Probiotic Mouthwash Research Articles

Probiotics, tetracycline fibres and chlorhexidine gel's effectiveness in treating chronic periodontitis as a supplement to scaling and root planning.

A periodontal pocket can result into progressive loss of attachment. Many agents are tried to improve periodontal health. Hence this research was done to estimate the effectiveness of Tetracycline fibers; Probiotics and Chlorhexidine gel as a conjunction to scaling and root planning (SRP) in the treatment of chronic periodontitis. In all, 60 patients between the ages of 25 and 35 who had generalized chronic periodontitis and had a probing pocket depth (PPD) of at least 5 mm were enrolled for this study. Four groups of 15 patients each were created from the patients: Group 1: Tetracycline fibres after SRP, Group 2: Chlorhexidine gel, Group 3: Probiotic mouthwash and Group 4: Rinse with regular saline. At baseline, oral prophylaxis was administered to all groups. Gingival index (GI), Plaque index (PI), and probing depth (PD), among other clinical indicators, were evaluated at baseline, two weeks, and four weeks, respectively. All clinical findings, along withPlaque index (PI), Gingival index (GI), and Probing depth at various time intervals, decreased statistically significantly. Tetracycline fibres, Chlorhexidine gel, and probiotic mouthwash are all similarly effective for treating chronic periodontitis, but they are all more effective than SRP alone, according to an intergroup comparison. When it comes to SRP, local medication delivery methods are beneficial in treating periodontitis.

Comparative evaluation of the efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine mouthwashes in the treatment of gingival inflammation: A randomized controlled trial.

Chemical plaque control with mouthwashes as an adjunct to mechanical plaque control with a toothbrush and dental floss has been considered an effective method for controlling gingivitis. The anti-inflammatory effects of chemical plaque control benefit the oral tissues by reducing inflammation and bleeding. The aim of the present study was to evaluate and compare the clinical efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine (CHX) mouthwashes in treating gingivitis patients by assessing changes in their clinical parameters. This prospective study was conducted on 40 patients from our outpatient department, divided into 4 groups of 10 patients each: probiotic mouthwash group (group 1); herbal (Aloe vera) mouthwash group (group 2); povidone-iodine mouthwash group (group 3); and CHX mouthwash group (group 4). All participants were provided with the same type of manual toothbrush, the Pepsodent® toothpaste and a respective mouthwash for twice-daily use until the end of a 28-day observation period. Clinical parameters, such as the marginal plaque index (MPI) and bleeding on interdental brushing (BOIB), were recorded at baseline, and on the 14th and 28th day of the study period. All groups showed a significant decrease in the MPI and BOIB scores. The results were similar in patients who used a probiotic mouthwash and those who used a CHX mouthwash. A comparable change in the mean scores was observed among the herbal and povidone-iodine groups from baseline to day 28. In the treatment of chronic gingivitis patients,a probiotic mouthwash was nearly as effective as CHX in reducing the plaque and bleeding scores. It showed better results in all clinical parameters than herbal and povidone-iodine mouthwashes. Using a mouthwash along with routine tooth brushing can help in treating gingivitis and slow the progression of the periodontal disease.

Comparative evaluation of probiotic solutions on surface roughness and microhardness of different restorative materials and enamel.

