, Foster JA, Bercik P, Shulman RJ, et al. The intestinal microbiome, probiotics and prebiotics in neurogastroenterology. Gut Microbes. 2013; 4(1): 17-27. https://doi.org/10.4161/gmic.22973.
  • Francavilla R, Ercolini D, Piccolo M, Vannini L, Siragusa S, De Filippis F, et al. Salivary microbiota and metabolome associated with celiac disease. Appl Environ Microbiol. 2014; 80(11): 3416-25. https://doi.org/10.1128/AEM.00362-14.
  • Acar S, Yetkiner AA, Ersin N, Oncag O, Aydogdu S, Arikan C. Oral findings and salivary parameters in children with celiac disease: A preliminary study. Med Princ Pract. 2012; 21(2): 129-33. https://doi.org/10.1159/000331794
  • Johnson KV-A. Gut microbiome composition and diversity are related to human personality traits. Hum Microbiome J. 2020; 15. https://doi.org/10.1016/j.humic.2019.100069
  • Miranda LA, Fischer RG, Sztajnbok FR, Figueredo CMS, Gustafsson A. Periodontal conditions in patients with juvenile idiopathic arthritis. J Clin Periodontol. 2003; 30(11): 969-74. https://doi.org/10.1034/j.1600-051x.2003.00406.x.
  • Grevich S, Lee P, Leroux B, Ringold S, Darveau R, Henstorf G, et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatr Rheumatol. 2019; 17(1): 81.
  • Sami A, Elimairi I, Stanton C, Ross RP, Ryan CA. The role of the microbiome in oral squamous cell carcinoma with insight into the microbiome– treatment axis. Int J Mol Sci. 2020; 21(21): 8061. https://doi.org/10.3390/ijms21218061.
  • Olsen I, Yamazaki K. Can oral bacteria affect the microbiome of the gut?. J Oral Microbiol. 2019; 11(1): 1586422. https://doi.org/10.1080/20002297.2019.1586422.
  • Hakim H, Dallas R, Wolf J, Tang L, Schultz-Cherry S, Darling V, et al. Gut microbiome composition predicts infection risk during chemotherapy in children with acute lymphoblastic leukemia. Clin Infect Dis. 2018; 67(4): 541-8. https://doi.org/10.1093/cid/ciy153.
  • Wen Y, Jin R, Chen H. Interactions between gut microbiota and acute childhood leukemia. Front Microbiol. 2019; 10: 1300. https://doi.org/10.3389/fmicb.2019.01300
  • Nascimento MM. Oral microbiota transplant: a potential new therapy for oral diseases. J Calif Dent Assoc. 2017; 45(10): 565-8.
  • Beikler T, Bunte K, Chan Y, Weiher B, Selbach S, Peters U, et al. Oral microbiota transplant in dogs with naturally occurring periodontitis. J Dent Res. 2021; 100(7): 764-70. https://doi.org/10.1177/0022034521995423.
  • Pozhitkov AE, Leroux BG, Randolph TW, Beikler T, Flemmig TF, Noble PA. Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism. BMC Oral Health. 2015; 15: 125. https://doi.org/10.1186/s12903-015-0109-4.
  • Xiao H, Fan Y, Li Y, Dong J, Zhang S, Wang B, et al. Oral microbiota transplantation fights against head and neck radiotherapy-induced oral mucositis in mice. Comput Struct Biotechnol J. 2021; 19: 5898-910. https://doi.org/10.1016/j.csbj.2021.10.028.
  • Gurram B, Sue PK. Fecal microbiota transplantation in children: Current concepts. Curr Opin Pediatr. 2019; 31(5): 623-9. https://doi.org/10.1097/MOP.0000000000000787.
  • Helve O, Dikareva E, Stefanovic V, Kolho K-L, Salonen A., De Vos WM, et al. Protocol for oral transplantation of maternal fecal microbiota to newborn infants born by cesarean section. STAR Protoc. 2021; 2(1): 100271. https://doi.org/10.1016/j.xpro.2020.100271
  • Twetman S, Keller MK. Probiotics for caries prevention and control. Adv Dent Res. 2012; 24(2): 98-102. https://doi.org/10.1177/0022034512449465.
  • Kasımoğlu Y, Pınar Erdem A. Probiyotikler ve ağız sağlığı [Probiotics and Oral Health], Çocuk Diş Hekimliğinde Oral Mikrobiyata Etkinliğine Yönelik Güncel Yaklaşımlar. 1. Baskı. Ankara: Türkiye Klinikleri. 2021.p.42-50.

