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Puzhankara L, Banerjee A, Chopra A, Venkitachalam R, Kedlaya MN. Effectiveness of probiotics compared to antibiotics to treat periodontal disease: Systematic review. Oral Dis 2024; 30:2820-2837. [PMID: 37964394 DOI: 10.1111/odi.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/11/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Probiotics are promising adjuncts to non-surgical periodontal therapy (scaling and root planing (SRP)) for managing gingival and periodontal diseases. Probiotics are considered alternatives to antibiotics, especially with the emergence of antimicrobial resistance. Hence, the present systematic review aims to generate evidence on the role of probiotics compared to antimicrobial agents for managing periodontal diseases (gingivitis and periodontitis). METHOD Six electronic databases (PubMed, SCOPUS, Web of Science, EBSCO, Cochrane, Clinical Trial Registry) were searched to collect studies comparing the effect of probiotics with antibiotics for periodontal disease. In total, 5530 articles were retrieved from all databases, of which 1891 were included for title and abstract screening. After screening, a total of ten clinical studies were included for data extraction and analysis. Probing pocket depth (PPD), Clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI), gingival index (GI), and microbial profile were recorded. RESULTS Probiotics showed a significant reduction in the PPD and CAL compared to antibiotics. Antibiotics were more effective in reducing the PI and GI. A combination of probiotics and antibiotics superior compared to probiotics and antibiotics alone. CONCLUSION Probiotics can be used as an alternative to antibiotics, however, a combination is more effective for managing periodontal disease.
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Affiliation(s)
- Lakshmi Puzhankara
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Avishikta Banerjee
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | | | - Madhurya N Kedlaya
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
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ŞAHİN T, AKCA G, ÖZMERİÇ N. The role of probiotics for preventing dysbiosis in periodontal disease: a randomized controlled trial. Turk J Med Sci 2023; 54:357-365. [PMID: 38812644 PMCID: PMC11031156 DOI: 10.55730/1300-0144.5798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/15/2024] [Accepted: 12/07/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Scaling and root planing remain inadequate in periodontitis treatment caused by dysbiotic microbial dental plaque. The aim of this clinical trial is to evaluate the effects of probiotics and kefir consumption in initial periodontal therapy (IPT) on oral microbiota composition and treatment outcomes in patients with periodontitis. Materials and methods The study was carried out in the Gazi University Department of Periodontology, including a sample size of 36 individuals and utilizing a randomized controlled design. Thirty-six patients with periodontitis were randomly allocated to three groups: one receiving probiotic treatment, another receiving kefir, and a third serving as the control group. Obtaining subgingival microbial samples, we recorded plaque, gingival index, bleeding on probing, periodontal pocket depth, and clinical attachment level (periodontal clinical indices) and then performed IPT. For 14 days, patients took either probiotics, kefir, or no supplements. Data for the first and third months were collected using periodontal clinical indices. DNA sequencing was performed to detect Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola in subgingival plaque samples collected at baseline and three months. Results Significant differences were observed regarding periodontal clinical indices among groups in the intragroup comparisons. Moreover, levels of Tannerella forsythia were significantly decreased in all groups. Conclusion Kefir can be administered in addition to IPT, providing results similar to those observed with probiotics.
