The effect of a streptococci containing probiotic in periodontal therapy: a randomized controlled trial

Exploring preventive and treatment strategies for oral cancer: Modulation of signaling pathways and microbiota by probiotics

The evidence suggests that the microbiome plays a crucial role in cancer development. The oral cavity has many microorganisms that can influence oral cancer progression. Understanding the mechanisms and signaling pathways of the oral, gum, and teeth microbiome in tumor progression can lead to new treatment strategies. Probiotics, which are friendly microorganisms, have shown potential as anti-cancer agents. These positive characteristics of probiotic strains make them suitable for cancer prevention or treatment. The oral-gut microbiome axis supports health and homeostasis, and imbalances in the oral microbiome can disrupt immune signaling pathways, epithelial barriers, cell cycles, apoptosis, genomic stability, angiogenesis, and metabolic processes. Changes in the oral microbiome in oral cancer may suggest using probiotics-based treatments for their direct or indirect positive roles in cancer development, progression, and metastasis, specifically oral squamous cell carcinoma (OSCC). Here, reported relationships between probiotics, oral microbiota, and oral cancer are summarized.

Clinical effects of probiotics on the treatment of gingivitis and periodontitis: a systematic review and meta-analysis

AIMS

This study aimed to evaluate the impact of probiotics as an adjunct to periodontal therapy on clinical outcomes in patients with gingivitis and periodontitis through a meta-analysis of available evidence.

MATERIALS AND METHODS

A detailed bibliographic search on four databases (PubMed, Scopus, Cochrane and EMBASE) was conducted with a language restriction. The collected data were assessed according to the predefined eligibility criteria and randomized clinical trials reporting the effects of probiotics on plaque index (PI), bleeding on probing (BOP) and pocket probing depth (PPD) compared to control or placebo groups were selected and analysed. The risk of bias assessment was conducted using SYRCLE's RoB- 2 tool. The GRADEpro tool was used to determine the overall quality of evidence.

RESULTS

Twenty-four studies (10 about gingivitis and 14 about periodontitis) were included in the meta-analysis. In the gingivitis studies, lower but non-significant PI and BOP were found in the probiotic group. In periodontitis, lower PI (95%-CI [- 0.54; - 0.15], p = 0.001) were reported in the probiotic group, and this difference was greater in studies with longer follow-up. Lower BOP (95%-CI [- 0.58; - 0.05], p = 0.021) was also reported, but this difference was only significant in studies with a shorter follow-up (95%-CI [- 0.86; - 0.11], p = 0.012). Meta-analysis for PPD showed lower, but non-significant, values (95%-CI [- 0.53; + 0.03], p = 0.077). However, this difference became significant when assessing studies with shorter follow-up (95% CI [- 0.77; - 0.07], p = 0.019).

CONCLUSIONS

The meta-analysis provides evidence suggested that probiotics can serve as a beneficial adjunct to periodontal treatment in patients with periodontitis, particularly in improving clinical outcomes such as plaque index and bleeding on probing. The results from gingivitis studies highlight the need for further investigation to better understand the impact of probiotics in the early stages of periodontal disease. These findings emphasize the importance of future research with standardized protocols and longer follow-up periods to confirm and expand on the clinical utility of probiotics in periodontal therapy.

Methods used to deliver adjunctive probiotic treatment during the non-surgical management of periodontitis: A scoping review

OBJECTIVE

To identify which methods have been used to deliver adjunctive probiotics during the non-surgical management of periodontitis in clinical trials. This review also investigates which probiotics have been used and at what dose, along with the periodontal treatment outcomes achieved.

DATA

Conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.

SOURCES

MEDLINE, Embase, Web of Science, and Scopus were searched on 02/02/2024 from inception with no date limits applied.

STUDY SELECTION

Clinical trials investigating the use of probiotics as an adjunctive treatment to non-surgical periodontal therapy in humans.

CONCLUSIONS

Out of 4769 studies 66 met the inclusion criteria. Over 30 different probiotics were identified along with 18 different delivery methods with varying dosages and duration. 48 of the included studies reported a beneficial effect when a probiotic was used, 14 reported no difference, 3 found the outcomes comparable to the use of antibiotics, and 1 study reported a better outcome from the control group. The probiotic used, its dosage, delivery method, duration of application, and outcome measures differ across studies making it difficult to draw conclusions on their efficacy. This scoping review highlights the need for further research to establish a uniform treatment protocol and to identify the most effective probiotic bacteria.

CLINICAL SIGNIFICANCE

Despite the majority of included studies indicating a potential benefit from the use of probiotics during the non-surgical management of periodontitis, the high level of heterogeneity between interventions they currently cannot be recommended for use in clinical practice.

Microbial dysbiosis in periodontitis and peri-implantitis: pathogenesis, immune responses, and therapeutic

The oral microbiome comprises over 700 distinct species, forming complex biofilms essential for maintaining oral and systemic health. When the microbial homeostasis in the periodontium is disrupted, pathogens within the biofilm can cause periodontitis and peri-implantitis, inducing host immune responses. Understanding the role of microbial communities and the immune mechanisms in oral health and disease is crucial for developing improved preventive, diagnostic and therapeutic strategies. However, many questions remain about how changes in bacterial populations contribute to the development and progression of these conditions. An electronic and manual literature search was conducted using PubMed, Excerpta Medica, Frontiers Reports and the Wiley Online Library databases for relevant articles. Data from these publications were extracted and the overall findings were summarized in a narrative manner. The variations in microbial communities and immune responses of periodontitis and peri-implantitis are explored. Dysbiosis of the subgingival microbiome-characterized by an increase in pathogenic bacteria such as Porphyromonas gingivalis, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans-plays a pivotal role in the initiation and progression of periodontitis. As for peri-implantitis, alterations include a higher abundance of opportunistic pathogens and reduced microbial diversity around implants. Moreover, oral dysbiosis potentially influencing systemic health through immune-mediated pathways. Regional immunity of periodontium involving neutrophils, T helper cells-17, and immune-related cytokines is crucial for maintaining periodontal homeostasis and responding to microbial imbalances. Additionally, the impact of non-mechanical treatments-such as probiotics and laser therapy-on the oral microbiome is discussed, demonstrating their potential in managing microbial dysbiosis. These findings underscore that bacterial dysbiosis is a central factor in the development of periodontitis and peri-implantitis. Maintaining microbial balance is essential for preventing these diseases, and interventions targeting the microbiome could enhance treatment outcomes. Strategies focusing on controlling pathogenic bacteria, modulating immune responses, and promoting tissue regeneration are key to restoring periodontal stability. Further research is needed to clarify the mechanisms underlying the transition from peri-implant mucositis to peri-implantitis and to optimize prevention and treatment approaches, considering the complex interactions between the microbiome and host immunity.

Modulatory Effect of Probiotic Fiber (Lactobacillus reuteri) in Residual Periodontal Pockets: A Randomized, Double-Blind, Placebo-Controlled Study

BACKGROUND AND AIM

Periodontal disease is a chronic microbial infection characterized by inflammation and destruction of periodontal tissues. Probiotics, such as Lactobacillus reuteri, offer potential benefits in periodontal therapy due to their antimicrobial and anti-inflammatory properties. This study aimed to evaluate the clinical and microbiological efficacy of locally administered biodegradable fibers containing L. reuteri as an adjunct to scaling and root planing (SRP) in managing chronic periodontitis.

MATERIAL AND METHODS

A single-center, double-blind, placebo-controlled, parallel-arm, randomized clinical trial was conducted with 30 patients aged 30-60 years diagnosed with chronic periodontitis were randomized into test (SRP + probiotic fiber) and control (SRP + placebo fiber) groups. Clinical parameters, including plaque index (PI), bleeding index (BI), probing pocket depth (PPD), clinical attachment level (CAL), and microbial load (Porphyromonas gingivalis via quantitative reverse transcription-polymerase chain reaction (qRT-PCR)) were assessed at baseline and three months post-treatment. Quantification of P. gingivalis was conducted using real-time quantitative PCR. The Shapiro-Wilk test assessed normality, and the Mann-Whitney U and Wilcoxon tests were used for inter- and intra-group comparisons.