This research study aimed to investigate the impact of probiotic mouthwash and kefir on the surface characteristics, specifically surface roughness and microhardness, of different restorative materials, as well as permanent and deciduous tooth enamels. Thirty disc-shaped specimens were prepared from composite resin (G-ænial Posterior (GP)), polyacid-modified composite resin (compomer) (Dyract-XP (DXP)), and resin-modified glass ionomer cement (Ionoseal (IS)). Additionally, thirty specimens of enamel were obtained from permanent teeth (PT) and thirty from deciduous teeth (DT) by embedding buccal and lingual sections, acquired through vertical sectioning of 15 permanent and 15 deciduous human tooth crowns in the mesiodistal orientation within acrylic resin blocks. The specimens were then categorized into three distinct groups and immersed for 14 days in one of the following solutions: distilled water, kefir or probiotic mouthwash. The mean surface roughness values of all specimens were assessed using an atomic force microscope, while the mean surface microhardness was measured using a Vickers hardness measuring instrument. The results revealed a statistically significant difference in mean surface roughness among the various restorative materials (p < 0.001). Among the restorative materials, the IS material exhibited notably higher mean surface roughness values than other restorative materials and tooth enamel, while no significant differences were observed between the PT and DT groups. Importantly, the main effect of the solutions under investigation was not statistically significant (p = 0.208). No significant difference was found between the surface roughness values of specimens subjected to the different solutions. When evaluating the effects of materials and solutions on microhardness, the main effects of material and solution variables and the influence of material-solution interactions were statistically significant (p < 0.001). Taken together, these results indicate that consistent use of kefir or probiotic mouthwashes may impact the surface properties of various restorative materials and tooth enamel.

Effect of Charcoal, Probiotic, and Chlorhexidine Mouthwashes on Mechanical Properties and Surface Characterization of Ceramic-Coated Nickel-Titanium Orthodontic Arch Wires: A Comparative In-Vitro Study.

To determine the impact on the mechanical properties and surface features of ceramic-coated nickel-titanium (CC-Ni-Ti) archwires when subjected to charcoal, probiotic, and chlorhexidine mouthwashes in in vitro conditions. Eighty samples of 25 mm were cut from the posterior end of preformed maxillary 0.016'' CC-Ni-Ti super elastic archwires (Koden Company, USA) anddistributed into four equal groups. Each group of wires was immersed in artificial saliva (Wet Mouth Mouthwash, ICPA Health Products Ltd., India) (control), charcoal mouthwash (Hello activated charcoal extra freshening mouthwash, Hello Products LLC, USA), probiotic mouthwash (Perfora, Probiotic Rinse, India), and 0.2% chlorhexidine gluconate mouthwash (Sensorange, Orange Biotech, Pvt., Ltd., India) (experimental groups) for 90 min at 37 °C. All samples were taken out of their respective solutions and washed with distilled water prior to testing. A three-point bending test was performed on 15 samples from each group using a universal testing device. During the loading and unloading of the archwires, the yield strength (YS), flexural modulus of elasticity (E), and spring back ratio (YS/E) were calculated. The remaining five wires from each group were observed under the scanning electron microscope (SEM) for surface topography evaluation. The mean differences of loading YS, E, and YS/E between chlorhexidine and charcoal are 302.91 MPa, 4.28 GPa, and 0.0004, whereas unloading values are 172.32 MPa, 4.16 GPa, and 0.0003, respectively, with a statistical significance of <0.001 in terms of YS and E. The mean differences of loading YS, E, and YS/E between charcoal and probiotic are 305.36 MPa, 4.54 GPa, and 0.0005, whereas unloading values are 173.77 MPa, 3.66 GPa, and 0.0003, respectively, with a statistical significance of <0.001 in terms of YS and E. The mean differences of loading YS, E, and YS/E between chlorhexidine and probiotic are 2.45 MPa, 0.26 GPa, and 0.00007, whereas unloading values are 1.44 MPa, 0.49 GPa, and 0.0000533, respectively, with no statistical significance of >0.001 in terms of YS, E, and YS/E. Surface topography alteration was clearly appreciated in the charcoal and probiotic mouthwash groups compared to charcoal mouthwash. Loading and unloading of 0.016" ceramic-coated nickel-titanium archwires showed an increase in mechanical properties except for the spring back ratio on exposure to chlorhexidine, probiotic, and charcoal mouthwashes. Chlorhexidine and probiotic mouthwashes had a higher yield strength and flexural modulus of elasticity in comparison with charcoal mouthwash and artificial saliva on 0.016" ceramic-coated nickel-titanium archwires. More corrosive changes were seen on 0.016" ceramic-coated nickel-titanium archwires when immersed in chlorhexidine, followed by probiotic and charcoal mouthwashes.

