Probiotics may be effective adjuncts to nonsurgical periodontal therapy in patients with periodontal disease.
Periodontal disease—the eleventh most prevalent condition globally—is a chronic immune-inflammatory disease caused by the interaction of the oral microbiome with the gingival and periodontal soft tissues. The condition can lead to tooth loss, compromised mastication, esthetics, self-confidence, and poor quality of life. It is also linked to many systemic diseases including diabetes, cardiovascular disease, Alzheimer's disease, rheumatoid arthritis, and chronic kidney disease.
Treatment for periodontal disease primarily involves the mechanical removal of oral biofilm through thorough periodontal debridement (scaling and root planing - SRP) either manually or with machine-driven instruments. Antimicrobial agents in various forms are also used either systemically or locally as adjuncts to SRP.
In a systematic review published in Oral Diseases, investigators searched six electronic databases and identified 10 clinical studies comparing the efficacy of probiotics with antimicrobial agents in patients with periodontal disease. A total of 360 participants were included across these studies.
The review included studies on chronic periodontitis, aggressive periodontitis, and gingivitis. The study participants were aged 14 to 60 years. Various probiotic strains were examined, including Lactobacillus brevis, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus reuteri, Lactobacillus sporogenes, Bifidobacterium bifidum, and Bifidobacterium longum. The probiotics were compared to several antibiotics, including doxycycline, tetracycline, amoxicillin/metronidazole, azithromycin, and chlorhexidine. The follow-up periods in the included studies ranged from 7 days to 12 months.
The meta-analysis showed no statistically significant difference between probiotics and antibiotics in controlling probing pocket depth. Probiotics showed a significant reduction in clinical attachment loss compared to antibiotics. Antibiotics were more effective in reducing the plaque index and gingival index. A combination of probiotics and antibiotics was found to be superior compared to probiotics and antibiotics alone.
The authors noted that probiotics can be used as an alternative to antibiotics, however, a combination is more effective for managing periodontal disease. They emphasized that these adjuncts should not be used as stand-alone therapy, and effective scaling and root planing, patient education, and regular monitoring should be an integral part of periodontal disease management. The review also highlighted that patient compliance and home oral care are important factors in the long-term success of periodontal therapy.
The review noted some advantages of probiotics over antibiotics, including maintaining beneficial bacteria and avoiding gut dysbiosis.
The review highlighted limitations including high clinical heterogeneity among the included studies and a high risk of bias in some studies due to poor blinding and concealment of outcomes and assessor. The authors called for future studies to be conducted with more standardized controls and specific patient populations to further evaluate the efficacy of probiotics compared to antibiotics in managing periodontal disease.
No conflicts of interest were disclosed.
