Abstract
(1) Background: Periodontal diseases are a global health concern. They are multi-stage, progressive inflammatory diseases triggered by the inflammation of the gums in response to periodontopathogens and may lead to the destruction of tooth-supporting structures, tooth loss, and systemic health problems. This systematic review and meta-analysis evaluated the effects of probiotic supplementation on the prevention and treatment of periodontal disease based on the assessment of clinical, microbiological, and immunological outcomes. (2) Methods: This study was registered under PROSPERO (CRD42021249120). Six databases were searched: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Dentistry and Oral Science Source. The meta-analysis assessed the effects of probiotic supplementation on the prevention and treatment of periodontal diseases and reported them using Hedge’s g standardized mean difference (SMD). (3) Results: Of the 1883 articles initially identified, 64 randomized clinical trials were included in this study. The results of this meta-analysis indicated statistically significant improvements after probiotic supplementation in the majority of the clinical outcomes in periodontal disease patients, including the plaque index (SMD = 0.557, 95% CI: 0.228, 0.885), gingival index, SMD = 0.920, 95% CI: 0.426, 1.414), probing pocket depth (SMD = 0.578, 95% CI: 0.365, 0.790), clinical attachment level (SMD = 0.413, 95% CI: 0.262, 0.563), bleeding on probing (SMD = 0.841, 95% CI: 0.479, 1.20), gingival crevicular fluid volume (SMD = 0.568, 95% CI: 0.235, 0.902), reduction in the subgingival periodontopathogen count of P. gingivalis (SMD = 0.402, 95% CI: 0.120, 0.685), F. nucleatum (SMD = 0.392, 95% CI: 0.127, 0.658), and T. forsythia (SMD = 0.341, 95% CI: 0.050, 0.633), and immunological markers MMP-8 (SMD = 0.819, 95% CI: 0.417, 1.221) and IL-6 (SMD = 0.361, 95% CI: 0.079, 0.644). (4) Conclusions: The results of this study suggest that probiotic supplementation improves clinical parameters, and reduces the periodontopathogen load and pro-inflammatory markers in periodontal disease patients. However, we were unable to assess the preventive role of probiotic supplementation due to the paucity of studies. Further clinical studies are needed to determine the efficacy of probiotic supplementation in the prevention of periodontal diseases.
Highlights
Periodontal disease is a growing public health concern, affecting approximately 750Periodontal disease is a growing million individuals worldwide [1]
The gingival crevicular fluid (GCF) volume had statistically significant reductions in both gingivitis and periodontitis patients; Probiotic formulations consisting of Lactobacillus species and, L. reuteri were associated with statistically significant improvements in all clinical outcomes in patients with periodontal disease; Probiotic treatment duration, which showed that probiotic supplementation resulted in statistically significant improvements in the clinical outcomes after one month of supplementation in periodontal disease patients; Mode of probiotic delivery, which indicated that probiotic supplementation through the “oral and ingestion” mode was associated with statistically significant improvements in all clinical outcomes in periodontal disease patients
There is evidence indicating that, when probiotics or antibiotics were administered independently, neither one was more efficacious than Scaling and Root Planing (SRP) alone [10,61]. These conclusions warrant more research, our meta-analysis indicated improved clinical outcomes, and it is plausible from a mechanistic perspective that probiotic supplementation as an adjuvant to SRP may be a safer and more effective long-term therapeutic option in the management of periodontal disease compared to antibiotics
Summary
Periodontal disease is a growing million individuals worldwide [1]. Thepublic burdenhealth of thisconcern, disease isaffecting expectedapproximately to continue to million individuals worldwide [1]. The burden of this disease is expected to congrow as the global population ages [2,3]. Periodontal disease is preventable and reversible tinue to grow as the global population ages [2,3]. Periodontal disease is preventable and in its early stages; it can progress to chronic, irreversible states with significant reversible in its early stages; it can progress to chronic, irreversible states with destruction of the tooth-supporting tissues [4]. The cause of periodontal disease is multisignificant destruction of the tooth-supporting tissues [4]. The underlying link of periodontal disease with other temic health and quality of life [5,6]. The underlying link of periodontal disease with other chronic systemic diseases likely results from the dissemination of periodontopathogens chronic systemic diseases likely results from the dissemination of periodontopathogens into into the bloodstream, endotoxin release, and the associated imbalanced inflammatory rethe bloodstream, endotoxin release, and the associated imbalanced inflammatory response sponse to periodontopathogens [7,8]
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