Evaluation of the Effects of Gut Flora on General Health and Oral Health

Yıl 2023, Cilt: 13 Sayı: 2, 268 - 275, 10.05.2023
https://doi.org/10.33631/sabd.1118898

Öz

Intestinal flora, also known as gut microbiota, contains an extensive variety of microbial organisms ranging from bacteria and viruses to archaea, protozoa, and fungi. Over 70% of the microbiota lives in the gastrointestinal tract in a mutually beneficial relationship with host. The oral cavity is a primary gateway to the human body and has the second largest and diverse microbiota after the gut, harboring more than 770 species of bacteria. The human gut microbiota contributes to host physiologic development and maintenance, including education of the host immune system, nutrient digestion, and defense against colonization by pathogenic microorganisms and influencing immune and neurobehavioral function. Early life interactions between the microbiome and human host are responsible for features of postnatal innate and acquired immune functions and physiological development that influence future health. Dysbiosis of microbial communities in the gut and mouth is associated with many autoimmune and inflammatory diseases such as autism, asthma, obesity, inflammatory bowel disease, and may affect the immune system, cognitive functions and metabolism. Considering the importance of microbiome, fecal and oral microbiota transplantation has been evaluated as a treatment option. This review considers the establishment of the microbiome, interaction between oral microbiota and intestinal microbiota and the bidirectional relationship between systemic diseases and microbiota.