Effect of probiotic mouthwashes in comparison to chlorhexidine on periodontal health

Aim: To evaluate and compare the efficacy of Chlorhexidine and Probiotic mouthwashes in reducing plaque accumulation and gingivitis. Materials and methods: PubMed, Ovid SP, Embase, and Google Scholar databases were searched from years 1980 upto April 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria by two independent reviewers. Studies comparing Probiotics and Chlorhexidine in mouthwash form were included and evaluated for outcomes such as plaque score, gingival score. Results: A total of eleven articles were included for qualitative analysis, among them seven studies qualified for quantitative analysis. Random effects model was carried out to perform meta-analysis, basing on heterogeneity. Plaque index (PI): Significant reduction of plaque scores post-intervention were found when compared to baseline in both Probiotic mouthwash group [p=0.00001, MD: 0.87, 95% CI: 0.41 to 1.33] and chlorhexidine mouthwash groups [p=0.00001, MD: 0.97, 95% CI: 0.66 to 1.28]. No significant intergroup difference was found between Chlorhexidine and Probiotic mouthwash groups (p= 0.73). Gingival index (GI): Significant reduction of gingival index scores post-intervention were found when compared to baseline in both Probiotic mouthwash group [p=0.001, MD: 0.48, 95% CI: 0.19 to 0.77] and chlorhexidine mouthwash groups [p=0.0001, MD: 0.46, 95% CI: 0.23 to 0.68].

Evaluation of the Effectiveness of Probiotic Mouthwashes in Reducing Dental Plaque in Primary and Permanent Teeth: A Randomized Clinical Trial

Background: Due to the disadvantages of chemical mouthwashes, the search for an effective and safe anti-plaque agent has led to the emergence of probiotics.Aim: To compare the effectiveness of nonchemical mouthwashes (probiotic) with chemical mouthwashes (fluoride) on plaque accumulation in orphan children after seven, 14, and 30 days of use.Materials and methods: The present study was a triple-blind randomized controlled trial with two parallel groups (A and B), which included 30 healthy children. Each group included 15 children aged between eight and 10 years from Dar Al-Rahma Orphanage in Damascus, Syrian Arab Republic. Group A used 10 ml of probiotic mouthwash (ProbioClean) and group B used 10 ml of fluoride mouthwash (Colgate) for 60 seconds for 30 days. Turesky Modified Quigley-Hein (TMQH) plaque index was used in this study to record the values of plaque accumulation on days seven, 14, and 30.Results: Mann-Whitney U test showed statistical significance between probiotics and fluoride mouthwashes on days 14 (p < 0.001) and 30 (p = 0.001), and there was no statistical significance on day seven (p = 0.934).Conclusion: According to the results of this study, probiotic mouthwashes are considered an effective solution for maintaining oral health. However, probiotics are more effective in reducing plaque accumulation after a month of use.

Effects of Probiotics Mouthwash on Levels of Red Complex Bacteria in Chronic Periodontitis Patients: A Clinico-microbiological Study

The red complex includes Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are recognized as the most important pathogens and are the indicators of infection in chronic periodontal disease. This study was to assess the levels of red complex bacteria in chronic periodontitis patients following treatment with probiotic mouthwash. Twenty chronic periodontitis patients with ages ranging from 18 to 55 years were recruited for the study. The control group was given placebo mouthwash and the study group was given probiotic mouthwash. After clinical monitoring and scaling and root planing, the collected plaque samples at baseline and 14th day were transferred for microbiological analysis by transport media for Conventional Multiplex Polymerase Chain Reaction. On the 14th day, all the clinical parameters were significantly reduced in the study group with gingival index (p = 0.003 HS) and plaque index (p = 0.001 VHS). In the study group, there was significant bacterial cell reduction with T. denticola (p = 0.041 S) and T. forsythia (p = 0.037 S). In patients with chronic periodontitis, treatment with probiotic mouthwash significantly reduces the levels of red complex bacteria. The use of probiotic mouthwash could be a useful adjunct to scaling and root planing in chronic periodontitis.