RESULTS

Both groups showed significant improvements in clinical parameters (p<0.05). The test group achieved a 45.66% reduction in PI, 57.83% reduction in BI, and significant improvements in PPD (43.06%) and CAL (43.06%). Microbial load decreased more in the test group (63.00%) than in the control group (26.08%).

CONCLUSIONS

Adjunctive use of L. reuteri in biodegradable fiber form improves clinical outcomes, highlighting its potential as a non-invasive adjunctive treatment for chronic periodontitis. Further studies are warranted to validate long-term efficacy.

The strategic role of biotics in dental caries prevention: A scoping review

Dental caries is a global oral health issue that is prevalent and preventable. Biotics (probiotics, prebiotics, symbiotics, and postbiotics) are recommended as low-cost methods for preventing dental caries. This scoping review aimed to critically review the scientific evidence concerning the role of biotics in caries prevention and maintaining oral health benefits. A systematic search was conducted in several databases from 2012 onward, using specific keywords. The search resulted in 69 articles. While there is limited research on the mechanism of biotics in preventing caries, numerous studies have investigated the impacts of probiotics on decreasing caries risk factors. Probiotics can reduce cariogenic bacteria, reduce acidogenic bacteria, increase pH, and produce antimicrobial compounds. Probiotics can be used as a therapeutic approach to manage caries by restoring eubiosis at the host-microbial interface, which may not be accomplished with traditional therapies. Its positive effect on reducing dental caries is influenced by the choice of potent probiotic strains, appropriate dosage, treatment period, vehicle, and microbial interaction with the host. Specific oral bacteria have also been shown to utilize prebiotics such as urea and arginine, increasing pH levels. This highlights the potential of combining prebiotic and probiotic bacteria for caries prevention. In addition, this review is focused on bacterial-derived compounds, namely postbiotics, due to their valuable effects in preventing caries. Biotics have demonstrated potential in preventing dental caries and maintaining oral health. Further research is needed to optimize their use and explore the potential of postbiotics for caries prevention.

Probiotics in the non-surgical treatment of periodontitis: a systematic review and network meta-analysis

This systematic review and network meta-analysis aimed to assess the impact of combining professional mechanical plaque removal (PMPR) with probiotics compared to PMPR + placebo on probing pocket depth (PPD) and clinical attachment level (CAL). Randomized controlled trials published until November 2023 were searched across electronic databases, peer-reviewed journals, and grey literature. Two authors independently selected, extracted data, and assessed bias risk. Primary outcomes were mean changes in PPD and CAL. Secondary outcomes included mean changes in bleeding on probing (BOP), plaque index, and colony-forming units. Network meta-analysis with the frequentist weighted least squares approach evaluated the data quantitatively, and CINeMA framework evaluated the quality of evidence. In 33 articles involving 1290 patients, results were stratified by follow-up period (short and long-time studies) and sensitivity analyses conducted based on probiotic therapy duration (1 month reference). Network meta-analysis revealed significant mean differences in PPD for nine probiotic interventions, CAL for eighteen interventions, and BOP for eight interventions, with Lactobacillus demonstrating the most substantial effects. Combining PMPR with probiotics as adjuvants to subgingival instrumentation may be more effective in improving PPD and CAL. Lactobacillus emerged as the most comprehensive and effective among the studied probiotic.

A Three-Month Probiotic (the Streptococcus salivarius M18 Strain) Supplementation Decreases Gingival Bleeding and Plaque Accumulation: A Randomized Clinical Trial

S. salivarius M18 administration has been proven to provide positive effects on periodontal health; however, there is still no consensus on the optimum duration of probiotic administration. This study aimed to evaluate the effect of three months of probiotic supplementation on bleeding on probing, signs of gingival inflammation, and dental biofilm. Sixty-two eligible individuals with gingivitis were enrolled in this placebo-controlled, double-blind trial and randomly allocated to the M18 or control groups. Primary outcomes were changes in gingival condition (gingival index, GI; gingival bleeding index, GBI) after 1, 2, and 3 months of lozenges administration and after a one-month washout. Secondary outcomes included changes in the Quigley-Hein plaque index (modified by Turesky et al.) after 1, 2, and 3 months of lozenges administration and after a washout. In total, 60 individuals completed the study (31 and 29 in the M18 group and the control group, respectively). No severe adverse events were reported. Probiotic supplementation resulted in a significant decrease in gingival bleeding at 1 month (effect size 1.09 [CI95%: 0.55-1.63]), 2 months (effect size 0.78 [CI95%: 0.26-1.30]), and 3 months (effect size 0.67 [CI95%: 0.15-1.18]) and a significant reduction in dental plaque accumulation at 2 months (effect size 0.63 [CI95%: 0.12-1.14]) and 3 months (effect size 0.55 [CI95%: 0.03-1.05]). A three-month supplementation with the probiotic resulted in a significant reduction in gingival bleeding and biofilm accumulation; however, a long-lasting effect is not expected, indicating the need for probiotic intake on a long-term basis.

Microbiome-based therapies for periodontitis and peri-implantitis

OBJECTIVES

Periodontitis and peri-implantitis are oral infectious-inflammatory diseases associated with oral microbial dysbiosis. Microbiome-based therapies, characterized by manipulation of the microbiota, are emerging as promising therapeutic approaches to resolve the microbial dysbiosis and associated dysregulation of immune system. This review aims at summarizing recent progress on microbiome-based therapies in periodontitis and peri-implantitis, promoting a further understanding of the related therapeutic mechanisms.

SUBJECTS AND METHODS

Pertinent literatures focused on microbiome-based therapies for periodontitis and peri-implantitis are obtained from PubMed and Web of Science.

RESULTS

In this article, we review the roles and therapeutic mechanisms of four microbiome-based therapies, including probiotics, postbiotics, predatory bacteria and phages, and microbiota transplantation, in the management of periodontitis and peri-implantitis. Challenges facing this field are also discussed, highlighting the areas that require more attention and investigation.

CONCLUSIONS

Microbiome-based therapies may serve as effective treatment for periodontitis and peri-implantitis. This review presents a new viewpoint to this field.

Preparation and In Vitro Characterization of Lactococcus lactis-Loaded Alginate Particles as a Promising Delivery Tool for Periodontal Probiotic Therapy

Probiotic microorganisms are used in a variety of food supplements and medical formulations to promote human health. In periodontal therapy, probiotics are mainly used in the form of gels, tablets or rinses that often tend to leak from the periodontal pocket, resulting in a strongly reduced therapeutic effect. In this pilot in vitro study, we present biodegradable alginate-based particles as an alternative, highly efficient system for a periodontal delivery of probiotic bacteria to the inflammation site. For this purpose, Lactococcus (L.) lactis was encapsulated using a standardized pump-controlled extrusion-dripping method. Time-dependent bacterial release in artificial saliva was investigated over 9 days. The effect of freeze drying was explored to ensure long-term storage of L. lactis-loaded particles. Additionally, the particles were bound to dentin surface using approved bioadhesives and subjected to shear stress in a hydrodynamic flow chamber that mimics the oral cavity in vitro. Thus, round particles within the range of 0.80-1.75 mm in radius could be produced, whereby the diameter of the dripping tip had the most significant impact on the size. Although both small and large particles demonstrated a similar release trend of L. lactis, the release rate was significantly higher in the former. Following lyophilization, particles could restore their original shape within 4 h in artificial saliva; thereby, the bacterial viability was not affected. The attachment strength to dentin intensified by an adhesive could resist forces between 10 and 25 N/m2. Full degradation of the particles was observed after 20 days in artificial saliva. Therefore, alginate particles display a valuable probiotic carrier for periodontal applications that have several crucial advantages over existing preparations: a highly stable form, prolonged continuous release of therapeutic bacteria, precise manufacturing according to required dimensions at the application site, strong attachment to the tooth with low risk of dislocation, high biocompatibility and biodegradability.

