Probiotic Lozenges Research Articles

PROBIOTIC LACTOBACILLUS REUTERI EFFECT’S ON THE LEVELS OF INTERLEUKIN-4 IN PERIODONTITIS PATIENTS AFTER SCALING AND ROOT PLANING

Objective: Periodontal disease is an inflammatory disease principally caused by a complex interaction between pathogenic bacteria and immuneresponses. Probiotics stimulate the immune system of the oral mucosa by increasing the production of anti-inflammatory cytokines. Interleukin-4 (IL-4) isthe anti-inflammatory cytokine that is most closely associated with the pathogenesis of periodontitis. This study assessed the effect of Lactobacillus reuteri(L. reuteri) containing probiotic lozenges toward clinical attachment loss (CAL) and IL-4 levels in periodontitis patients after scaling and root planing.Materials and Methods: Clinical samples were collected from the gingival crevicular fluid of 16 periodontitis patients with pocket depth (PD) of6 mm. The samples were divided into two groups. The non-probiotic group included periodontitis patients treated through scaling and root planing(SRP) only (n=8), whereas the probiotic group included periodontitis patients treated through SRP and probiotics (n=8). The measurements of theclinical parameters of PD and CAL were included as diagnostic criteria. Probiotic lozenges were given daily for 14 days. IL-4 levels were measured inboth groups using the enzyme-linked immunosorbent assay (ELISA) method.Results: IL-4 levels decreased in the non-probiotic group and increased in the probiotic group, but there was no statistical difference between thegroups. CAL decreased in both groups and was significantly different.Conclusion: SRP with the consumption of probiotic-containing L.reuteri in periodontitis patients resulted in decreased CAL and increased IL-4 levelscompared with SRP only.

Effectiveness of probiotic lozenges and Chlorhexidine mouthwash on plaque index, salivary pH, and Streptococcus mutans count among school children in Makkah, Saudi Arabia

PurposeTo compare the effect of the probiotic lozenges and chlorhexidine (CHX) mouthwash on plaque index (PI) , salivary pH and Streptococcus mutans (S. mutans) 3 count among groups of Saudi children. MethodsA total of 54 participants aged 8-12 years were randomly allocated into three groups, 18 children in each group. Children in the probiotic group consumed one probiotic lozenge (Biogaia prodentis) daily, while children in the CHX group were instructed to use CHX mouthwash twice daily. The control group was only instructed to follow regular oral hygiene measures. Saliva samples were taken at baseline, 15th and 30th days. PI scores, salivary pH values and S. mutans count were evaluated. Data were statistically analyzed using the ANOVA and the Tukey post-hoc test. ResultsProbiotic lozenges and CHX mouthwash significantly reduced PI and S. mutans count and increased the salivary pH values. However, there were no statistical differences between the effect of probiotic lozenges and CHX mouthwash on PI (p-value= 800) and pH values (p-value= 0.927) on the 30th day. Conversely a significant difference was reported among their effects on S. mutans count (p-value=0.014) on the 30th day. Greater acceptance and compliance of children to probiotic lozenges were reported. ConclusionsProbiotic lozenges could be an alternative to CHX mouthwash and encouraged to be included with the daily oral hygiene measures.

Effectiveness of Probiotic Lozenges in Periodontal Management of Chronic Periodontitis Patients: Clinical and Immunological Study.

Objective The main purpose of this article was to evaluate the effect of probiotics used as an adjunctive to scaling and root planing (SRP) on the periodontal parameters and matrix metalloproteinase-8 (MMP-8) levels in gingival crevicular fluid (GCF) of chronic periodontitis patients. Materials and Methods A total of 25 chronic periodontitis patients who completed the treatment course of 40 subjects, aged 25 to 58 years, participated in this study. They were categorized into two groups: the first group was treated by SRP while the second group was treated by SRP and probiotic lozenges twice a day for 30 days. All patients were evaluated clinically by measuring the plaque index, bleeding index (BI), pocket depth, clinical attachment loss, and immunologically by assaying GCF/MMP-8 at baseline and 30 days after periodontal management. Results There was a significant improvement in periodontal parameters after SRP treatment with and without probiotic lozenges in both groups. However, there was a significant decrease in the BI ( p = 0.05) in SRP and probiotic lozenges group after 30 days compared with SRP alone. In addition, there was a significant decrease in GCF/MMP-8 levels after 30 days in patients managed by SRP only ( p = 0.017) compared with the baseline in both groups, whereas a highly significant decrease in patients treated by SRP and probiotics ( p = 0.001). Conclusion The current study suggested that the probiotics might have a beneficial effect on clinical and immunological outcomes in the management of chronic periodontitis patients. Further research is needed on a large-scale population and for a long recall time to confirm the response to probiotics as an adjunctive to SRP.