Probiotic mouthwash as an adjunct to mechanical therapy in the treatment of stage II periodontitis: A randomized controlled clinical trial.

Dysbiosis of oral microbiome play an integral role in periodontitis. Bacterial balance is an important aspect of host defence. Mechanical debridement alone is insufficient to manage many cases. Probiotics are a novel adjunctive strategy, but the beneficial effects of probiotics in the management of moderate periodontitis have not been evaluated before. The objective of the present study was to assess the efficacy of probiotic mouth rinse of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii as an adjunct to mechanical debridement in grade II periodontitis. The study also evaluated change in salivary pH and IgA in both groups. The study was registered under Clinical Trial Registry of India (CTRI NO: CTRI/2019/10/021630). 60 patients with stage II periodontitis were randomized into probiotic and placebo group (n=30 in each group) after mechanical debridement. Patients were instructed to use mouth rinse twice a day for 30days. Periodontal parameters (Plaque index, Gingival index, Pocket depth and clinical attachment level) were recorded at baseline, after 1 and 3months. Salivary pH was tested using a pH metre and IgA using enzyme linked immunosorbent assay. Significant improvement in all clinical parameters were noted in both the groups after 1 and 3months. Intergroup comparison revealed significant difference in gingival index, probing depth and clinical attachment gain. Significant elevation of salivary IgA and pH was noticed in probiotic group in contrast to placebo group. The present study supports the use of probiotic mouthwash as an adjunct to mechanical therapy for the management of stage II periodontitis.

Evaluation of the Topical Effect of Probiotic Mouthwash in the Treatment of Patients with Peri-Implant Mucositis.

Peri-implant mucositis is a reversible inflammatory process of the soft tissue surrounding a dental implant. If left untreated, peri-implant mucositis can evolve into peri-implantitis, which leads to the loss of the supporting bone around the implant. The treatment of peri-implantitis is of special importance, since peri-implantitis can be very expensive and troublesome for both the patient and the dentist and a lack of complete resolution can lead to a low probability of implant success. This study aims to evaluate the effects of probiotic tablets on the condition of patients with peri-implant mucositis after scaling. In this double-blind randomized intervention trial, packages containing 14 probiotic capsules or a single-dose placebo were provided to 25 volunteer patients after scaling among those called to a private clinic in Mashhad. During the research process, we used the probing depth (PD) index and the bleeding on probing (BOP) index to diagnose peri-implant mucositis before and after the 28-day period. According to the study findings, on the day of scaling and 4 weeks after scaling and mouthwash use, there was a statistically significant difference in BOP index values between the probiotic group and the placebo group (P < 0.001). There was no difference in PD index values between these two groups. In conclusion, probiotic treatment can be used in interventions, prevention, and dentists' recommendations to alleviate or eradicate peri-implant mucositis.

Effectiveness of probiotic and herbal mouthwashes on gingival health among children with intellectual disability: An interventional study

Background: Maintaining good oral health is particularly challenging among children with intellectual disability (ID) because of increased oral health risks due to underlying disease, limitations on access to care, and competing demands. For ID children, the standard oral hygiene procedures such as brushing and flossing are too difficult to practice due to reduced manual dexterity and difficulty for the caregivers to handle these tools. Moreover, usage of mouth rinses is a nightmare for parents of children with ID as they lack the dexterity to spit the mouthwashes. Although many studies support the use of chlorhexidine mouth rinses, it should be taken into account that the side effects of chlorhexidine are well documented, but the same is not so in case of herbal and probiotic mouth washes. With this milleu, this interventional study was formulated to compare the efficacy of probiotic and herbal mouth rinses on gingival health among intellectually disabled children. Materials and Methods: The present study included thirty children with ID aged 10–15 years at New Hope Child Development Centre. The participants were randomly divided into two Groups: I and II, with 15 children in each group as follows: group I: probiotic mouthwash and Group II: herbal mouth wash. Baseline scores of plaque index (PI) and gingival index (GI) were recorded. The designated mouth rinses were distributed to the respective groups, and they were instructed to rinse once daily. Their parents supervised the children during the use of mouthwash. At the end of 3 months, the children were assessed to the same clinical measurements. Results: Intragroup comparisons for both the GI and PI scores were statistically significant (P ≤ 0.001) in both the groups. Intergroup comparisons between the two groups were not statistically significant. There was a significant difference in the effect of herbal and probiotic mouthwashes on plaque accumulation, gingival health status of these children. Conclusion: Herbal and probiotic mouthwashes can prove to be effective in reducing plaque and in improving the gingival status of children.