Kaynakça

  • Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature. 2010; 464(7285): 59-65. https://doi.org/10.1038/nature08821.
  • Gomez A, Nelson KE. The oral microbiome of children: Development, disease, and implications beyond oral health. Microb Ecol. 2017; 73(2): 492-503. https://doi.org/ 10.1007/s00248-016-0854-1.
  • Xiao J, Fiscella KA, Gill SR. Oral microbiome: possible harbinger for children's health. Int J Oral Sci. 2020; 12(1): 12. https://doi.org/10.1038/s41368-020-0082-x.
  • Poddighe D, Kushugulova A. Salivary microbiome in pediatric and adult celiac disease. Front Cell Infect Microbiol. 2021; 17; 11: 625162. https://doi.org/10.3389/fcimb.2021.625162
  • D'Agostino S, Ferrara E, Valentini G, Stoica SA, Dolci M. Exploring oral microbiome in healthy infants and children: A systematic review. Int J Environ Res Public Health. 2022; 19(18): 11403. https://doi.org/10.3390/ijerph191811403.
  • Walker WA. The importance of appropriate initial bacterial colonization of the intestine in newborn, child, and adult health. Pediatr Res. 2017; 82(3): 387-95. https://doi.org/ 10.1038/pr.2017.111.
  • De Filippo C, Di Paola M, Giani T, Tirelli F, Cimaz R. Gut microbiota in children and altered profiles in juvenile idiopathic arthritis. J Autoimmun. 2019; 98: 1-12. https://doi.org/10.1016/j.jaut.2019.01.00
  • Kundu P, Blacher E, Elinav E, Pettersson S. Our gut microbiome: the evolving inner self. Cell. 2017; 171(7): 1481-93. https://doi.org/10.1016/j.cell.2017.11.024.
  • Carding S, Verbeke K, Vipond DT, Corfe BM, Owen LJ. Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis. 2015; 26(0): 26191. https://doi.org/10.3402/mehd.v26.26191.
  • Shishniashvili T, Suladze T, Makhviladze M, Kalandaze M, Margvelashvili V. Dental diseases and intestinal dysbiosis among children. J Clin Pediatr Dent. 2018; 42(3): 217-20. https://doi.org/10.17796/1053-4628-42.3.9.
  • Duran-Pinedo AE, Frias-Lopez J. Beyond microbial community composition: Functional activities of the oral microbiome in health and disease. Microbes Infect. 2015; 17(7): 505-16. https://doi.org/10.1016/j.micinf.2015.03.014.
  • Lu M, Xuan S, Wang Z. Oral microbiota: A new view of body health. Food Sci. Hum. Wellness. 2019; 8(1): 8-15. https://doi.org/10.1016/j.fshw.2018.12.001
  • Schirmer M, Denson L, Vlamakis H, Franzosa EA, Thomas S, Gotman NM, et al. Compositional and temporal changes in the gut microbiome of pediatric ulcerative colitis patients are linked to disease course. Cell Host Microbe. 2018; 24(4): 600-10. https://doi.org/10.1016/j.chom.2018.09.009.
  • Elmaghrawy K, Hussey S, Moran GP. The oral microbiome in pediatric IBD: A source of pathobionts or biomarkers?. Front Pediatr. 2021; 8: 928. https://doi.org/ 10.3389/fped.2020.620254.
  • Docktor MJ, Paster BJ, Abramowicz S, Ingram J, Wang YE, Correll M, et al. Alterations in diversity of the oral microbiome in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2012; 18(5): 935-42. https://doi.org/10.1002/ibd.21874.
  • Lucafo M, Franzin M, Lagatolla C, Franca R, Bramuzzo M, Stocco G, et al. Emerging insights on the interaction between anticancer and immunosuppressant drugs and intestinal microbiota in pediatric patients. Clin Transl Sci. 2020; 13(2): 238-59. https://doi.org/10.1111/cts.12722.
  • Olsen I, Hicks SD. Oral microbiota and autism spectrum disorder (ASD). J Oral Microbiol. 2020; 12(1): 1702806. https://doi.org/10.1080/20002297.2019.1702806.
  • Ogbonnaya ES, Clarke G, Shanahan F, Dinan TG, Cryan JF, O’Leary OF. Adult hippocampal neurogenesis is regulated by the microbiome. Biol Psychiatry. 2015; 78(4): 7-9. https://doi.org/10.1016/j.biopsych.2014.12.023.
  • Braniste V, Al-Asmakh M, Kowal C, Anuar F, Abbaspour A, Toth M, et al. The gut microbiota influences blood-brain barrier permeability in mice. Sci Transl Med. 2014; 6(263): 158. https://doi.org/10.1126/scitranslmed.3009759.
  • Ley RE. Obesity and the human microbiome. Curr Opin Gastroenterol. 2010; 26(1): 5-11. https://doi.org/10.1097/MOG.0b013e328333d751.
  • Thorsen J, Mccauley K, Fadrosh D, Lynch K, Barnes KL, Bendixsen CG, et al. Evaluating the effects of farm exposure on infant gut microbiome. J Allergy Clin Immunol. 2019; 143(2). https://doi.org/10.1016/j.jaci.2018.12.911
  • Abrahamsson TR, Jakobsson HE, Andersson AF, Björksten B, Engstrand L, Jenmalm MC. Low gut microbiota diversity in early infancy precedes asthma at school age. Clin Exp Allergy. 2014; 44(6): 842-50. https://doi.org/10.1111/cea.12253.