Oral Biofilm Composition, Dissemination to Keratinocytes, and Inflammatory Attenuation Depend on Probiotic and Synbiotic Strain Specificity

Several inflammatory diseases are characterized by a disruption in the equilibrium between the host and its microbiome. Due to the increase in resistance, the use of antibiotics for the widespread, nonspecific killing of microorganisms is at risk. Pro-microbial approaches focused on stimulating or introducing beneficial species antagonistic toward pathobionts may be a viable alternative for restoring the host-microbiome equilibrium. Unfortunately, not all potential probiotic or synbiotic species and even subspecies (to strain level) are equally effective for the designated pathology, leading to conflicting accounts of their efficacy. To assess the extent of these species- and strain-specific effects, 13 probiotic candidates were evaluated for their probiotic and synbiotic potential with glycerol on in vitro oral biofilms, dissemination from biofilms to keratinocytes, and anti-inflammatory activity. Species- and strain-specific effects and efficacies were observed in how they functioned as probiotics or synbiotics by influencing oral pathobionts and commensals within biofilms and affected the dissemination of pathobionts to keratinocytes, ranging from ineffective strains to strains that reduced pathobionts by 3 + log. In addition, a minority of the candidates exhibited the ability to mitigate the inflammatory response of LPS-stimulated monocytes. For a comprehensive assessment of probiotic therapy for oral health, a judicious selection of fully characterized probiotic strains that are specifically tailored to the designated pathology is required. This approach aims to challenge the prevailing perception of probiotics, shifting the focus away from "form over function." Rather than using unproven, hypothetical probiotic strains from known genera or species, one should choose strains that are actually functional in resolving the desired pathology before labelling them probiotics.

Manipulating the diseased oral microbiome: the power of probiotics and prebiotics

Dental caries and periodontal disease are amongst the most prevalent global disorders. Their aetiology is rooted in microbial activity within the oral cavity, through the generation of detrimental metabolites and the instigation of potentially adverse host immune responses. Due to the increasing threat of antimicrobial resistance, alternative approaches to readdress the balance are necessary. Advances in sequencing technologies have established relationships between disease and oral dysbiosis, and commercial enterprises seek to identify probiotic and prebiotic formulations to tackle preventable oral disorders through colonisation with, or promotion of, beneficial microbes. It is the metabolic characteristics and immunomodulatory capabilities of resident species which underlie health status. Research emphasis on the metabolic environment of the oral cavity has elucidated relationships between commensal and pathogenic organisms, for example, the sequential metabolism of fermentable carbohydrates deemed central to acid production in cariogenicity. Therefore, a focus on the preservation of an ecological homeostasis in the oral environment may be the most appropriate approach to health conservation. In this review we discuss an ecological approach to the maintenance of a healthy oral environment and debate the potential use of probiotic and prebiotic supplementation, specifically targeted at sustaining oral niches to preserve the delicately balanced microbiome.

Periodontal disease in down syndrome: Predisposing factors and potential non-surgical therapeutic approaches

BACKGROUND

Periodontal diseases (PDs) have been documented to be significantly more prevalent and severe in patients with Down syndrome (DS). Different immunological and microbiological factors contributed to predisposing these patients to progressive and recurrent PDs.

AIM

The aim of this review was to investigate the altered immunological responses and oral microbiota disorders as well as focus on adjunctive non-surgical methods for the treatment of PDs and its applicability in patients with DS.

MATERIAL AND METHODS

A literature review was conducted addressing the following topics: (1) the altered immunological responses, (2) orofacial disorders related to DS patients, (3) oral microbiota changing, and (4) adjunctive non-surgical treatment and its efficacy in patients with DS.

RESULTS

Due to the early onset of PDs in children with DS, the need for prompt and effective treatment in these patients is essential.

DISCUSSION AND CONCLUSION

So, investigating underlying factors may open a new window to better understand the pathology of PDs in DS people and thus, find better strategies for treatment in such group. Although non-surgical treatments such as photodynamic therapy and probiotic consumption represented acceptable outcomes in different examined patients without DS, data about the application of these convenience and no need for local anesthesia methods in patients with DS is limited.

Clinical, microbiological and immunological short, medium and long-term effects of different strains of probiotics as an adjunct to non-surgical periodontal therapy in patients with periodontitis. Systematic review with meta-analysis

Introduction/objectives

Probiotics have been proposed as adjuncts to non-surgical periodontal therapy (NSPT), however, the effect of their use remains unclear. The aim of this systematic review and meta-analysis was to analyze the evidence regarding the use of probiotics as an adjunct to NSPT in patients with periodontitis at a clinical, microbiological and immunological level.

Data/sources

A comprehensive search to identify clinical studies investigating the use of probiotics as an adjunct to NSPT in patients treated for periodontitis was performed. The data were grouped according to probiotic strain, frequency, form and duration of the probiotic intake.

Study selection

A total of 25 articles were included, all articles analysed clinical parameters, 10 included also microbiological findings and only 4 had immunological findings. The difference in probing depth (PD) between the test and the control group was statistically significant in favour of the test group when the probiotics were in the form of lozenges, administered twice a day and when the strain was L. reuteri. In terms of Clinical Attachment Level (CAL) gain the difference was statistically significant in the short and in the medium term but not in the long term. Due to the heterogeneity of the data, it was not possible to compare trough a meta analysis the immunological and the microbiological findings that were therefore analysed only descriptively.

Conclusions

The use of probiotics as an adjunct to NSPT in patients with periodontitis appears to provide additional clinical benefits that depend on the duration, the frequency, the form and the strain of probiotic used.

Clinical significance

This review not only shows data on the efficacy of probiotics in non-surgical periodontal therapy, but provides important information on their effects over time and which forms of probiotic administration might be most clinically useful.

Probiotic-fortified fruit juices: Health benefits, challenges, and future perspective

Consumers' growing interest in using foods that improve health has motivated researchers and the food industry to develop new functional products, such as foods containing probiotics or live microbes. Probiotics have functional attributes that could satisfy most basic nutritional and therapeutic supplementation requirements. These microbes positively respond to clinical therapies against diseases and illnesses such as rotavirus-associated diarrhea, irritable bowel syndrome, and food allergies. Moreover, the role of probiotics in the prevention and treatment of obesity, diabetes, cancer, and diseases related to pathogenic microbes is an exciting and rapidly advancing research arena. Probiotic supplementation usually involves dairy products. However, because of the growing number of individuals affected by lactose intolerance and/or vegans, other food matrices like fruits, vegetables, cereals, and so on, have been studied as potential carriers for these microorganisms, presenting an alternative and better source in the process of assessing novel probiotic strains. The present review discusses the various factors affecting the survival of probiotics during storage in fruit juices, the possible effect of probiotics on sensory attributes and the overall acceptance of the products, and future technologies to improve the viability of probiotics.

Molecular commensalism-how to investigate underappreciated health-associated polymicrobial communities

The study of human commensal bacteria began with the first observation of prokaryotes >340 years ago. Since then, the study of human-associated microbes has been justifiably biased toward the study of infectious pathogens. However, the role of commensal microbes has in recent years begun to be understood with some appreciation of them as potential protectors of host health rather than bystanders. As our understanding of these valuable microbes grows, it highlights how much more remains to be learned about them and their roles in maintaining health. We note here that a thorough framework for the study of commensals, both in vivo and in vitro is overall lacking compared to well-developed methodologies for pathogens. The modification and application of methods for the study of pathogens can work well for the study of commensals but is not alone sufficient to properly characterize their relationships. This is because commensals live in homeostasis with the host and within complex communities. One difficulty is determining which commensals have a quantifiable impact on community structure and stability as well as host health, vs benign microbes that may indeed serve only as bystanders. Human microbiomes are composed of bacteria, archaea, fungi, and viruses. This review focuses particularly on oral bacteria, yet many of the principles of commensal impacts on host health observed in the mouth can translate well to other host sites. Here, we discuss the value of commensals, the shortcomings involved in model systems for their study, and some of the more notable impacts they have upon not only each other but host health.

Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis

The primary etiological agent for the initiation and progression of periodontal disease is the dental plaque biofilm which is an organized aggregation of microorganisms residing within a complex intercellular matrix. The non-specific plaque hypothesis was the first attempt to explain the role of the dental biofilm in the pathogenesis of periodontal diseases. However, the introduction of sophisticated diagnostic and laboratory assays has led to the realisation that the development of periodontitis requires more than a mere increase in the biomass of dental plaque. Indeed, multispecies biofilms exhibit complex interactions between the bacteria and the host. In addition, not all resident microorganisms within the biofilm are pathogenic, since beneficial bacteria exist that serve to maintain a symbiotic relationship between the plaque microbiome and the host's immune-inflammatory response, preventing the emergence of pathogenic microorganisms and the development of dysbiosis. This review aims to highlight the development and structure of the dental plaque biofilm and to explore current literature on the transition from a healthy (symbiotic) to a diseased (dysbiotic) biofilm in periodontitis and the associated immune-inflammatory responses that drive periodontal tissue destruction and form mechanistic pathways that impact other systemic non-communicable diseases.

