Probiotics a Potential Therapeutic for Periodontal Disease

Objectives: Periodontal disease is a worldwide health concern. It is an inflammatory disease, triggered by mild inflammation of the gum line in response to periodontopathogens causing progressive destruction of the tooth-supporting structures and may eventually lead to tooth loss and systemic health problems. Although several lines of treatment exist, there is still a need for non-invasive treatment options.The objectives of this systematic review and meta-analysis are to evaluate the effectiveness of probiotic supplements in the prevention and treatment of periodontal disease through assessing clinical, microbiological and immunological outcomes.
Methods: Databases searched included: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and Dentistry and Oral Science Source. Randomized clinical trials comparing the effects of using probiotics reporting clinical (Clinical Attachment Level (CAL), Probing Pocket Depth (PPD), Bleeding on Probing (BOP), Plaque Index (PlI) and Gingival Index (GI)), microbiological (Periodontopathogen load) or immunological outcomes were included. Meta-analysis was conducted to estimate the pooled effect size.
Results: Out of 1883 studies, 70 remained after screening. Results of the meta-analysis indicated probiotics improved the majority of clinical outcomes in periodontal disease patients (CAL: SMD=0.439, 95% CI:0.289-0.590; PPD: SMD=0.571, 95% CI:0.440-0.701; BOP: SMD=0.634, 95% CI:0.481-0.786; PlI: SMD=0.404, 95% CI:0.049-0.759; GI: SMD=0.794, 95% CI:0.344-1.244), the subgingival count of P. gingivalis (SMD=0.410, 95% CI:0.121-0.698), F. nucleatum (SMD=0.4, 95% CI:0.129-0.670), and T. forsythia (SMD=0.348, 95% CI:0.051-0.645), immunological outcomes MMP-8 (SMD=0.832 , 95% CI:0.424-1.241), and IL-6 (SMD=0.366, 95% CI:0.080-0.652) and the gingival crevicular fluid (GCF) volume (SMD=0.583, 95% CI:0.242-0.925).
Conclusions: The results of this study suggest probiotics can improve clinical outcomes, reduce periodontopathogen load and GCF volume in periodontitis patients. Their preventive and therapeutic roles in gingivitis was difficult to assess due to the dearth of studies. Thus, probiotics can be recommended as a potential therapeutic avenue in the management of periodontal disease.