Comparative evaluation of different probiotic products on salivary Streptococcus mutans and Lactobacillus level in caries risk population.

Introduction:Dental caries is a multifactorial disease with the main causative organism being Streptococcus mutans and Lactobacillus spp. “Probiotics” are defined as living microorganisms, principally bacteria, which are safe for human consumption and when ingested in sufficient quantities, have beneficial effects on human health, beyond basic nutrition. These can be used to replace the pathogenic strains of bacteria with the nonpathogenic type in the oral cavity thus can help prevent dental caries.Aims:To evaluate and compare the role of probiotic milk and lozenges on S. mutans and Lactobacillus spp. count on patients who are exposed to probiotics continuously for 7 days.Materials and Methods:Sixty volunteers who were prone to caries were divided into three equal groups. Experimental groups were given probiotics daily for 7 days. In Group A, patients were given milk without any probiotics (control); in Group B, probiotic milk is given; and in Group C, probiotic lozenges are given. Saliva samples were assessed on the 1st day and after 7 days of intervention. The collected saliva samples were inoculated on the selected culture media and estimation was done by measuring the colony-forming unit.Statistical Analysis Used:Statistical analysis was performed using Student's paired t-test and multiple comparisons by Tukey's honest significant difference test.Results:There was a significant reduction in salivary S. mutans level in both experimental groups after 7 days (P < 0.05). However, there was no significant difference in Lactobacillus count before and after the intervention.Conclusions:Probiotics have a role in reducing salivary S. mutans count. Probiotics lozenges showed greater efficacy in reducing salivary S. mutans count than probiotic milk.

A dual-strain Lactobacilli reuteri probiotic improves the treatment of residual pockets: A randomized controlled clinical trial.

AimTo examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re‐instrumentation of residual pockets.Materials and MethodsThis randomized, double‐blind, placebo‐controlled study included 39 previously non‐surgically treated periodontitis patients. A re‐instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact.ResultsNo effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4–6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens.ConclusionThe adjunctive consumption of L. reuteri lozenges after re‐instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens.

Clinical efficacy of Lactobacillus reuteri-containing lozenges in the supportive therapy of generalized periodontitis stage III and IV, grade C: 1-year results of a double-blind randomized placebo-controlled pilot study.

The aim of this 12-month mono-centre double-blind randomized placebo-controlled clinical study was to evaluate the efficacy of Lactobacillus reuteri-containing lozenges during the supportive therapy of generalized periodontitis stage III and IV, grade C (GPIII-IVC) patients. Twenty treated GPIII-IVC patients were randomly divided into 2 groups. The test group received two 3-month-long administrations of L. reuteri (2 lozenges/day after brushing) with a 3-month washout period, while the control one received a placebo. Outcome measures were tooth survival, complications and adverse events, change in probing pockets depth (PPD), change in probing attachment level (PAL), presence of bleeding on probing (BOP) and patient's evaluation of treatment. Measurements were collected at 3, 6, 9 and 12months. At 1year, no dropout, tooth loss, complications or adverse event were recorded. Mean PPD and mean PAL and percentages of sites with BOP were statistically improved (p < 0.05) compared with baseline in both groups, while more PPD reduction at all time points (p < 0.05) and more PAL gain at 6months and more BOP reduction at 6 and 9months were found in the probiotic group (p < 0.05). Within the limitation of the study, the use of L. reuteri probiotics lozenges improved some clinical outcomes in treated GPIII-IVC patients during maintenance therapy. Studies with a larger number of patients are needed to confirm these data. The use of L. reuteri probiotic lozenges could be considered as an adjunct in the maintenance therapy of GPIII-IVC patients.