Bifidobacterium animalis subsp. lactis as adjunct to non-surgical periodontal treatment in periodontitis: a randomized controlled clinical trial

OBJECTIVES

The purpose of this study is to investigate the clinical and microbiological effects of Bifidobacterium animalis subsp. lactis DN-173010 containing yogurt as an adjunct to non-surgical periodontal treatment in periodontitis patients.

MATERIALS AND METHODS

This is a prospective randomized controlled clinical study registered with NCT05408364 under clinical trial registration. Thirty periodontitis patients were divided into 2 groups at random. As adjunctive to supra and subgingival instrumentation, the test group consumed Bifidobacterium animalis subsp. lactis DN-173010 containing yogurt while the control group consumed natural yogurt, once daily for 28 days. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, 28th day, and 3rd month. Microbiological analysis was performed using culture method by obtaining subgingival plaque samples from 2 periodontal sites with 4≤PD≤6 mm at the same time points.

RESULTS

The inter-group comparisons of PI, GI, and BOP as well as the changes between the measurement time points were statistically significant in favor of the test group. There were no significant differences in terms of PD and CAL changes between the study groups at all times (∆baseline-28 days, ∆baseline-3 months) (p>0.05). The number of patients presenting subgingival Bifidobacterium species was significantly greater in the test group than the control group at the 28th day (p<0.05).

CONCLUSIONS

The administration of probiotics has shown beneficial effects, albeit limited, on clinical and microbiological outcomes in the management of periodontitis patients.

CLINICAL RELEVANCE

Daily consumption of probiotic yogurt may be supportive for supra and subgingival instrumentation.

Effects of oral administration of Bifidobacterium animalis subsp. lactis HN019 on the treatment of plaque-induced generalized gingivitis

OBJECTIVES

This double-blind, randomized, placebo-controlled clinical trial evaluated the adjuvant effects of Bifidobacterium lactis HN019 on the treatment of plaque-induced generalized gingivitis.

MATERIALS AND METHODS

Sixty patients were submitted to professional supragingival scaling and prophylaxis. They were randomly assigned to test (probiotic lozenges containing B. lactis HN019, n = 30) or control (placebo lozenges, n = 30) groups. Lozenges were consumed twice a day for 8 weeks. Bleeding on probing (BoP), Gingival Index (GI), Plaque Index (PI), probing depth (PD), and clinical attachment level (CAL) were evaluated at baseline and after 2 and 8 weeks. Gingival crevicular fluid (GCF) was collected at baseline and at 8 weeks for analysis of the inflammatory mediators IL-1β, IL-1α, IL-8, MCP-1, and MIP-1β. Data were statistically analyzed (p < 0.05).

RESULTS

After 8 weeks, both groups showed reduction in the percentage of PI, with no significant difference between groups (p = 0.7423). The test group presented a lower percentage of BoP and a higher percentage of sites with GI ≤ 1 when compared with the control group at the end of the study (p < 0.0001). At 8 weeks, the test group had a greater number of patients without generalized gingivitis than the control group (20 and 11 patients, respectively; p < 0.05). The test group presented significantly lower levels of IL-1α, IL-1β, and MCP-1 in GCF than the control group at the end of the study (p < 0.05).

CONCLUSION

The adjunct use of B. lactis HN019 promotes additional clinical and immunological benefits in the treatment of generalized gingivitis.

CLINICAL RELEVANCE

B. lactis HN019 can be an efficient and side-effect-free adjunct strategy in the treatment of generalized gingivitis.

A comprehensive review of the application of probiotics and postbiotics in oral health

Oral diseases are among the most common diseases around the world that people usually suffer from during their lifetime. Tooth decay is a multifactorial disease, and the composition of oral microbiota is a critical factor in its development. Also, Streptococcus mutans is considered the most important caries-causing species. It is expected that probiotics, as they adjust the intestinal microbiota and reduce the number of pathogenic bacteria in the human intestine, can exert their health-giving effects, especially the anti-pathogenic effect, in the oral cavity, which is part of the human gastrointestinal tract. Therefore, numerous in vitro and in vivo studies have been conducted on the role of probiotics in the prevention of tooth decay. In this review, while investigating the effect of different strains of probiotics Lactobacillus and Bifidobacteria on oral diseases, including dental caries, candida yeast infections, periodontal diseases, and halitosis, we have also discussed postbiotics as novel non-living biological compounds derived from probiotics.

Role of Probiotics in Human Health

Certain bacteria, known as probiotics, have had a vastly beneficial effect on people's health; considering their benefits they have been mixed with a wide variety of foods for several decades now. The ability of probiotics to modify the immunological response of the host, antagonize pathogenic microbes, or compete for adhesion sites with pathogenic microorganisms is related to the action of probiotics against microorganisms. Infections of the digestive tract, irritable bowel, lactose intolerance, allergies, infections of the urogenital tract, cystic fibrosis, and various cancers can all be prevented and treated with the use of probiotics. They can reduce the side effects of various antibodies. In the field of oral health, dental caries, periodontal disease, and bad breath can be prevented and treated with the use of probiotics. The findings of several of these clinical studies indicate that probiotics may be beneficial in the treatment and prevention of various diseases and health issues. Validation of a significant number of these clinical investigations is necessary before the results can be applied to the clinical setting. Clinical studies play an important part in such investigations, and in the not-too-distant future, the outcomes of such trials will determine whether or not probiotics are effective in the treatment of disease. This article will attempt to provide a summary of the available literature on the benefits that these probiotics have with regard to health and disease. Probiotics are foods and/or supplements that contain non-pathogenic microbes such as bacteria and yeast that colonize the gut and can potentially yield a variety of health benefits. Research into the various ways in which probiotic bacteria could be used in the treatment of intestinal disorders is ongoing. Thanks to clinical studies and laboratory experiments, we now know more about how probiotics affect gut microbiome disorders. Studies can prove that probiotics can alleviate a variety of gastrointestinal ailments and improve overall health. This article concentrates on probiotics and commensal microbes, as well as their potential role in gut microbiome-related illnesses. In this section, we mark certain areas that need further work and studies so as to enhance our understanding of how probiotics help in the treatment and reduction of chances of gastrointestinal diseases.

Nutritional factors influencing microbiota-mediated colonization resistance of the oral cavity: A literature review

The oral cavity is a key biocenosis for many distinct microbial communities that interact with both the external environment and internal body systems. The oral microbiota is a vital part of the human microbiome. It has been developed through mutual interactions among the environment, host physiological state, and microbial community composition. Indigenious microbiota of the oral cavity is one of the factors that prevent adhesion and invasion of pathogens on the mucous membrane, i.e., the development of the infectious process and thereby participating in the implementation of one of the mechanisms of local immunity-colonization resistance. The balance between bacterial symbiosis, microbial virulence, and host resistance ensures the integrity of the oral cavity. In this review we have tried to address how nutritional factors influence integrity of the oral indigenous microbiota and its involvement in colonization resistance.

Nisin probiotic prevents inflammatory bone loss while promoting reparative proliferation and a healthy microbiome

Dysbiosis of the oral microbiome mediates chronic periodontal disease. Realignment of microbial dysbiosis towards health may prevent disease. Treatment with antibiotics and probiotics can modulate the microbial, immunological, and clinical landscape of periodontal disease with some success. Antibacterial peptides or bacteriocins, such as nisin, and a nisin-producing probiotic, Lactococcus lactis, have not been examined in this context, yet warrant examination because of their biomedical benefits in eradicating biofilms and pathogenic bacteria, modulating immune mechanisms, and their safety profile in humans. This study's goal was to examine the potential for nisin and a nisin-producing probiotic to abrogate periodontal bone loss, the host inflammatory response, and changes in oral microbiome composition in a polymicrobial mouse model of periodontal disease. Nisin and a nisin-producing Lactococcus lactis probiotic significantly decreased the levels of several periodontal pathogens, alveolar bone loss, and the oral and systemic inflammatory host response. Surprisingly, nisin and/or the nisin-producing L. lactis probiotic enhanced the population of fibroblasts and osteoblasts despite the polymicrobial infection. Nisin mediated human periodontal ligament cell proliferation dose-dependently by increasing the proliferation marker, Ki-67. Nisin and probiotic treatment significantly shifted the oral microbiome towards the healthy control state; health was associated with Proteobacteria, whereas 3 retroviruses were associated with disease. Disease-associated microbial species were correlated with IL-6 levels. Nisin or nisin-producing probiotic's ability to shift the oral microbiome towards health, mitigate periodontal destruction and the host immune response, and promote a novel proliferative phenotype in reparative connective tissue cells, addresses key aspects of the pathogenesis of periodontal disease and reveals a new biomedical application for nisin in treatment of periodontitis and reparative medicine.