  • Saulnier DM, Ringel Y, Heyman MB, Foster JA, Bercik P, Shulman RJ, et al. The intestinal microbiome, probiotics and prebiotics in neurogastroenterology. Gut Microbes. 2013; 4(1): 17-27. https://doi.org/10.4161/gmic.22973.
  • Francavilla R, Ercolini D, Piccolo M, Vannini L, Siragusa S, De Filippis F, et al. Salivary microbiota and metabolome associated with celiac disease. Appl Environ Microbiol. 2014; 80(11): 3416-25. https://doi.org/10.1128/AEM.00362-14.
  • Acar S, Yetkiner AA, Ersin N, Oncag O, Aydogdu S, Arikan C. Oral findings and salivary parameters in children with celiac disease: A preliminary study. Med Princ Pract. 2012; 21(2): 129-33. https://doi.org/10.1159/000331794
  • Johnson KV-A. Gut microbiome composition and diversity are related to human personality traits. Hum Microbiome J. 2020; 15. https://doi.org/10.1016/j.humic.2019.100069
  • Miranda LA, Fischer RG, Sztajnbok FR, Figueredo CMS, Gustafsson A. Periodontal conditions in patients with juvenile idiopathic arthritis. J Clin Periodontol. 2003; 30(11): 969-74. https://doi.org/10.1034/j.1600-051x.2003.00406.x.
  • Grevich S, Lee P, Leroux B, Ringold S, Darveau R, Henstorf G, et al. Oral health and plaque microbial profile in juvenile idiopathic arthritis. Pediatr Rheumatol. 2019; 17(1): 81.
  • Sami A, Elimairi I, Stanton C, Ross RP, Ryan CA. The role of the microbiome in oral squamous cell carcinoma with insight into the microbiome– treatment axis. Int J Mol Sci. 2020; 21(21): 8061. https://doi.org/10.3390/ijms21218061.
  • Olsen I, Yamazaki K. Can oral bacteria affect the microbiome of the gut?. J Oral Microbiol. 2019; 11(1): 1586422. https://doi.org/10.1080/20002297.2019.1586422.
  • Hakim H, Dallas R, Wolf J, Tang L, Schultz-Cherry S, Darling V, et al. Gut microbiome composition predicts infection risk during chemotherapy in children with acute lymphoblastic leukemia. Clin Infect Dis. 2018; 67(4): 541-8. https://doi.org/10.1093/cid/ciy153.
  • Wen Y, Jin R, Chen H. Interactions between gut microbiota and acute childhood leukemia. Front Microbiol. 2019; 10: 1300. https://doi.org/10.3389/fmicb.2019.01300
  • Nascimento MM. Oral microbiota transplant: a potential new therapy for oral diseases. J Calif Dent Assoc. 2017; 45(10): 565-8.
  • Beikler T, Bunte K, Chan Y, Weiher B, Selbach S, Peters U, et al. Oral microbiota transplant in dogs with naturally occurring periodontitis. J Dent Res. 2021; 100(7): 764-70. https://doi.org/10.1177/0022034521995423.
  • Pozhitkov AE, Leroux BG, Randolph TW, Beikler T, Flemmig TF, Noble PA. Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism. BMC Oral Health. 2015; 15: 125. https://doi.org/10.1186/s12903-015-0109-4.
  • Xiao H, Fan Y, Li Y, Dong J, Zhang S, Wang B, et al. Oral microbiota transplantation fights against head and neck radiotherapy-induced oral mucositis in mice. Comput Struct Biotechnol J. 2021; 19: 5898-910. https://doi.org/10.1016/j.csbj.2021.10.028.
  • Gurram B, Sue PK. Fecal microbiota transplantation in children: Current concepts. Curr Opin Pediatr. 2019; 31(5): 623-9. https://doi.org/10.1097/MOP.0000000000000787.
  • Helve O, Dikareva E, Stefanovic V, Kolho K-L, Salonen A., De Vos WM, et al. Protocol for oral transplantation of maternal fecal microbiota to newborn infants born by cesarean section. STAR Protoc. 2021; 2(1): 100271. https://doi.org/10.1016/j.xpro.2020.100271
  • Twetman S, Keller MK. Probiotics for caries prevention and control. Adv Dent Res. 2012; 24(2): 98-102. https://doi.org/10.1177/0022034512449465.
  • Kasımoğlu Y, Pınar Erdem A. Probiyotikler ve ağız sağlığı [Probiotics and Oral Health], Çocuk Diş Hekimliğinde Oral Mikrobiyata Etkinliğine Yönelik Güncel Yaklaşımlar. 1. Baskı. Ankara: Türkiye Klinikleri. 2021.p.42-50.
Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Diş Hekimliği
Bölüm Derlemeler
Yazarlar

Büşra Güzel Yıldırım 0000-0002-3027-6863

Doğa Naz Açar 0000-0002-9932-3031

Yelda Kasımoğlu 0000-0003-1022-2486

Yayımlanma Tarihi 10 Mayıs 2023
Gönderilme Tarihi 21 Mayıs 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 13 Sayı: 2

Kaynak Göster

Vancouver Güzel Yıldırım B, Açar DN, Kasımoğlu Y. Bağırsak Florasının Genel Sağlık ve Ağız Sağlığı Üzerine Olan Etkilerinin Değerlendirilmesi. SABD. 2023;13(2):268-75.