Evaluation of Streptococcus mutans serotypes e, f, and k in saliva samples of 6-12-year-old school children before and after a short-term daily intake of the probiotic lozenge.

The aim of this study is to assess the variations in the levels of Streptococcus mutans in saliva before and after short-term daily intake of the probiotic lozenge. To estimate the prevalence of S. mutans serotypes e, f, and k and its variations in salivary levels before and after short-term daily intake of the probiotic lozenge. This double-blind randomized controlled trial was conducted among 60 children of 6-12 years old, who were given lozenge twice daily containing probiotic bacteria twice daily, one in the morning and another in the evening after brushing for 1 month. The placebo lozenge group also followed the same protocol. A pre- and post-quantitative analysis of S. mutans and serotypes e, f, and k level were done in the saliva of both experiment and control groups. The data thus collected were statistically evaluated using repeated measures of ANOVA, followed by post hoc test and independent t-test. When compared with baseline, a significant reduction of S. mutans was seen after 1 month intervention and 6 months follow-up. The prevalence of serotype e was found to be 5% and serotype k was found to be 12%, whereas none of the samples carried serotype f. Future long-term research with a larger sample size is required to determine the prevalence of S. mutans serotype and longer evaluation period is required to assess the preventive role against caries development.

A double-blind, placebo controlled study to assess the clinical and microbiological effects of a probiotic lozenge as an adjunctive therapy in the management of chronic periodontitis

Background: The study was conducted to determine the effect of a probiotic lozenge as an adjunct to scaling and root planing in patients having chronic generalized periodontitis in a double blinded, placebo-controlled design. Materials and Methods: A total of 30 chronic generalized periodontitis patients, in the age group of 25–60 years were recruited for the study. Clinical parameters of plaque index (PI), bleeding index (BI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and microbiological levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia were assessed at baseline, 3, 6, and 12 weeks. All patients underwent scaling and root planing (SRP) at baseline and were recalled after 3 weeks. At 3 weeks, the patients were prescribed either probiotic or placebo lozenges for a 3-week period. Statistical analysis was conducted for clinical and microbiological parameters. Results: The PI, PPD, and CAL significantly reduced in both the groups from baseline to 12 weeks. GI and BI reduced significantly at 3 and 6 weeks in the probiotic group and at 3, 6, and 12 weeks in the placebo group. There was a significant decrease in the assayed periopathogens in both the probiotic and placebo groups at all-time intervals. Conclusions: The present study did not show a significant difference of using probiotic over SRP. As the duration of the study was limited to a period of 3 months, the need to conduct large multicenter studies is warranted to substantially validate the use of probiotics in the management of chronic periodontitis.

Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial.

AimThis randomized placebo‐controlled clinical trial evaluated the effect of Bifidobacterium animalis subsp. lactis (B. lactis) HN019‐containing probiotic lozenges as adjuvant to scaling and root planing (SRP) in patients with generalized chronic periodontitis.Materials and MethodsForty‐one chronic periodontitis patients were recruited and monitored clinically, immunologically, and microbiologically at baseline (before SRP) and 30 and 90 days after SRP. All patients were randomly assigned to a Test (SRP + Probiotic, n = 20) or Control (SRP + Placebo, n = 21) group. The probiotic lozenges were used twice a day for 30 days. The data were statistically analysed.ResultsThe Test group presented a decrease in probing pocket depth and a clinical attachment gain significantly higher than those of the Control group at 90 days. The Test group also demonstrated significantly fewer periodontal pathogens of red and orange complexes, as well as lower proinflammatory cytokine levels when compared to the Control group. Only the Test group showed an increase in the number of B. lactis HN019 DNA copies on subgingival biofilm at 30 and 90 days.ConclusionThe use of B. lactis HN019 as an adjunct to SRP promotes additional clinical, microbiological, and immunological benefits in the treatment of chronic periodontitis (NCT03408548).