Clinical effects of local use of probiotics as an adjunct to non-surgical periodontal therapy

Introduction. Periodontal disease is a chronic inflammatory disease caused by pathologic microorganisms/periopathogens from oral biofilm. Standard periodontal therapy consists of scaling and root planing (SRP). Probiotics can be used as an adjunctive to standard periodontal therapy, since it is known that probiotics can modify pathogenic potential of biofilm by suppressing the colonization of periopathogens. The aim of this study was to assess the clinical effect of Bifidobacterium and Lactobacillus probiotic lozenges, probiotic mouthwash, as an adjuvant to SRP in the treatment of initial to moderate chronic periodontitis. Material and methods. Thirty patients with initial to moderate chronic periodontitis were recruited and monitored clinically at baseline (before SRP) and 60 days following SRP. All patients were randomly assigned to experimental group: SRP + probiotic (n = 15) and control group: SRP only (n = 15). The probiotic mouthwash was used twice a day for 60 days. Clinical parameters: the probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP) were measured at baseline and 60th day following SRP. Data were statistically analyzed using the one-way Anova test and SPSS 19 software (IMB Company, New York, U.S.). The Friedman and Mann Whitney tests were used as a post hoc test for intergroup analysis. Statistical significance was set at p &lt; 0.05. Results. After 60 days of treatment, the clinical parameters PPD, CAL and BOP were significantly lower in both groups compared to the baseline. In the experimental group, the clinical parameters PPD, CAL and BOP were significantly reduced after 60 days of treatment compared to the initial measurements (p &lt; 0.05). In the control group, statistically significant decrease after 60 days of treatment was recorded only for BOP parameter, while there was no statistically significant decrease of PPD and CAL values (p &gt; 0.05). Conclusion. The results of the present study demonstrated clinical benefits of adjunctive use of probiotics to SRP in terms of pocket depth reduction in initial to moderate periodontal disease.

Effects of probiotic and fluoride mouthrinses on Streptococcus mutans in dental plaque around orthodontic brackets: A preliminary explorative randomized placebo-controlled clinical trial.

Background:Although it is shown that probiotic agents might reduce Streptococcus mutans, no study has evaluated this effect in the form of probiotic mouthrinse. The purpose of this study was to compare the effect of probiotic experimental mouthwash Lactobacillus plantarum versus sodium fluoride and placebo mouthwashes on the number of S. mutans present in dental plaque around orthodontic brackets in fixed orthodontic patients.Materials and Methods:This study was a randomized clinical trial. The total of 38 patients participate consisting of 12 patients in the fluoride group, 13 in the probiotic, and 12 in the placebo group. They were given mouthwashes to use twice a day for 2 weeks. Plaque sampling was performed using the 4-pass technique in all three groups in two stages: before the intervention and after 2 weeks of using the mouthwash. The number of bacteria present in the dental plaque was then reported based on the number of colonies grown on agar medium. Data were analyzed using Kruskal–Wallis and Wilcoxon tests (α = 0.05).Results:Gender distribution, mean age, and protocol adherence were not significantly different among all three groups. After the intervention, the number of S. mutans present in the dental plaque followed an increasing manner in the placebo (P = 0.005) and probiotic (P = 0.158) groups and decreased in fluoride group (P = 0.025).Conclusion:The L. plantarum probiotic mouthwash was ineffective in reduction of S. mutans in dental plaque. However, fluoride mouthwash is considerably effective against S. mutans and thus recommended.