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Affiliation(s)
- Tuğba ŞAHİN
- Division of Periodontology, Faculty of Dentistry, University, Bolu Abant İzzet Baysal University, Bolu,
Turkiye
| | - Gülçin AKCA
- Division of Microbiology, Faculty of Dentistry, Gazi University, Ankara,
Turkiye
| | - Nurdan ÖZMERİÇ
- Division of Periodontics, Faculty of Dentistry, Gazi University, Ankara,
Turkiye
- Division of Periodontics, School of Dentistry, Cyprus International University, Lefkoşa, North Cyprus,
Turkiye
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Araujo LDC, da Silva RAB, Silva CMPC, Salvador SLS, Messora MR, Furlaneto FAC, Mastrange MDA, Pucinelli CM, da Silva LAB. Bifidobacterium animalis subsp. lactis HN019 has antimicrobial activity against endodontic pathogens in vitro. Braz J Microbiol 2023; 54:2289-2295. [PMID: 37632683 PMCID: PMC10484865 DOI: 10.1007/s42770-023-01083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/25/2023] [Indexed: 08/28/2023] Open
Abstract
The aim of the present study was to evaluate, in vitro, the antimicrobial activity of the probiotic Bifidobacterium animalis subsp. lactis HN019, through the well technique, against 10 microorganisms can be found involved in endodontic infections. The antimicrobial activity of the probiotic was performed on Streptococcus mutans, Streptococcus sobrinus, Lacticaseibacillus casei, Enterococcus faecalis, Staphylococcus aureus, Candida albicans, Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum and Prevotella intermedia. For the control group, it was used non-pathogenic bacteria Escherichia coli, Saccharomyces cerevisiae, and Kocuria rizhopilla. After 48 to 72 h of incubation of the petri dishes containing the culture medium, the microorganism strains, and the probiotic, the plates were examined to assess the uniformity of microbial growth, presence of contaminants, and the halo of inhibition. After visual inspection, the reading of the halo of inhibition was performed with the aid of a digital caliper using a reflected light source to illuminate the inverted plate on a black, opaque background after removing the cap. Thus, 3 values were obtained from each bacterial inoculum, which were added and divided by three to obtain the average of the values. The results of the in vitro study demonstrated that the probiotic B. animalis subsp. lactis HN019 promoted the inhibition of all strains of the pathogens evaluated, with the exception of Candida albicans, demonstrating antimicrobial activity on these microorganisms.
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Affiliation(s)
- Lisa Danielly Curcino Araujo
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
| | - Raquel Assed Bezerra da Silva
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Sérgio Luiz Sousa Salvador
- Department of Clinical Analyses, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Michel Reis Messora
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Flávia Aparecida Chaves Furlaneto
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina Del Arco Mastrange
- Department of Clinical Analyses, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Carolina Maschietto Pucinelli
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Léa Assed Bezerra da Silva
- Department of Pediatric Dentistry, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Song B, Xian W, Sun Y, Gou L, Guo Q, Zhou X, Ren B, Cheng L. Akkermansia muciniphila inhibited the periodontitis caused by Fusobacterium nucleatum. NPJ Biofilms Microbiomes 2023; 9:49. [PMID: 37460552 DOI: 10.1038/s41522-023-00417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Periodontitis is the most important cause of tooth loss in adults and is closely related to various systemic diseases. Its etiologic factor is plaque biofilm, and the primary treatment modality is plaque control. Studies have confirmed that Fusobacterium nucleatum can cause periodontitis through its virulence factors and copolymerizing effects with other periodontal pathogens, such as the red complex. Inhibiting F. nucleatum is an essential target for preventing periodontitis. The time-consuming and costly traditional periodontal treatment, periodontal scaling, and root planing are a significant burden on individual and public health. Antibiotic use may lead to oral microbial resistance and microbiome imbalance, while probiotics regulate microbial balance. Akkermansia muciniphila is a critical probiotic isolated from the human intestine. It can protect the integrity of the epithelial barrier, regulate and maintain flora homeostasis, improve metabolism, and colonize the oral cavity. Its abundance is inversely correlated with various diseases. We hypothesized that A. muciniphila could inhibit the effects of F. nucleatum and alleviate periodontitis. Bacterial co-culture experiments showed that A. muciniphila could inhibit the expression of the virulence gene of F. nucleatum. After treating gingival epithelial cells (GECs) with F. nucleatum and A. muciniphila, transcriptome sequencing and ELISA experiments on medium supernatant showed that A. muciniphila inhibited the inflammatory effect of F. nucleatum on GECs by inhibiting TLR/MyD88/NF-κB pathway modulation and secretion of inflammatory factors. Finally, animal experiments demonstrated that A. muciniphila could inhibit F. nucleatum-induced periodontitis in BALB/c mice.