The Effectiveness of Orally Administered Probiotic on Peri-Implant Tissue Condition: A Prospective Study

Purpose: This study investigated the effects of a probiotic lozenges in peri-implantitis patients. Method: 40 patients with mild to moderate peri-implantitis were involved in this study. Following a baseline clinical examination, a probiotic supplementation along with routine oral hygiene was recommended. The clinical examination was repeated at 30 and 90 days after beginning of probiotics supplementation. The clinical examination included probing pocket depth (PPD), bleeding on probing (BOP), the implant plaque index (IPI), implant stability (IS) and radiographic assessment. Results: Significant difference was observed in bleeding on probing (BOP), the implant plaque index (IPI) while probing pocket depth (PPD), implant stability (IS) and radiographic assessment didn’t show any statistical difference from baseline. Conclusion: This study suggests that probiotic supplementation prevents inflammation (bleeding on probing) by potentially interfering with microbial biofilm formation and affecting host responses in peri-implantitis patients.

PG - 71: Evaluation of Streptococcus Mutans (Serotypes E, F, And K) in Saliva Samples of 6-12 Years School Children Before and after a Short term daily intake of Probiotic Lozenge

PG - 71: Evaluation of Streptococcus Mutans (Serotypes E, F, And K) in Saliva Samples of 6-12 Years School Children Before and after a Short term daily intake of Probiotic Lozenge

Effect of probiotic lozenges containing Lactobacillus reuteri on oral wound healing: a pilot study.

It has been suggested that beneficial bacteria may stimulate wound healing. The aim was to investigate the effect of topical applications of probiotic lactobacilli on the healing of standardised oral wounds. This pilot study employed a randomised, placebo-controlled, double-blind cross-over design. Standardised biopsies were punched in the oral mucosa of 10 healthy volunteers, with and without exposure to two strains of Lactobacilli reuteri administrated as lozenges and topical oil. The healing was scored clinically after 2, 5 and 8 days. The amount of exudate was quantified through filter papers and the levels of selected cytokines and chemokines were determined with multiplex immunoassays. Saliva samples were collected before the biopsy and after healing for determination of oxytocin with ELISA. Subjectively perceived pain and discomfort was reported through a daily logbook. There was a clear tendency of improved healing in test group at the 2-and 5-day check-ups but the difference compared with the placebo intervention was not statistically significant (P=0.08). Higher but non-significant expressions of the tumour necrosis factor (TNF) superfamily ligand members 13 (APRIL) and 13B (BAFF), as well as the chemokine interleukin 8 (IL-8), were displayed in wound exudates from the probiotic group as compared with placebo, particularly after 5 and 8 days. The salivary levels of oxytocin were significantly lower (P<0.05) in the placebo group at the 8-day follow-up. The mean number of days with pain and/or discomfort after the biopsies was similar in both groups. No side-effects were reported. The findings of this pilot study justify a larger clinical trial to elucidate the possible role of probiotic supplements on oral wound healing.

Clinical and microbiological evaluation of the effect of Lactobacillus reuteri in the treatment of mucositis and peri-implantitis: A triple-blind randomized clinical trial.

Oral probiotics appear to improve the treatment of periodontal diseases but there is limited evidence on their efficacy in the treatment of peri-implant diseases. The objective of the present study was to evaluate, clinically and microbiologically, the effect of the oral probiotic, Lactobacillus reuteri Prodentis, as adjuvant to non-surgical mechanical therapy in implants with mucositis or peri-implantitis, placed in patients with a history of periodontal disease. A randomized, controlled, parallel-design, triple-blind prospective clinical study was designed. Patients included in the study were partially edentulous and had implants with mucositis or peri-implantitis. Implants with radiographic bone loss of ≥5mm and/or ≥50% of the implant length were excluded, and only one implant per patient was included. After non-surgical mechanical therapy, subjects were randomly assigned to take either 1 probiotic lozenge or 1 placebo lozenge every day for 30days. Clinical measurements were taken in the whole mouth (general plaque index and general bleeding on probing) and at the implant site (probing pocket depth, plaque index and bleeding on probing) at baseline and 30 and 90days Microbiological examination (to identify Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus and Eikenella corrodens) was performed at the same study time points that clinical measurements were made. A total of 44 patients - 22 with mucositis and 22 with peri-implantitis - randomly received treatment with either probiotic or placebo. The probiotic L. reuteri, together with mechanical therapy, produced an additional improvement over treatment with mechanical therapy alone, both in the general clinical parameters of patients with mucositis (bleeding on probing) and at the level of implants with mucositis (probing pocket depth) or peri-implantitis (bleeding on probing and probing pocket depth). However, L. reuteri had a very limited effect on the peri-implant microbiota because the only parameter in which a significant decrease was found was the bacterial load of P.gingivalis in implants with mucositis (P=.031). The administration of a daily lozenge of L. reuteri for 30 days, together with mechanical debridement of the whole mouth, improved the clinical parameters of implants with mucositis or peri-implantitis over a period of at least 90days, but the microbiological effect was much more limited. Probiotics provide an alternative therapeutic approach to consider in the prevention and treatment of peri-implant diseases, but further long-term prospective studies with standardized variables are needed.