Efficacy of Topical Intervention for Recurrent Aphthous Stomatitis: A Network Meta-Analysis

Background and objectives: To compare the efficacy and safety of topical interventions used for recurrent aphthous stomatitis. Materials and Methods: This network meta-analysis was conducted in accordance with the PRISMA statement. We searched four electronic databases, PubMed, Web of Science (WOS), Cochrane Central Register of Controlled Trials and Embase, for randomized controlled trials reporting efficacy and safety data on topical interventions for recurrent aphthous stomatitis. We performed a quality evaluation using a methodology based on the Cochrane Handbook. Two authors independently extracted data on healing effect, size reduction effect, symptom reduction effect, recurrence and safety assessment. Network meta-analysis was then performed using ADDIS and RevMan. Results: A total of 72 trials (5272 subjects) involving 29 topical interventions were included. Honey, lnsulin liposome gel, laser, amlexanox, glycyrrhiza and triamcinolone had better efficacy performance. Probiotics and chlorhexidine helped to prolong ulcer intervals and reduce recurrence. Doxycycline and penicillin had a high risk of adverse events. Hematologic evaluation showed no preference. The rank possibility of size-reducing effect and symptom-reducing effect supported the short-term effect of laser and the long-term effect of probiotics. Conclusions: We recommend the use of laser as a short-term intervention during the exacerbation phase of RAS and probiotics as a long-term intervention during the exacerbation and remission phases of RAS.

The Use of Probiotics as Adjuvant Therapy of Periodontal Treatment: A Systematic Review and Meta-Analysis of Clinical Trials

For many years, the use of probiotics in periodontitis treatment was reflected in their abilities to control the immune response of the host to the presence of pathogenic microorganisms and to upset periodontopathogens. Accordingly, the aim of the present study was to assess the use of probiotics as adjuvant therapy on clinical periodontal parameters throughout a systematic review and meta-analysis. The literature was screened, up to 4 June 2021, by two independent reviewers (L.H. and R.B.) in four electronic databases: PubMed (MedLine), ISI Web of Science, Scielo, and Scopus. Only clinical trials that report the effect of the use of probiotics as adjuvants in the treatment of periodontal disease were included. Comparisons were carried out using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A total of 21 studies were considered for the meta-analysis. For the index plaque, the use of probiotics did not improve this clinical parameter (p = 0.16). On the other hand, for the periodontal pocket depth, the clinical attachment loss, the bleeding on probing, and the use of probiotics as adjuvant therapy resulted in an improvement of these parameters, since the control group achieved statistically higher values of this parameter (p < 0.001; p < 0.001; and p = 0.005, respectively). This study suggests that the use of probiotics led to an improvement in periodontal pocket depth, clinical attachment loss, and bleeding on probing parameters. On the other hand, this protocol seems to not be beneficial for the index plaque parameter.

Comparative evaluation of locally delivered probiotic paste and chlorhexidine gel as an adjunct to scaling and root planing in treating chronic periodontitis: A split-mouth randomized clinical trial

Introduction

The etiological factors of periodontal diseases are the habitation of dysbiotic bacteria, absence of beneficial bacteria, and susceptibility of the host. Irresolute pattern in the periodontal diseases pathogenesis leads to the evolution of novel antimicrobial therapy.

Objective

The objective of the study is to assess and compare the competency of locally delivered probiotic paste with chlorhexidine gel as a supplement to scaling and root planing (SRP) in chronic periodontitis patients.

Materials and Methods

A split-mouth randomized controlled trial was designed on 10 systemically healthy participants having chronic periodontitis at three distinct quadrants with 5-6-mm pocket depth. The sites in each participant were randomly selected for Group A (negative control), Group B (positive control), and Group C (test). In Group A, only SRP, Group B - SRP + chlorhexidine local drug delivery (LDD), Group C - SRP + probiotic LDD were done, respectively. Gingival index (GI) and bleeding index (BI) were determined at baseline, 3rd, 6th, and 9th weeks, whereas probing pocket depth (PPD), Russell's periodontal index, and clinical attachment level were checked at baseline and after 9 weeks.

Results

It shows a significant reduction in GI, BI, PPD, and gain of CAL in probiotic LDD group.

Conclusion

Nowadays, since microbes are rapidly developing resistance to antibiotics, the development of probiotics is a boon for the treatment of periodontal diseases. Diseases of the periodontium are not restricted to the oral cavity alone but also have strong systemic effects. Hence, probiotics give a natural and promising choice of therapy to establish both good oral and systemic health.

Probiotic Species in the Management of Periodontal Diseases: An Overview

Periodontal diseases are one of the most common chronic inflammatory diseases of the oral cavity, which are initiated and sustained by pathogenic plaque biofilms. Central to modern periodontology is the idea that dysbiosis of periodontal microecology and disorder of host inflammatory response gives rise to degradation of periodontal tissues together, which eventually leads to tooth loss, seriously affecting the life quality of patients. Probiotics were originally used to treat intestinal diseases, while in recent years, extensive studies have been exploring the utilization of probiotics in oral disease treatment and oral healthcare. Probiotic bacteria derived from the genera Lactobacillus, Bifidobacterium, Streptococcus, and Weissella are found to play an effective role in the prevention and treatment of periodontal diseases via regulating periodontal microbiota or host immune responses. Here, we review the research status of periodontal health-promoting probiotic species and their regulatory effects. The current issues on the effectiveness and safety of probiotics in the management of periodontal diseases are also discussed at last. Taken together, the use of probiotics is a promising approach to prevent and treat periodontal diseases. Nevertheless, their practical use for periodontal health needs further research and exploration.

Effectiveness of Oral Probiotics in Reducing S. Mutans Count in Caries-active Children: A Comparison with Chlorhexidine and Herbal Mouthrinse (Hiora®)

Aim

The purpose of this study was to compare the reduction in salivary mutans streptococci counts and to evaluate any change in the salivary pH values after the use of oral probiotics, chlorhexidine, and herbal mouthrinse.

Method

Oral probiotics, chlorhexidine, and herbal mouthrinse [Hiora^®] were evaluated for their efficacy against S. mutans in 75 caries-active children, aged 6-14 years.

Results

The values obtained were subjected to statistical analysis. Oral probiotics showed lesser reduction in the S. mutans count as compared to chlorhexidine but the values were statistically insignificant. Herbal mouthrinse was not as effective as the oral probiotics or chlorhexidine in reducing the S. mutans count.

Conclusion

Oral probiotics show a similar efficacy as the gold standard, chlorhexidine, in reduction of oral S. mutans.

How to cite this article

Kamble A, Jabin Z, Agarwal N, et al. Effectiveness of Oral Probiotics in Reducing S. Mutans Count in Caries-active Children: A Comparison with Chlorhexidine and Herbal Mouth-rinse (Hiora®). Int J Clin Pediatr Dent 2022;15(S-2):S207-S211.

Adjunctive probiotics after periodontal debridement versus placebo: a systematic review and meta-analysis

OBJECTIVE

To comprehensively investigate the efficacy of adjunctive probiotics compared to placebo, using conventional and novel treatment outcomes.

MATERIALS AND METHODS

Three databases (MEDLINE, EMBASE, and CENTRAL) were searched. Outcomes included percent change in the total number of deep sites before and after therapy, change in mean probing pocket depth (mm), percentage patients requiring additional therapy, risk for disease progression, and microbiological and immunological results. Meta-analysis was conducted to evaluate treatment effects wherever appropriate.