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Affiliation(s)
- Bingqing Song
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Wenpan Xian
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Yan Sun
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Lichen Gou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China.
| | - Lei Cheng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, 610041, Chengdu, China.
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, 610041, Chengdu, China.
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Vale GC, Mota BIS, Ando-Suguimoto ES, Mayer MPA. Effect of Probiotics Lactobacillus acidophilus and Lacticaseibacillus rhamnosus on Antibacterial Response Gene Transcription of Human Peripheral Monocytes. Probiotics Antimicrob Proteins 2023; 15:264-274. [PMID: 34405373 DOI: 10.1007/s12602-021-09832-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 12/23/2022]
Abstract
Periodontitis and related systemic inflammatory diseases are characterized by imbalanced ratio between pro- and anti-inflammatory factors. Probiotics may control inflammation by altering the inflammatory phenotype of defense cells. We aimed to evaluate the gene transcription of the antibacterial response of monocytes to exposure to probiotic lactobacilli. CD14 + monocytes were obtained by positive selection from peripheral blood mononuclear cells from healthy donors (5 × 104 CD14 + /mL) and cultured with probiotic strains of Lacticaseibacillus rhamnosus (LR-32) and Lactobacillus acidophilus (LA-5) at a 1:10 multiplicity of infection in 24-well plates for 12 h. The gene expression analysis was performed by RT-qPCR using the Kit RT2 human antibacterial response, and in the supernatant, the cytokines were determined by ELISA. Tukey's post hoc test following an ANOVA with a p value of 5% was used for statistical analysis. Both probiotic strains increased the levels of cytokines TNF-α and CXCL-8 in the supernatant compared to the control of non-challenged cells (p < 0.05), but for IL-1Β and IL-6, this effect was observed only for LA-5 (p < 0.05). The fold-regulation values for the following genes for LA-5 and LR-32 were, respectively, IL-12B (431.94 and 33.30), IL-1Β (76.73 and 17.14), TNF-α (94.63 and 2.49), CXCL-8 (89.59 and 4.18), and TLR-2 (49.68 and 3.40). Likewise, most of the other genes evaluated showed greater expression for LA-5 compared to LR-32 (p < 0.05). The positive regulation of inflammatory factors such as IL-1β promoted by L. acidophilus LA-5 may increase the antibacterial activity of innate defense in periodontal tissues. However, this property may be deleterious by increasing inflammatory response.
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Affiliation(s)
- Glauber Campos Vale
- Restorative Dentistry Department, Federal University of Piauí, Teresina, Brazil.
| | | | | | - Marcia Pinto Alves Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Amato M, Di Spirito F, D’Ambrosio F, Boccia G, Moccia G, De Caro F. Probiotics in Periodontal and Peri-Implant Health Management: Biofilm Control, Dysbiosis Reversal, and Host Modulation. Microorganisms 2022; 10:2289. [PMID: 36422359 PMCID: PMC9694231 DOI: 10.3390/microorganisms10112289] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 07/30/2023] Open
Abstract
Periodontitis and peri-implantitis are microbially associated diseases of the tissues supporting the teeth and dental implants that are mediated by host inflammation and eventually lead to tooth and dental implant loss. Given the probiotics' role in biofilm control, dysbiosis reversal, and host modulation, their potential beneficial effects on the improvement of periodontitis and peri-implantitis have been recently investigated. Moreover, probiotics use has also been proposed in periodontal health management in patients undergoing fixed orthodontic therapy. Therefore, the present study aimed to review, considering the periodontal microbiome composition around teeth and dental implants in healthy and pathological conditions, the putative favorable effects of probiotics on gingivitis, periodontitis, and peri-implantitis. The secondary aim of the present narrative review was to synthesize the supporting evidence and proposed protocols for probiotics use as adjuncts in periodontitis and peri-implantitis treatment and the periodontal health management of orthodontic patients with fixed appliances. Contrasting findings from the literature may be due to the different methods, posology, and duration of probiotics prescriptions and due to the heterogeneous biological and clinical measurement methods employed. Thus, no definitive conclusions could be drawn about the effectiveness of probiotics in periodontal management, both in healthy and pathological conditions. Further studies are needed to validate probiotics for periodontal management and provide recommended protocols.