Clinical outcomes using prebiotic and probiotic lozenges in non-surgical management of chronic periodontitis patients

Clinical outcomes using prebiotic and probiotic lozenges in non-surgical management of chronic periodontitis patients

Effect of Probiotic Lactobacillus reuteri on Salivary Cariogenic Bacterial Counts among Groups of Preschool Children in Jeddah, Saudi Arabia: A Randomized Clinical Trial

To evaluate the effect of probiotic Lactobacilli reuteri lozenges on caries-associated salivary bacterial counts (Mutans streptococci and Lactobacillus), dental plaque accumulation, and salivary buffer capacity in a group of preschool children. The study group consisted of 178 healthy children (aged 3-6 years). Children were randomly grouped: the experimental group (n = 90) received L. reuteri probiotic lozenges and the control group (n = 88) received placebo lozenges, twice daily, for 28 days. Salivary Mutans streptococci and Lactobacillus counts, and buffer capacity were assessed using chair-side caries-risk test (CRT®) kits. The Simplified Oral Hygiene index (OHI-S) was used to assess dental plaque accumulation at baseline and after 28 days. After 28 days, the experimental group had a statistically significant reduction in Mutans streptococci and lactobacilli (p = 0.000 and p = 0.020, respectively) and both groups had less plaque accumulation than at baseline. While the buffer capacity in the experimental group increased more than in the control group, it was not statistically significant (p = 0.577). Compliance was 90%, with no adverse events. Consumption of probiotic lozenges containing L. reuteri reduces caries-associated bacterial counts significantly. Probiotics consumption may have a beneficial caries-preventive effect.

Efficacy of probiotic lozenges to reduce Streptococcus mutans in plaque around orthodontic brackets

Efficacy of probiotic lozenges to reduce Streptococcus mutans in plaque around orthodontic brackets

Development of a potential probiotic lozenge containing Enterococcus faecium CRL 183

In this work, a diet lozenge with the microencapsulated probiotic strain Enterococcus faecium CRL 183 was developed. The microbiological, physicochemical and sensorial characteristics were analyzed and the anticariogenic potential of the strain was also evaluated. The results showed that the complex coacervation microencapsulation technique enables higher viability during storage at room temperature. Lozenges were produced through three treatments: PC–control formulation; PPP1–probiotic formulation; PPP2–probiotic formulation with inulin. The probiotic strain had the viability decreased after lozenges production and during the storage from 5.53 to 4.83 log CFU/g at the beginning to 1.05–1.86 log CFU/g after 28 days, for both PPP1 and PPP2. Formulations were different concerning water activity, moisture and color (p < 0.05). All formulations remained microbiologically safe during the storage period. Association of probiotic bacteria and inulin improves the lozenges flavor acceptance and the purchase intent. The anticariogenic evaluation showed that the probiotic bacteria were able to survive in saliva and inhibit the growth of Streptococcus mutans ATCC 25175 in this study. The lozenge with E. faecium CRL183 and inulin represents an alternative to the diversification of the probiotic segment which aggregates anticariogenic potential. However, a process refinement and use of gas resistant packaging to preserve the probiotic viability, is necessary.