RESULTS

Ten studies were selected from 818 records. Meta-analysis showed that adjunctive probiotics had no additional benefit for percentage change of the total number of deeper sites (≥5 mm, ≥6 mm, ≥7 mm) before and after therapy. No significant difference was observed for mean probing pocket depth reduction at 3 and 6 months. Statistically significant beneficial odds ratios for need for additional therapy (OR = 0.19, 95% CI [0.07-0.56]) and risk of disease progression (OR = 0.32, 95% CI [0.14-0.73]) were observed with probiotic administration. Immunological rather than microbiological outcomes correlated more consistently with clinical findings. No adverse events were reported.

CONCLUSIONS

Adjunctive probiotics are safe in systemically healthy individuals and could offer additional patient-level benefits compared to placebo, hence its use can sometimes be justified.

The Clinical, Microbiological, and Immunological Effects of Probiotic Supplementation on Prevention and Treatment of Periodontal Diseases: A Systematic Review and Meta-Analysis

(1) Background: Periodontal diseases are a global health concern. They are multi-stage, progressive inflammatory diseases triggered by the inflammation of the gums in response to periodontopathogens and may lead to the destruction of tooth-supporting structures, tooth loss, and systemic health problems. This systematic review and meta-analysis evaluated the effects of probiotic supplementation on the prevention and treatment of periodontal disease based on the assessment of clinical, microbiological, and immunological outcomes. (2) Methods: This study was registered under PROSPERO (CRD42021249120). Six databases were searched: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Dentistry and Oral Science Source. The meta-analysis assessed the effects of probiotic supplementation on the prevention and treatment of periodontal diseases and reported them using Hedge’s g standardized mean difference (SMD). (3) Results: Of the 1883 articles initially identified, 64 randomized clinical trials were included in this study. The results of this meta-analysis indicated statistically significant improvements after probiotic supplementation in the majority of the clinical outcomes in periodontal disease patients, including the plaque index (SMD = 0.557, 95% CI: 0.228, 0.885), gingival index, SMD = 0.920, 95% CI: 0.426, 1.414), probing pocket depth (SMD = 0.578, 95% CI: 0.365, 0.790), clinical attachment level (SMD = 0.413, 95% CI: 0.262, 0.563), bleeding on probing (SMD = 0.841, 95% CI: 0.479, 1.20), gingival crevicular fluid volume (SMD = 0.568, 95% CI: 0.235, 0.902), reduction in the subgingival periodontopathogen count of P. gingivalis (SMD = 0.402, 95% CI: 0.120, 0.685), F. nucleatum (SMD = 0.392, 95% CI: 0.127, 0.658), and T. forsythia (SMD = 0.341, 95% CI: 0.050, 0.633), and immunological markers MMP-8 (SMD = 0.819, 95% CI: 0.417, 1.221) and IL-6 (SMD = 0.361, 95% CI: 0.079, 0.644). (4) Conclusions: The results of this study suggest that probiotic supplementation improves clinical parameters, and reduces the periodontopathogen load and pro-inflammatory markers in periodontal disease patients. However, we were unable to assess the preventive role of probiotic supplementation due to the paucity of studies. Further clinical studies are needed to determine the efficacy of probiotic supplementation in the prevention of periodontal diseases.

Clinical Effects of Locally Delivered Lactobacillus reuteri as Adjunctive Therapy in Patients with Periodontitis: A Split-Mouth Study

Different methods and products have been investigated as measures of adjunctive therapy to scaling and root planing (SRP). Probiotic use has gained interest for this particular application, especially Lactobacillus spp. This split-mouth interventional prospective study aimed to evaluate the clinical effects of L. reuteri DSM 17938 with local application in periodontal pockets of severe periodontitis patients. The study was conducted on 40 subjects with stage 3–4 periodontitis who, based on a split-mouth model, followed SRP and SRP + L. reuteri solution in five weekly sessions. Probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were assessed at baseline and at three months after probiotic treatment completion. Both SRP and SRP + L. reuteri generated significant improvements of all three clinical parameters, but the changes were significantly better for SRP + L. reuteri treated sites. Therefore, we can conclude that adjunctive therapy with L. reuteri DSM 17938 could represent an interesting treatment option, particularly for severe periodontitis cases.

Are probiotics a possible treatment of periodontitis? Probiotics against periodontal disease: a systematic review

Introduction Periodontal disease is one of the most prevalent oral diseases. Until now, periodontal disease treatments offer good results but periodontal pockets can be immediately recolonised by pathogenic bacteria. The limitations of these treatments have led to the need to find more effective alternatives that reinforce the periodontal treatments.Aim To evaluate the clinical effect of probiotics as an adjuvant treatment to scaling and root planing in patients with periodontitis.Materials and methods An electronic search in Medline (via PubMed) of randomised clinical trials published in the last ten years that include the effects of using probiotics in periodontal disease was performed.Results In total, ten trials were included and in seven of them the evaluated clinical parameters were significantly improved in the test group compared to the placebo group. In five trials, a significant reduction of the main periodontal pathogens was reported. No side effects were observed in any trial.Conclusions The administration of probiotics as an adjuvant treatment to periodontal treatment helps improve the clinical parameters, significantly decreases the concentration of the main periodontal pathogens and does not cause any side effects.

Randomized clinical trials in periodontology: focus on outcomes selection

Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs - the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health-related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

Probiotics in the Management of Gingivitis and Periodontitis. A Review

In the management of intestinal health problems, the targeted use of probiotic microorganisms is a common therapeutic measure with a long-standing tradition. In clinical dentistry however, probiotics-based therapy is still a rather new and developing field, whose usefulness for the control of gingivitis and periodontitis has been questioned by recent meta-analyses and systematic reviews. The purpose of the subsequent descriptive review is to provide an introduction to the concept of probiotic microorganisms and their multifaceted health-promoting interactions with the human host and microbial competitors, followed by a detailed comparison of the results of available controlled clinical trials assessing the use of probiotics in the control of gingival and periodontal inflammations. It aims at contributing to a deeper understanding of the unique capabilities of probiotics to resolve chronic plaque-induced inflammation even in the absence of mechanical plaque control and will discuss how possible misconceptions about the rationale for using probiotics may have led to the present controversies about their usefulness as a therapeutic option.

Orally Administered Probiotics Decrease Aggregatibacter actinomycetemcomitans but Not Other Periodontal Pathogenic Bacteria Counts in the Oral Cavity: A Systematic Review and Meta-Analysis

Introduction: At the initial part of the gastrointestinal tract, multiple tissues serve the normal function of food delivery. Periodontal structures are integral elements of these. When they deteriorate, it is extremely challenging to regenerate and reconstruct them. The conventional intervention for periodontal disease is scaling and root planning with the aim of reducing pathogenic bacteria. However, periodontal pathogens can rapidly recolonize treated areas. Probiotics have been proposed as novel tools for managing oral health by suppressing pathogenic bacteria through their anti-inflammatory effect, but the available data are controversial. Aim: Therefore, we performed a meta-analysis to study the effect of probiotics on periodontal pathogenic bacteria. Methods: The study was registered in PROSPERO under registration number CRD42018094903. A comprehensive literature search from four electronic databases (PubMed, Cochrane CENTRAL, Embase, and Web of Science) yielded nine eligible records for statistical analysis. Studies measuring bacterial counts in saliva and supra- and subgingival plaque were included. Bacterial counts were analyzed using standard mean difference (SMD) and by a random effects model with the DerSimonian-Laird estimation. Results: The results showed a significant decrease in the overall count of Aggregatibacter actinomycetemcomitans in the probiotic-treated group compared to the control at 4 weeks (SMD: -0.28; 95% CI: -0.56--0.01; p = 0.045) but not later. Analyzing the bacterial counts in subgroups, namely, in saliva and supra- and subgingival plaque, separately, yielded no significant difference. Probiotics had no significant effect on the overall count of Porphyromonas gingivalis at 4 weeks (SMD: -0.02; 95% CI: -0.35-0.31; p = 0.914) or later. Subgroup analysis also revealed no significant difference between treatment and control groups nor did probiotics significantly decrease the overall and subgroup bacterial counts of Prevotella intermedia, Tannerella forsythia, and Fusobacterium nucleatum. Conclusion: Our data support the beneficial effect of probiotics in reducing A. actinomycetemcomitans counts, but not of other key periodontal pathogenic bacteria in periodontal disease patients. However, due to the complex mechanism associated with periodontal disease and the limitations of the available studies, there is a further need for well-designed randomized clinical trials to assess the efficacy of probiotics.