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Jørgensen MR, Abrahamsson P, Wälivaara DÅ, Twetman S. Probiotic supplements and postoperative complications after tooth extractions and third molar surgery: a systematic review. Minerva Dent Oral Sci 2022; 71:242-247. [PMID: 35920291 DOI: 10.23736/s2724-6329.22.04661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Probiotics have gained considerable attention as intervention for various conditions in dentistry. The purpose of this review is to evaluate the current literature on the efficacy of probiotic supplements for alleviating symptoms after tooth extractions and third molar surgery. EVIDENCE ACQUISITION We searched the PubMed and Google Scholar databases up to October 15, 2021 using pertinent keywords to retrieve relevant literature. Based on abstracts, the authors reviewed the full text papers, extracted key outcome data, and assessed the risk of bias. EVIDENCE SYNTHESIS Four articles based on three RCT's were included of which three allowed compilation. There were no beneficial effects on the occurrence of postoperative infections or alveolitis, but we disclosed a significant trend towards less self-reported pain one week after the tooth extractions (RD -0.22; 95% CI -0.33; -0.11; P<0.05). Findings concerning swelling, discomfort and use of painkillers were inconsistent. CONCLUSIONS Probiotic supplements may offer clinical benefits within oral surgery, such as alleviating pain after tooth extractions. However, the certainty of these findings was very low due to risk of bias, heterogeneity, and inconsistencies across the studies. Further and larger investigations are required to strengthen the level of evidence.
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Affiliation(s)
- Mette R Jørgensen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark -
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Di Stefano M, Polizzi A, Santonocito S, Romano A, Lombardi T, Isola G. Impact of Oral Microbiome in Periodontal Health and Periodontitis: A Critical Review on Prevention and Treatment. Int J Mol Sci 2022; 23:ijms23095142. [PMID: 35563531 PMCID: PMC9103139 DOI: 10.3390/ijms23095142] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
The skin, oral cavity, digestive and reproductive tracts of the human body harbor symbiotic and commensal microorganisms living harmoniously with the host. The oral cavity houses one of the most heterogeneous microbial communities found in the human organism, ranking second in terms of species diversity and complexity only to the gastrointestinal microbiota and including bacteria, archaea, fungi, and viruses. The accumulation of microbial plaque in the oral cavity may lead, in susceptible individuals, to a complex host-mediated inflammatory and immune response representing the primary etiological factor of periodontal damage that occurs in periodontitis. Periodontal disease is a chronic inflammatory condition affecting about 20-50% of people worldwide and manifesting clinically through the detection of gingival inflammation, clinical attachment loss (CAL), radiographic assessed resorption of alveolar bone, periodontal pockets, gingival bleeding upon probing, teeth mobility and their potential loss in advanced stages. This review will evaluate the changes characterizing the oral microbiota in healthy periodontal tissues and those affected by periodontal disease through the evidence present in the literature. An important focus will be placed on the immediate and future impact of these changes on the modulation of the dysbiotic oral microbiome and clinical management of periodontal disease.
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Affiliation(s)
- Mattia Di Stefano
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
- Correspondence: (A.P.); (S.S.); Tel.: +39-095-3782638 (A.P. & S.S.)
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
- Correspondence: (A.P.); (S.S.); Tel.: +39-095-3782638 (A.P. & S.S.)
| | - Alessandra Romano
- Department of General Surgery and Surgical-Medical Specialties, Unit of Hematology, University of Catania, 95124 Catania, Italy;
| | - Teresa Lombardi
- Department of Health Sciences, Magna Græcia University, 88100 Catanzaro, Italy;
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy; (M.D.S.); (G.I.)
