Canut-Delgado, N., Giovannoni, M. & Chimenos-Küstner, E. Are probiotics a possible treatment of periodontitis? Probiotics against periodontal disease: a systematic review. Br Dent J (2021).
Background
Periodontal disease is an extremely prevalent oral disease according to the 2009 UK Adult Dental Health Survey, 37% of the adult population suffer from moderate levels of chronic periodontitis. Periodontal disease is currently treated by either surgical or non-surgical treatments and in rarer cases systemic antibiotics, the most preferred of these being scaling and root planing (SRP). SRP is an effective treatment however it does not address the ability of pathogenic bacteria to immediately recolonise periodontal pockets after treatment, antibiotics are the logical solution to this problem however they have the unwanted side effect of inducing antibiotic resistance. An alternative solution is to pair SRP with probiotic treatment and this article aims to evaluate the clinical effect of probiotics as an adjuvant treatment to scaling and root planing in patients with periodontitis.
Probiotics: Probiotics can be defined as ‘‘live microorganisms whose consumption in adequate quantities can bring health benefits’’ according to WHO. They have 2 methods of action in the oral environment: direct and indirect actions (Fig 1). Direct action occurs when the probiotics interact directly with dental plaque and either interrupt the formation of the biofilm or produce antimicrobial compounds e.g. oxygen peroxide. Indirect action occurs when probiotics modulate the innate/adaptive immune system by interacting with immunocompetent cells, such as macrophages and T cells, altering cytokine production, furthermore, some species of probiotics can improve mucin production and barrier function, regulate defence peptides, promote angiogenesis and wound healing.
Fig 1. Mechanisms of action of probiotics (direct and indirect actions).
Additionally, probiotics can be combined with prebiotics (selectively fermentable ingredients that allow specific changes in the composition and/or activity of the gastrointestinal microbiome, providing benefits in the host) to create a symbiotic to further improve the efficacy of the treatment.
Methods
This article uses a systematic review to investigate the use of probiotics in conjunction with SRP; this review adheres to the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) statement. A total of 10 studies were selected from the original 66, the details of which are outlined below in Fig 2.
Fig 2. The details of the included studies.
Results
The results from each study are shown in Fig 3.
Fig 3. Results from the 10 included studies.
Conclusion
Overall in 7 studies we can see an improvement in periodontal/microbial parameters when probiotics are used in conjunction with SRP when compared with SRP in conjunction with a placebo. 3 studies showed an insignificant difference between the 2 groups, however in two trials, a reduction of other factors involved in inflammation was obtained, such as IL-8, TNF IL-17 and IL-1B. Currently, across multiple studies, a significant difference in administration route has not yet been found but L. reuteri, L. salivarius and B. animalis lactis are seen to be more effective. A significant reduction in the pathogenic bacteria P. gingivalis and Prevotella intermedia, Treponema denticola, Fusobacterium nucleatum and A. actinomycetemcomitans can also be seen. To conclude, the majority of the evidence proves that using probiotics in conjunction with standard non-surgical periodontal therapy can provide a significant improvement in both the periodontal and microbial parameters.
Research Summary Written By: Bilal Aslam, University of Manchester – BDS3