Comparison of The Effectiveness of Probiotic and Chlorhexidine Mouth Rinses on Plaque Accumulation and Gingival Inflammation

Background: Chemical agents have been increasingly used as an adjunct to mechanical control. The use of a mouthwash augments maintenance of oral health through its antiplaque and antibacterial chemical properties The aim of the study was to compare the effectiveness of probiotic and chlorhexidine mouth rinses on plaque accumulation and gingival inflammation. Methods: A total of 60 patients with chronic gingivitis were divided into 3 groups. Group A ‑ 20 subjects were advised probiotic mouthwash, Group B ‑ 20 subjects were advised chlorhexidine mouthwash and Group C ‑ 20 subjects into a negative control group (normal saline). Oral prophylaxis was done for all groups at baseline. Baseline scores of plaque index (PI) gingival index (GI) and oral hygiene index-simplified (OHI-S) were recorded. The designated mouth rinses were distributed to the respective groups and they were instructed to rinse twice daily. Variables were again recorded on the seventh and 14th day after use of mouthwashes and data obtained was subjected to statistical analysis. Results: A significant difference in PI, GI, and OHI(S) were found when group 1 and group II was compared with group 3 on day14 and day28. However, there were no significant differences in the mean PI, GI and OHI(S) between the Probiotic and Chlorhexidine groups on the 14th day of examination. Conclusion: The Probiotic mouth rinse was found to be effective in reducing plaque accumulation and gingival inflammation. Therefore, the Probiotic mouth rinse has a potential therapeutic value and further long-term study is recommended to determine its efficacy.

Comparative Evaluation of Plaque Inhibitory and Antimicrobial Efficacy of Probiotic and Chlorhexidine Oral Rinses in Orthodontic Patients: A Randomized Clinical Trial.

Background Antimicrobial agents serve as an effective adjunct in plaque control, and chlorhexidine has been the gold standard. However, the philosophy that natural agents are better for children's oral health is on the rise. Probiotic technology represents a breakthrough approach to maintain oral health by utilizing natural beneficial bacteria commonly found in healthy mouths. Aim and Objective To compare efficacy of probiotic and chlorhexidine oral rinses in orthodontic patients. Materials and Methods 30 healthy patients undergoing fixed orthodontic treatment were randomly selected for the study by block randomization and allocation concealment and were divided into three groups: group a, 0.2% chlorhexidine mouthwash; group b, probiotic mouthwash; and group c, a control group. Results Probiotic and chlorhexidine groups had significantly decreased plaque indices as compared to the control group. However, greater improvement was seen in the gingival indices than plaque indices with better results in the probiotic group than the chlorhexidine group. No statistical significance was observed in the streptococcus count of probiotic and chlorhexidine groups at the end of the intervention period. Conclusion The comparison of probiotics to chlorhexidine has proven that probiotics are as effective as chlorhexidine as an adjunctive chemical plaque control agent.

Effects of amine fluoride and probiotic mouthwash on levels of Porphyromonas gingivalis in orthodontic patients: A randomized controlled trial.

