Abstract
Purpose: Probiotics may exclude or antagonize oral pathogens and be useful to prevent oral dysbiosis and treat oral diseases. The objective of this review was to assess the benefits of probiotics in oral health and disease, and in dental practice; Methods: Primary articles published between January 2012 and 30 December 2020 with full text available were searched in PubMed, ClinicalTrials.gov, ScienceDirect, Google Scholar, B-on, and SciELO; Results: The electronic search identified 361 references of which 91 (25.2%) met all the inclusion criteria. In total, data from 5374 participants with gingivitis, periodontitis, peri-implantitis, caries, orthodontic conditions, halitosis, or oral conditions associated with chemo-radiotherapy were included. Despite major inconsistencies between clinical trials, probiotics have been found to contribute to reduce S. mutans counts (L. paracasei SD1), reduce probing depth in chronic periodontitis (B. animalis subsp. lactis DN-173010 with L. reuteri), reduce levels of volatile sulfur compounds and halitosis (L. salivarius WB21), treat oral mucositis and improve the quality of life of patients undergoing cancer chemo-radiotherapy (L. brevis CD2). Combinations of probiotic bacteria tend to lead to higher clinical efficacy than any individual probiotic agent; Conclusion: Oral probiotics influence favorably the oral microbiota and provide benefits to the oral ecosystem in periodontal diseases, cariology, halitosis, orthodontics and management of oral mucositis resulting from cancer treatment. However, the use of probiotics in dental practice or in self-management preventive strategies requires additional well controlled clinical trials to determine the most effective probiotic combinations, the most appropriate probiotic vehicle, and the frequency of administration.
Highlights
308 references were selected for eligibility based on the titles and abstracts, excluding in vitro studies, animal studies, and ongoing and unpublished clinical trials
38 clinical trials were excluded because oral health was not the focus of the study, because the study design was unclear, there was no information about allocation, the intake of probiotics was evaluated in animals, and studies were performed in vitro
The 91 randomized controlled trials (RTCs) included in the review involve data from 5374 participants with gingivitis (n = 14), periodontitis (n = 21), peri-implantitis (n = 8), carie (n = 23), orthodontic conditions (n = 6), halitosis (n = 4), oral conditions associated with chemo-radiotherapy (n = 6) and changes in the oral ecosystem (n = 9)
Summary
The oral cavity is a dynamic ecosystem, with environmental changes and permanent interactions in which commensal bacteria limit the colonization of pathogenic microorganisms. The oral microbiota is heterogeneous and diverse, and its imbalance leads to the onset of major oral diseases such as periodontitis and dental caries [1]. Conventional treatment of these diseases involves removal of the bacterial plaque by mechanical means and antimicrobial drug therapy which may have limited efficacy due to drug resistance [2]. It is necessary to look for alternatives and adjuvants to conventional therapeutic and prevention approaches and probiotics may play an important role in this context
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