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Comparison Between Different Delivery Vehicles for the Probiotic Bifidobacterium animalis subsp. lactis HN019 on Experimental Periodontitis in Rats. Probiotics Antimicrob Proteins 2022; 14:313-325. [PMID: 35260963 DOI: 10.1007/s12602-022-09930-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to assess the effects of the probiotic (PROB) Bifidobacterium animalis subsp. lactis HN019 in two different delivery vehicles in experimental periodontitis (EP), including the gene expression for IL-10, IFN-γ, and FOXP3. In total, 32 rats were assigned into groups (n=8): C (control), EP, EP-PROB/Water, and EP-PROB/Milk. The probiotic was administered for 4 weeks, from baseline to euthanasia. Periodontitis was induced by ligatures 14 days after baseline. Data were statistically analyzed (p<0.05). Both probiotic groups presented decreased alveolar bone loss and increased interproximal attachment level than group EP. Also, these parameters were significantly improved in the Milk group when compared with the Water group. EP-PROB/Milk showed higher gene expression for IL-10 and lower for FOXP3 in relation to EP-PROB/Water and EP groups. The use of milk was able to potentiate the protective effects of B. lactis HN019 in rats under EP.
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Gheisary Z, Mahmood R, Harri shivanantham A, Liu J, Lieffers JRL, Papagerakis P, Papagerakis S. The Clinical, Microbiological, and Immunological Effects of Probiotic Supplementation on Prevention and Treatment of Periodontal Diseases: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14051036. [PMID: 35268009 PMCID: PMC8912513 DOI: 10.3390/nu14051036] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
(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.
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Affiliation(s)
- Zohre Gheisary
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
| | - Razi Mahmood
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
| | - Aparna Harri shivanantham
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
| | - Juxin Liu
- Department of Mathematics and Statistics, College of Arts and Science, University of Saskatchewan, 106 Wiggins Road, Saskatoon, SK S7N 5E6, Canada;
| | - Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Petros Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, College of Dentistry, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Silvana Papagerakis
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
- Correspondence: ; Tel.: +1-3069661960
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11
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El-Bagoory GKM, El-Guindy HM, Shoukheba MYM, El-Zamarany EA. The adjunctive effect of probiotics to nonsurgical treatment of chronic periodontitis: A randomized controlled clinical trial. J Indian Soc Periodontol 2021; 25:525-531. [PMID: 34898919 PMCID: PMC8603793 DOI: 10.4103/jisp.jisp_114_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/28/2021] [Accepted: 07/11/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Probiotics catch more attention as adjunctive periodontal therapy. This study was conducted to assess the benefit of locally delivered Lactobacillus reuteri (L. reuteri) probiotic as an adjunctive to scaling and root planing (SRP) in the treatment of chronic periodontitis clinically and microbiologically. Materials and Methods: Bacterial cultures and clinical evaluation were recorded in 20 sites of chronic periodontitis in 12 patients and followed up at 3 and 6 months from the start of intervention using clinical attachment level, probing pocket depth, plaque index (PI), bleeding on probing, and microbiologically for Porphyromonas gingivalis (P. gingivalis) load. Patients meeting the inclusion criteria were scheduled within 1 week for two sessions of SRP. After SRP, oral hygiene measures were reassured, and sites were divided randomly into two groups 10 sites each. Group I received SRP only, while Group II received SRP and subgingival delivery of 1 ml of probiotic L. reuteri suspension at baseline and 1, 2, and 4 weeks using a blunt syringe. A periodontal pack was applied after the placement of the drug. Results: We found noticeable variation between the two groups in all evaluation aspects at 3 and 6-month follow-up periods except PI at 6 months in which there was no significant difference between both groups. Conclusions: The results proved the antimicrobial benefit of L. reuteri probiotic as a promising adjunctive therapy in improving periodontal parameters. However, further long-term studies with large sample size are needed to evaluate the extent of the added value of L. reuteri suspension.
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Affiliation(s)
| | - Hoda Mohamed El-Guindy
- Department of Periodontology, Oral Medicine, Oral Diagnosis and Radiology, Faculty of Dentistry, Tanta, Egypt
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12
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Schlagenhauf U, Jockel-Schneider Y. Probiotics in the Management of Gingivitis and Periodontitis. A Review. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.708666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
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.