Alleviation of halitosis by use of probiotics and their protective mechanisms in the oral cavity

Regarding the relation of halitosis with oral infections and its effects on social relations between humans, the present study investigated the positive effects of probiotics on prevention or treatment of halitosis. The causative agents of halitosis are volatile sulphur compounds (VSCs), and halitosis is divided into oral and non-oral types according to the source of the VSCs. H2S and CH3SH are two main halitosis metabolites-produced following the degradation of proteins by bacteria in the mouth-however, CH3SCH3 has a non-oral origin, and is a blood neutral molecule. Just as much as halitosis is important in medicine, its psychological aspects are also considered, which can even lead to suicide. Today, the use of probiotics as a new therapeutic in many roles is in progress. Most probiotics are used for the treatment of gastrointestinal tract disorders, but various studies on the alleviation of halitosis by use of probiotics have reported satisfactory results. The genera Lactobacillus, Streptococcus and Weissella are among the most useful probiotics for the prevention or treatment of halitosis in the oral cavity.

What are microbiological effects of the adjunctive use of probiotics in the treatment of periodontal diseases? A systematic review

Probiotics have aroused great interest as an adjunctive treatment to periodontal therapy, due to the frequent colonisation by periodontopathogens after therapy. The aim of this systematic review was to analyse in the scientific literature, evidence of the microbiological effects of probiotics as an adjunct to periodontal therapy in the treatment of periodontal diseases (PD). Only randomised controlled trials (RCT), evaluating the microbiological effect of probiotics as an adjunct to periodontal therapy. The authors conducted a search in PubMed/MEDLINE, LILACS, ScienceDirect, Web of Science and Cochrane Library to identify articles published in English until February 2020. 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. Of the 265 articles potentially relevant to this review, 10 studies were included. The most frequently used probiotic bacteria were those of the genus Lactobacillus spp. and the time of administration of the probiotics was between 14 days to 3 months. Most studies have shown that the adjuvant use of probiotics reduces the total mean counts of gram-negative anaerobic species (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia) and gram-negative coccobacillus (Aggregatibacter actinomycetemcomitans) of subgingival plaque samples. Probiotics adjuvant to periodontal therapy reduces periodontopathogenic species in a greater proportion, compared only to periodontal therapy. Especially the Lactobacillus reuteri strain, without combination with other strains, offered a greater reduction in pathogenic bacteria associated with greater destruction of periodontal tissues and deep periodontal pockets. Researchers should perform high-quality RCT, evaluating single strains without combinations, in order to observe the microbiological benefits as adjunctive treatment of PD.

Systematic review and meta-analysis on the adjunctive use of host immune modulators in non-surgical periodontal treatment in healthy and systemically compromised patients

Considering the central role of inflammation in the pathogenesis of periodontitis, the combination of NSPT with different agents that can modulate the host immune-inflammatory response has been proposed to enhance the outcomes of NSPT. The aim of this paper is to systematically review the literature on the efficacy of systemic host modulators (HMs) as adjuncts to non-surgical periodontal therapy (NSPT) in improving pocket depth (PD) reduction and clinical attachment level (CAL) gain in healthy and systemically compromised patients. RCTs with ≥ 3 months follow-up were independently searched by two reviewers. Meta-analysis was performed when ≥ 3 studies on the same HM were identified. The quality of the evidence was rated according to the GRADE approach to rate the certainty of evidence. 38 articles were included in the qualitative assessment and 27 of them were included in the meta-analysis. There is low/very low evidence that the adjunctive use of sub-antimicrobial dose of doxycicline, melatonin and the combination of omega-3 and low dose aspirin (in type 2 diabetic patients) to NSPT would improve PD and/or CAL. Conflicting evidence is available on the efficacy of probiotics. Future studies controlling for confounding factors, using composite outcomes to define the endpoint of therapy and considering not only the patient- but also as the site-specific effect of systemic HMs are warranted. The dosage, posology and long-term effect of HMs still need to be clarified, also in association to the presence of systemic conditions potentially affecting the response to HMs administration.

CLINICAL EFFICACY OF PROBIOTICS AS AN ADJUNCTIVE THERAPY TO SCALING AND ROOT PLANNING IN THE MANAGEMENT OF PERIODONTITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRAILS

OBJECTIVES

To evaluate the efficacy of probiotics as an adjunctive therapy to scaling and root planning treatment (SRP) in the management of periodontitis.

METHODS

PubMed, Embase, Web of science, SCOPUS and the Cochrane library were systematically searched to identify eligible studies. Stata 12.0 software was used to calculate the weighted mean differences (WMD) and 95% confidential interval (CI). The primary outcomes were clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing (BOP).

RESULTS

Twenty-four randomized controlled trials (RCT) were included in the meta-analysis. The pooled results showed CAL gain (WMD: 0.20, 95% CI 0.09 to 0.31), PPD reduction (WMD: -0.31, 95% CI -0.52 to -0.10) and BOP reduction (WMD: -2.98, 95% CI -4.70 to -1.26) in the SRP+ probiotics group were significantly improved compared to control group at 3 months follow-up, but no significant difference was observed at 6 months. In addition, the probiotics administration could improve Plaque index (WMD: -0.30, 95% CI -0.59 to -0.05) and Gingival index (WMD: -0.46, 95% CI -0.71 to -0.21) at short term.

CONCLUSIONS

The results support the clinical efficacy of probiotics as an adjunctive therapy to SRP in the management of periodontitis at least 3 months follow-up. Within the limits of the evidence, the long-term efficacy needs to further confirm.

Probiotic therapy for periodontal and peri-implant health - silver bullet or sham?

Probiotics are thought to be beneficial microbes that influence health-related outcomes through host immunomodulation and modulation of the bacteriome. Its reported success in the treatment of gastrointestinal disorders has led to further research on its potential applicability within the dental field due to similarities such as a polymicrobial aetiology and disease associated microbial-shifts. Although the literature is replete with studies demonstrating its efficacy, the use of probiotics in dentistry continues to polarise opinion. Here, we explore the evidence for probiotics and its effect on periodontal and peri-implant health. MEDLINE, EMBASE, and CENTRAL were systemically searched from June 2010 to June 2020 based on a formulated search strategy. Of 1,956 potentially relevant articles, we selected 27 double-blinded randomised clinical trials in the areas of gingivitis, periodontitis, residual pockets during supportive periodontal therapy, and peri-implant diseases, and reviewed their efficacy in these clinical situations. We observed substantial variation in treatment results and protocols between studies. Overall, the evidence for probiotic therapy for periodontal and peri-implant health appears unconvincing. The scarcity of trials with adequate power and follow-up precludes any meaningful clinical recommendations. Thus, the routine use of probiotics for these purposes are currently unsubstantiated. Further multi-centre trials encompassing a standardised investigation on the most promising strains and administration methods, with longer observation times are required to confirm the benefits of probiotic therapy for these applications.

Impact of systemic probiotics as adjuncts to subgingival instrumentation on the oral-gut microbiota associated with periodontitis: A randomized controlled clinical trial

BACKGROUND

The oral-gut axis may be a route linking periodontal and systemic diseases. Probiotics could be an alternative for the treatment of microbial dysbiotic conditions, including periodontitis. This randomized placebo-controlled clinical trial evaluated the short-term efficacy of systemic probiotics adjunctive to subgingival instrumentation (SI) in promoting a better restoration of the oral-gut microbiotas and greater periodontal clinical outcome.

METHODS

Systemically healthy adults with untreated periodontitis were recruited from a Dental School setting and allocated to receive SI plus placebo (n = 24) or probiotics (n = 24), one capsule/day for 30 days. Subgingival biofilm and stool were obtained at baseline and 2-months post-therapy for microbiological analyses by checkerboard and 16S rRNA gene sequencing. Differences in all parameters between placebo (n = 23) and probiotics (n = 19) groups were assessed by non-parametric tests.