Introduction:Porphyromonas gingivalis is one among the major etiological agent in periodontal diseases and has been proved to cause gingival inflammation under orthodontic appliances.Aim:To assess the effect of amine fluoride and probiotic mouthwashes on levels of P. gingivalis during orthodontic treatment, using real time-polymerase chain reaction (RT-PCR).Materials and Methods:A randomised controlled trial was performed including 45 patients. There were three groups: Group A (control group), Group B (patients using Amflor mouthwash) and Group C (patients using probiotic mouthwash). During the treatment, all the 3 groups were advised to brush twice a day using Colgate tooth paste and Group B patients were advised to swish 15 ml fluoridated mouthwash (Amflor) and Group C advised to swish probiotic for 60 s before swallowing, once in the morning and once before sleep. After gently removing supragingival plaque, subgingival plaque samples were collected by inserting a sterile dental curette into the bottom of the gingival crevice around 31, 32, 41, and 42 at two different intervals: T1 at start and T2 after 6 months of fixed orthodontic treatment. Sub-gingival plaque samples collected were transferred to laboratory within 48 h for RT-PCR analysis in Tris-buffer solution, to maintain the integrity of bacterial DNA.Results:The levels of P. gingivalis were significantly decreased with probiotic mouth wash.Conclusions:Probiotic mouth wash can be used as an adjunctive measure along with regular brushing to improve periodontal status during fixed orthodontic treatment.

Efficacy of probiotics used as a periodontal treatment aid: A pilot study

Gingivitis is the inflammation of the soft tissue surrounding the tooth that may progress to a more destructive disease called periodontitis (Carranza and Newman, 2012). The onset and progression of gingivitis is dependent on systemic and genetic factors; however, the main etiological factor for gingivitis is the accumulation of plaque and the harmful bacteria found attached to it (Carranza and Newman, 2012). The oral cavity is normally colonized by more than 500 bacterial species most of which are relatively harmless commensal bacteria; however, it can also host potentially pathogenic bacteria (Jakubovics and Palmer, 2013, Suzuki et al., 2005). The accumulation of plaque can increase the predominance of pathogenic bacteria, alter the homeostasis, and induce disease. The first line of periodontal therapy is mechanical removal of accumulated plaque/calculus through scaling, root planning and polishing accompanied by oral hygiene instruction for the maintenance of oral health (Carranza and Newman, 2012, Jakubovics and Palmer, 2013). Additionally, chemical antimicrobial agents can play a significant role in supporting standard mechanical procedures by temporarily controlling the microbial load. Antimicrobial agents such as chlorhexidine, cetylpyridinium chloride (CPC), essential oils, chlorine dioxide, hydrogen peroxide, and triclosan are the commonly used (Tartaglia et al., 2017). Chlorhexidine is considered the most effective agent used in plaque control and in periodontal therapy; however, side effects such as tooth discoloration, oral mucosal erosion and taste alteration can be observed (da Costa et al., 2017, Justus et al., 2015). Probiotics are living microorganisms, mainly bacteria, that are safe for human consumption and positively influence health (Gupta, 2011, Haukioja, 2010). Various strains of Lactobacillus and Bifidobacterium are commonly used to promote gastrointestinal health. Recently, it has been suggested that some of these strains, as well as strains of Streptococcus, can colonize the oral cavity and reduce the concentration of pathogenic bacteria responsible for caries, periodontal disease and halitosis (Haukioja, 2010, Hillman et al., 2009, Maekawa and Hajishengallis, 2014). Clinical trials have been performed to assess the effect of probiotics on pathogenic oral bacteria after systemic and topic application of the probiotics with promising results (Karuppaiah et al., 2013, Zahradnik et al., 2009); however, publications that include controlled clinical assessment after treatment with probiotics are not abundant. Probiotic products specifically formulated for oral health are limited and Probiora 3 is the only one containing three strains of streptococci. The purpose of this study is to assess the effect of Probiora 3 mouthwash used for the treatment of plaque induced gingivitis and produce controlled clinical data to support or reject the use of probiotics for treatment of gongivitis. The study also aims to compare the effect of the probiotic mouthwash relative to chlorhexidine, since it is considered the most effective chemical aid in the management of periodontal disease. The clinical signs of gingivitis were assessed and compared to conventional periodontal treatment protocols.