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Sang-Ngoen T, Czumbel LM, Sadaeng W, Mikó A, Németh DI, Mátrai P, Hegyi P, Tóth B, Csupor D, Kiss I, Szabó A, Gerber G, Varga G, Kerémi B. Orally Administered Probiotics Decrease Aggregatibacter actinomycetemcomitans but Not Other Periodontal Pathogenic Bacteria Counts in the Oral Cavity: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:682656. [PMID: 34447307 PMCID: PMC8383782 DOI: 10.3389/fphar.2021.682656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Wuttapon Sadaeng
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Alexandra Mikó
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dávid István Németh
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Mátrai
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Barbara Tóth
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Dezső Csupor
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szabó
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Gerber
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Beáta Kerémi
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
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Retamal-Valdes B, Teughels W, Oliveira LM, da Silva RN, Fritoli A, Gomes P, Soares GMS, Temporão N, Furquim CP, Duarte PM, Doyle H, Faveri M, Figueiredo LC, Feres M. Clinical, microbiological, and immunological effects of systemic probiotics in periodontal treatment: study protocol for a randomized controlled trial. Trials 2021; 22:283. [PMID: 33858486 PMCID: PMC8048221 DOI: 10.1186/s13063-021-05246-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Belen Retamal-Valdes
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, Katholieke Universiteit Leuven (KULeuven), Leuven, Belgium
| | - Laryssa Macedo Oliveira
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Rebeca Nascimento da Silva
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Aretuza Fritoli
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Patricia Gomes
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | | | - Natalie Temporão
- Department of Stomatology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Camila Pinheiro Furquim
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.,Department of Stomatology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.,Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Helio Doyle
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Marcelo Faveri
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
| | - Luciene Cristina Figueiredo
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil.
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Centro de Pós-Graduação e Pesquisa-CEPPE, Guarulhos University, Praça Tereza Cristina, 229 Centro, Guarulhos, SP, 07023-070, Brazil
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Alqahtani F, AlShaikh M, Mehmood A, Alqhtani N, Alkhtani F, AlEnazi A. Efficacy of antibiotic versus probiotics as adjuncts to mechanical debridement for managing peri-implant mucositis. J ORAL IMPLANTOL 2021; 48:99-104. [PMID: 33450748 DOI: 10.1563/aaid-joi-d-20-00259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective was to compare the efficiency of probiotic (PT) versus antibiotic therapy (AT) as adjuvants to non-surgical-mechanical debridement (NSMD) in the treatment of peri-implant mucositis (Pi-M). Volunteers with Pi-M were encompassed. Therapeutically, patients were randomly divided into 3-groups: (a) Group-1: NSMD + PT; (b) Group-2: NSMD + AT; and (c) Group-3: NSMD alone. Peri-implant plaque index (P.I), bleeding on probing (B.O.P), probing depth (P.D) and crestal-bone-loss (C.B.L) were recorded at baseline and at 3-and 6-months follow-up. P<0.05 was selected as the indicator of statistical significance. Forty-two male individuals (14, 14 and 14 in groups 1, 2 and 3, respectively) were included. At 3- and 6-months of follow-up, P.I (P<0.01), B.O.P (P<0.01) and P.D (P<0.01) were higher in Group-2 than Group-1. At 3-months of follow-up, P.I (P<0.01), B.O.P (P<0.01) and P.D (P<0.01) were higher in Group-3 than Group-2. At 6-months of follow-up, P.I, B.O.P and P.D were comparable in groups 2 and 3. In Group-3, P.I, B.O.P and P.D were comparable with the respective baseline values at 6-months of follow-up. The C.B.L in all groups remained unchanged up to 6-months of follow-up. The NSMD with adjuvant PT is more effective than adjunct AT in the treatment of Pi-M for up to 3-months.
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Affiliation(s)
- Fawaz Alqahtani
- Prince Sattam bin Abdulaziz University Associate professor Prosthodontics Al-Kharj SAUDI ARABIA Al-Kharj Al-Kharj 92354 9734209102 Prince Sattam bin Abdulaziz University
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