RESULTS

Most subgingival species and α-diversity decreased after therapies (P <0.05), whereas gut composition/diversity were slightly or not affected by treatments. In parallel, significant clinical improvement (P <0.05) was similar between groups, although a trend for a higher proportion of poor responders in the placebo (60.8%) than the probiotic group (31.5%) was observed (P = 0.07). Strong correlations between oral and fecal species were found (P <0.01), and distinct species related to poor response for different therapies (P <0.05). Patients were classified into five periodontitis oral-gut microbial clusters, which correlated differently with attachment loss after therapies (P <0.05).

CONCLUSION

Systemic probiotics combined with SI did not provide short-term additional clinical or microbiological benefits in the treatment of periodontitis; however, response to therapies seemed to correlate with distinct oral-gut microbial profiles.

Treatment challenges and delivery systems in immunomodulation and probiotic therapies for periodontitis

Introduction: Periodontitis is a widespread illness that arises due to disrupted interplay between the oral microbiota and the host immune response. In some cases, conventional therapies can provide temporary remission, although this is often followed by disease relapse. Recent studies of periodontitis pathology have promoted the development of new therapeutics to improve treatment options, together with local application using advanced drug delivery systems.Areas covered: This paper provides a critical review of the status of current treatment approaches to periodontitis, with a focus on promising immunomodulation and probiotic therapies. These are based on delivery of small molecules, peptides, proteins, DNA or RNA, and probiotics. The key findings on novel treatment strategies and formulation of advanced delivery systems, such as nanoparticles and nanofibers, are highlighted.Expert opinion: Multitarget therapy based on antimicrobial, immunomodulatory, and probiotic active ingredients incorporated into advanced delivery systems for application to the periodontal pocket can improve periodontitis treatment outcomes. Translation of such adjuvant therapy from laboratory to patient is expected in the future.

Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial

BACKGROUND

The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) plus amoxicillin (AMX) has shown to be an effective treatment protocol, particularly for periodontitis stages III and IV, generalized. More recently, probiotics have also been suggested as a promising adjunctive treatment for periodontal diseases due to their antimicrobial and anti-inflammatory properties. Therefore, the aim of this randomized clinical trial (RCT) is to evaluate the clinical, microbiological, and immunological effects of probiotics as adjuncts to SRP alone or with MTZ+AMX in the treatment of periodontitis.

METHODS

Subjects with periodontitis are being randomly assigned to receive (i) SRP alone, or with (ii) two probiotic lozenges/day for 90 days (Prob), (iii) MTZ (400 mg) and AMX (500 mg) thrice a day (TID) for 14 days (MTZ+AMX), or (iv) Prob and MTZ+AMX. Subjects are being monitored for up to 12 months post-treatment. Nine subgingival plaque samples per patient are being collected at baseline and at 3, 6, and 12 months post-therapy and analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Peripheral blood and gingival crevicular fluid (GCF) of four randomly selected periodontal sites will be analyzed by means of a multiplex fluorescent bead-based immunoassay for 17 cyto/chemokines.

STATISTICAL ANALYSES

The significance of differences in each group (over the course of the study) will be sought using repeated measures ANOVA or Friedman tests and among groups (at each time point) using either ANOVA/ANCOVA or Kruskal-Wallis tests, depending on normality of the data. The chi-square test will be used to compare differences in the frequency of subjects achieving the clinical endpoint for treatment (≤ 4 sites with PD ≥ 5 mm) at 1 year and of self-perceived adverse effects. A stepwise forward logistic regression analysis will be performed in order to investigate the impact of different predictor variables on the percentage of patients achieving the clinical endpoint for treatment. The Number Needed to Treat (NNT) with different treatment protocols will be also calculated. Statistical significance will be set at 5%.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03733379. Registered on November 7, 2018.

Heat-killed Lactobacillus acidophilus mediates Fusobacterium nucleatum induced pro-inflammatory responses in epithelial cells

Probiotics is widespreadly used nowadays. However, the safety issue with the use of live probiotics is still a matter of contention. In recent years, an expanding body of evidence supports the beneficial role of heat-killed probiotics in the maintenance of systemic health, whereas the role of these heat-killed bacteria on periodontal health remains unclear. This study aimed to evaluate the effects of heat-killed probiotics on periodontal pathogen virulence and associated mechanisms. We demonstrated that heat-killed Lactobacillus acidophilus was able to coaggregate with Fusobacterium nucleatum, the bridging bacteria of oral biofilm, and inhibit the adhesion and invasion of F. nucleatum, leading to a subsequent elimination of pro-inflammatory cytokine production in oral epithelial cells. This coaggregation further caused a suppression of the virulence gene fap2 expression in F. nucleatum. Therefore, heat-killed L. acidophilus might downregulate the pro-inflammatory cytokine expression in epithelial cells via coaggregation with F. nucleatum and suppression of F. nucleatum fap2 expression, which was the first demonstration that heat-killed probiotics modulate periodontal disease pathogenesis via coaggregation. Collectively, this finding provides new evidence that heat-killed probiotics might exert beneficial effects to periodontal health by coaggregating with periodontal pathogens and modulating their virulence.

Clinical effects of probiotic or azithromycin as an adjunct to scaling and root planning in the treatment of stage III periodontitis: a pilot randomized controlled clinical trial

Background

The aim of this triple-blind placebo-controlled parallel-arm randomized clinical trial was to evaluate the clinical effects of Lactobacillus rhamnosus SP1 or azithromycin as an adjunct to scaling and root planing (SRP) in patients with stage III periodontitis.

Methods

Forty-seven systemically healthy participants with stage III periodontitis were recruited. Following SRP, the participants were randomly assigned to one of three treatment modalities; (1) placebo (n = 15), (2) probiotics (n = 16) and (3) antibiotics-azithromycin (n = 16). The participants were monitored at baseline, 3, 6, 9 and 12 months after therapy. Probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment loss (CAL) and plaque accumulation (PI) were evaluated.

Results

All 47 participants completed the study. At 12 months, all groups showed significant improvements of PPD and PI (p < 0.012) irrespective of the treatment modality and without significant differences between the groups. Probiotics and azithromycin showed no added benefit in terms of CAL. While the placebo (p = 0.002) and the antibiotic-azithromycin (p = 0.002) group showed a significant reduction of BOP, only the placebo group revealed a significant reduction of CAL at 12 months follow-up (p = 0.003). The number of sites and teeth with PPD ≥ 5, ≥ 6 and ≥ 7 mm were significantly reduced in all groups at 12 months follow-up (p < 0.025) irrespective of the treatment regime and without significant differences between the groups.

Conclusion

The use of probiotics or azithromycin as an adjunct to SRP failed to provide additional benefits in the treatment of stage III periodontitis. The benefits of these two treatment regimes as an adjunct to SRP remain unclear.

Trial registration

NCT02839408, 10/28/2017, Clinicaltrial.gov.

The Effect of Lactobacillus salivarius SGL03 on Clinical and Microbiological Parameters in Periodontal Patients

The destruction of periodontal tissues during periodontitis is the result of the immune-inflammatory reactions to the bacteria of dental biofilm. Probiotics may reduce dysbiosis by the modification of the dental microbiome, which can influence the immune-inflammatory mechanisms. The aim of this study was to estimate the clinical and microbiological parameters, before and after 30 days of application of the dietary supplement containing Lactobacillus salivarius SGL03 or placebo. The study was conducted in 51 patients with stage I or II periodontitis during the maintenance phase of treatment. The clinical parameters and the number of colony forming units (CFU) of bacteria in supragingival plaque were assessed before and after 30 days of the oral once daily administration of the dietary supplement in the form of suspension containing L. salivarius SGL03 or placebo. There were no changes in the PI scores between and within the groups. The value of BOP decreased in both groups. In the study group the significant reduction of the mean pocket depth was revealed (from 2.5 to 2.42, p = 0,027) but without the difference between the groups. There were no significant changes in the number of bacteria within the groups. In the control, but not the study group, positive correlations were observed between the clinical parameters (variables) and the number of bacteria. The use of the dietary supplement containing L. salivarius SGL03 may reduce pocket depth despite the lack of changes in other clinical parameters and the number of bacteria in supragingival plaque.