Efficacy of probiotic lozenges to reduce Streptococcus mutans in plaque around orthodontic brackets

Background: Probiotics were defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host. The aim was to evaluate the effect of the application of probiotic lozenge on the Streptococcus mutans levels in the plaque of orthodontic patients. Materials and Methods: A sample of 30 randomly selected patients (14 females and 16 males) having orthodontic treatment were selected for the study. They were divided into two groups of 15 each. One group of patients (Group 2) was given the probiotic ( Lactobacillus brevis CD2) lozenges, and the other group (Group 1) was given the placebo lozenges. The lozenges were administered to the patients from day 1 after the first plaque sample had been assessed and continued until day 30. Plaque samples were again taken and evaluated at the end of day 30. The samples were placed into individual microcentrifuge tubes with anonymous coding and sealed for transport for real-time polymerase chain reaction to the 3B Blackbio Biotech India Ltd., Bhopal, India. Results: After the use of the probiotic lozenges, 14 of 15 subjects in Group 2 showed reduction in the S. mutans levels; in two subjects, there was no detectable S. mutans after 30 days. In Group 1 after use of placebo, 3 out of 15 patients showed a decrease in S. mutans levels. Conclusion: This indicates that daily short-term ingestion of a Lactobacilli brevis derived probiotic through a lozenge tablet could reduce the levels of S. mutans in plaque around orthodontic brackets.

Comparison between probiotic lozenges and drinks towards periodontal status improvement of orthodontic patients

Background: Fixed orthodontic appliances may interfere with daily oral hygiene procedure, causing more abundant plaque accumulation, therefore increasing the risk of periodontal disease. Probiotic methods represent a breakthrough approach in maintaining oral health and preventing periodontal disease. Purpose: The aim of this study was to compare the effect between probiotic lozenges containing Lactobacillus reuteri and probiotic drinks containing Lactobacillus casei strain Shirota towards periodontal status of orthodontic patients. Method: Fixed orthodontic patients (n=30) from Faculty of Dentistry, Trisakti University Dental Hospital were included in this clinical trial. Periodontal status consisting of Plaque Index (PlI), Interdental Hygiene Index (HYG), and Papillary Bleeding Index (PBI) were then recorded from each patient. All patients received the phase one of periodontal treatment, as well as plaque control instruction. The subjects (n=10/gp) were randomly assigned to one of three groups; control group; probiotic lozenges group (Biogaia ® ); and probiotic drinks group (Yakult ® ). For 14 days, the probiotic groups were instructed to use the probiotic. Periodontal index improvement (PlI, HYG, and PBI) was found in all groups after 14 days research periode. These indices were then analyzed using Kruskal-Wallis analysis test. Result: It was found that L. reuteri and L. casei strain Shirota may improve periodontal status in fixed orthodontic patients. The best results were obtained from probiotic lozenges group. However, the results were not statistically significant (p>0.05). Conclusion: It was concluded that probiotics consumption containing L. reuteri and L. casei strain Shirota may slightly improve periodontal status in fixed orthodontic patients.

Effect of Probiotic Bacteria on Oral Candida in Frail Elderly

The aim of this study was to investigate the effect of a daily intake of probiotic lactobacilli on the prevalence and counts of oral Candida in frail elderly patients living in nursing homes. The study had a double-blind randomized placebo-controlled design with 2 parallel arms. The study group consisted of 215 older adults (range, 60 to 102 y) who were enrolled after informed consent. After baseline examination and randomization, the subjects were given 1 lozenge containing 2 strains of the probiotic bacterium Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo twice daily (morning and evening). The intervention period was 12 wk, and saliva and plaque samples were collected at baseline and follow-up. The primary end point was prevalence of high Candida counts assessed from chairside tests. Secondary end points were levels of dental plaque and gingival inflammation. The groups were balanced at baseline. The attrition rate to follow-up was 19%. There was a statistically significant reduction in the prevalence of high Candida counts in the probiotic group but not in the placebo group, and the difference was statistically significant in both saliva and plaque (P < 0.05). No significant differences between the groups were noted concerning the levels of supragingival plaque or bleeding on probing. Thus, daily use of probiotic lozenges may reduce the prevalence of high oral Candida counts in frail elderly nursing homes residents (ClinicalTrials.gov NCT02391532).