Rebalancing the Dental Caries Microbiome Dysbiosis: The Role of Prebiotics, Probiotics, Postbiotics, and Synbiotics

Abstract Dental caries is a multifactorial, biofilm-mediated disease resulting from dysbiosis of the oral microbiome, where acidogenic and aciduric pathogens dominate and demineralize tooth structures. Conventional strategies such as fluoride primarily support remineralization but offer limited biofilm regulation, highlighting the need for adjunct microbiome-targeted approaches. Recent interest has focused on probiotics, prebiotics, synbiotics, and postbiotics, which modulate microbial communities to restore ecological balance rather than eliminate bacteria indiscriminately. Probiotics suppress cariogenic species through competitive adhesion, bacteriocin production, and immune modulation, while prebiotics selectively stimulate beneficial microbes, reducing pathogen virulence and acid production. Synbiotics combine these effects, enhancing probiotic colonization and activity, and postbiotics offer safe, stable bioactive components. This review synthesizes current evidence on microbial strategies for caries prevention, outlining their mechanisms, applications, limitations, and future directions. By supporting beneficial microbes and disrupting pathogenic biofilms, these approaches represent promising adjuncts to conventional preventive care, combating dental caries.