Oral hygiene instruction and scaling and root planing (SRP) is the mainstay of care for the management of chronic periodontal disease (CP) . The use of probiotics to modulate oral biofilms has been suggested as an adjunct to SRP.

The aim of this review was to assess the clinical influence of probiotics as an adjunctive therapy of scaling and root planing (SRP) when compared with SRP alone or in combination with placebo in the treatment of chronic periodontitis (CP)

Methods

Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL). Medline and Science Direct databases supplemented by hand searches of the Journal of Clinical Periodontology; Journal of Periodontology; Journal of Periodontal Research; Journal of Dental Research.

Randomised controlled trials in patients with chronic periodontitis comparing scaling and root planing (SRP) and probiotic verses SRP and placebo or SRP alone were considered. Two reviewers independently selected studies and assessed risk of bias. Primary outcome measures were periodontal pocket depth (PPD) and clinical attachment level (CAL). Meta-analysis estimated PPD reduction (mean PPD; moderate and deep pockets), CAL gain and reduction of percentage of sites with bleeding on probing (BOP) expressed as the average difference between baseline and follow-up.

Results

• 4 studies involving a total of 130 patients were included.
• Follow up periods ranged from 42 days to 1 year
• All 4 studies were considered to be at low risk of bias.
• 3 studies contributed to a meta-analysis
  • There was no significant difference in PPD
  • A statistically significant CAL gain (-0.42 mm, p = 0.002) and bleeding on probing (BOP) reduction (-14.66, p = 0.003) was seen for SRP + probiotic treatment versus SRP at short-term.

Conclusions

The authors concluded

To date, only a few studies investigated the effect of adjunctive probiotics to SRP in the management of CP, as it is an emerging potential therapeutic. Within the limitations of this study, the findings of this meta- analysis seem to support the adjunctive use of L. reuteri to SRP in CP treatment at short-term. This treatment protocol has shown similar results to other adjunctive treatments in CP treatment. However, long-term RCTs are needed.

Comments

This review was only able to include 4 small studies although there were all considered to be at low risk of bias. The review found a statistical significant benefit for CAL and bleeding on probing but not for PPD although subgroup analysis did suggest a benefit for PPD in moderate and deep pockets. These findings are similar to an earlier review by Gruner et al that we considered in a blog on the 18^th April 2016.  Another review by Matsubara et al has also been published this month. This includes 12 RCTs and the abstract reports that

in general, oral administration of probiotics improved the recognized clinical signs of chronic and aggressive periodontitis such as probing pocket depth, bleeding on probing, and attachment loss, with a concomitant reduction in the levels of major periodontal pathogens’

However, I have not been able to access the full review and  overall the number of studies available is small and mainly of short duration so larger studies of longer duration a needed to assess the clinical impact of probiotics.

Links

Primary paper

Martin-Cabezas R, Davideau JL, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2016 Jun;43(6):520-30. doi: 10.1111/jcpe.12545. Epub 2016 May 7. Review. PubMed PMID: 26970230.

Other references

Probiotics – insufficient evidence supporting use to manage caries or periodontal disease

Matsubara VH, Bandara HM, Ishikawa KH, Mayer MP, Samaranayake LP. The role of probiotic bacteria in managing periodontal disease: a systematic review. Expert Rev Anti Infect Ther. 2016 May 25. [Epub ahead of print] PubMed PMID: 27224284.