Systematic Literature Review Assesses the Role of Probiotics in Conjunction With Standard of Care for Treating Periodontal Disease

Findings from a literature review published in Applied Sciences indicated that employing probiotics as an adjunct therapy to non-surgical periodontal treatment (NSPT) demonstrates some improvement in treating periodontal diseases (PD); however, more research is warranted.

Researchers conducted a systematic literature review utilizing literature published between November 2016 and February 2022 in accordance with guidelines for systematic reviews and meta-analyses (PRIMSA), which included only randomized controlled trials. The study population included adult patients diagnosed with stage 3 or 4 periodontitis who were administered probiotics as an adjunctive therapy to NSPT.

The authors indicated that the usage of probiotics could have a possible benefit in the treatment of periodontal disease, and while numerous clinical studies have explored the impact of probiotics as adjunctive therapy to NSPT, there is a lack of clinical data regarding the clinical implications associated with probiotics in treating PD, including long-term microbiological and immunological clinical results.

The authors wrote, “The research question was formulated following the population, intervention, comparison, and outcome strategies. Randomized controlled trials (RCT), systematic review, and meta-analysis investigating the periodontal efficacy of domiciliary probiotic therapy in an adjunct to the mechanical therapy were included.”

The objective of this review was to evaluate the long-term efficacy of utilizing probiotics in conjunction with NSPT, the current standard of care (SOC) for treating periodontal disease, compared to control groups. The researchers also examined follow-up of clinical, microbiological, and immunological outcomes in patients with periodontitis.

The primary outcome measures noted by the authors in this literature review included the following: “ 1) probing depth of the pocket (PPD), 2) the level of clinical attachment (CAL), and 3) bleeding on probing (BOP).”

The authors indicated that their search yielded 11 studies that met their inclusion criteria, with 9 being double-blind placebo-controlled RCTs and two being placebo-controlled RCTs.

Results revealed that with regard to clinical outcomes, in a short-term period, comparing the control with test groups, there was a decrease in PPD, CAL, BoP, and plaque index (PI) among the test groups. The authors also noted that over more than three months, for most of the studies reviewed, no variances were typically detected in the above mentioned indices.

Based on their findings, the authors wrote, “In conclusion, weak evidence suggests that the use of probiotics as an adjunct to non-surgical periodontal therapy treatment may be able to show improvements in periodontal clinical parameters for up to 3 months. However, a significant and large heterogeneity of studies, along with the absence of long-term microbiological and immunological data, preclude any definitive conclusions.”

Lastly, the authors noted that more research, including conducting large-scale RCTs, is necessary with uniform approaches and long-term follow-up periods to verify the efficacy of probiotics as adjunctive therapy in periodontal disease management. Moreover, additional research is warranted to identify the clinical recommendations, which include appropriate dosage, dosage intervals, and optimal routes of administration.

Source

Butera A, Folini E, Cosola S, Russo G, Scribante A, Gallo S, Stablum G, Menchini Fabris GB, Covani U, Genovesi A. Evaluation of the Efficacy of Probiotics Domiciliary Protocols for the Management of Periodontal Disease, in Adjunction of Non-Surgical Periodontal Therapy (NSPT): A Systematic Literature Review. Applied Sciences. 2023; 13(1):663. https://doi.org/10.3390/app13010663.