Evaluation of the clinical effect of a probiotic mouthwash in the treatment of generalized marginal chronic gingivitis. Randomized pilot study

Objective. To evaluate the clinical effect of a probiotic mouthwash in reducing generalized marginal chronic gingivitis using positive and negative control groups. Methodology. Four-week study conducted in San Luis Potosí, Mexico, from January to March 2017. Participants were healthy, non-smokers with generalized marginal chronic gingivitis; age range 18-45 years. Subjects were randomized and divided into three groups: Group A: mouthwash based on 0.05% cetylpyridinium chloride (CPC) (positive control); Group B: mouthwash based on probiotics (experimental); Group C: placebo mouthwash (negative control). No oral hygiene practices or routines were modified; subjects were followed for 4 weeks. The primary outcome variable of interest was the Löe and Silness gingival index, and the secondary one, the Quigley Heinn plaque index modified by Turesky. Results. Of the 45 patients included, 19 (42.2%) were men and 26 (57.7%) women, mean age was 22.8±2.07. Each group consisted of 15 subjects; all subjects completed the study. There was no statistically significant reduction in gingival inflammation when comparing the 3 treatment groups (p=0.540) with respect to the gingival index. A comparison was made before and after the treatment and in the 3 groups there was no reduction of the gingival inflammation. Plaque reduction was not statistically significant when comparing the 3 groups (p=0.278). However, when doing intra-group comparison, it was found that the patients in group A had a reduction in plaque index (p&lt;0.005), which was not observed in groups B (p=0.1103) and C (p=0.1508). Conclusions. The use of a probiotic mouth mouthwash did not reduce gingival inflammation or the accumulation of dentobacterial plaque in a period of 4 weeks. There were no statistically significant differences between the study groups.

Comparison of the Effectiveness of Probiotic, Chlorhexidine-based Mouthwashes, and Oil Pulling Therapy on Plaque Accumulation and Gingival Inflammation in 10- to 12-year-old Schoolchildren: A Randomized Controlled Trial.

IntroductionThe use of a mouthwash augments mechanical removal of plaque by brushing and flossing and helps maintain oral health through its antiplaque and antibacterial chemical properties.AimTo evaluate the effectiveness of a probiotic mouthwash, sesame oil pulling therapy, and chlorhexidine-based mouth-wash on plaque accumulation and gingival inflammation in schoolchildren aged 10 to 12 years.Materials and methodsThe randomized controlled trial included 45 healthy schoolchildren aged 10 to 12 years and studying in Government High School, Tiruchengode, Tamil Nadu, India. The participants were randomly divided into three groups, I, II, and III, with 15 children in each group as follows: group I: probiotic mouthwash; group II: chlorhexidine mouthwash; and group III: sesame oil. Baseline scores of plaque index (PI) and modified gingival index (GI) were recorded followed by a full mouth oral prophylaxis. The designated mouth rinses were distributed to the respective groups and they were instructed to rinse once daily. Their parents supervised the children during the use of mouthwash. On the 15th and 30th day, the children were subjected to the same clinical measurements. Children’s acceptance of their plaque control method was assessed using a modified facial image scale.ResultsIntragroup comparisons for both the GI and PI scores were statistically significant (p ≤ 0.001) in all the three groups. Difference in the GI scores between the 15th and 30th day was statistically significant for chlorhexidine group alone (p = 0.024). Intergroup comparisons between the three groups were not statistically significant.ConclusionProbiotic mouthwash, chlorhexidine mouthwash, and sesame oil were equally effective in reducing plaque and in improving the gingival status of children. The difference between the gingival scores on the 15th and 30th day was statistically significant in the chlorhexidine group.How to cite this article: Kandaswamy SK, Sharath A, Priya PRG. Comparison of the Effectiveness of Probiotic, Chlorhexidine-based Mouthwashes, and Oil Pulling Therapy on Plaque Accumulation and Gingival Inflammation in 10- to 12-year-old Schoolchildren: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2018;11(2):66-70.

Comparison of Antibacterial Efficacy of Probiotic Mouthwash with Chlorhexidine Against Common Oral Pathogens: An In-Vitro Study

Background: The basic method in prevention of oral disorders and hygiene of an oral cavity is control of plaque growth and germ accumulation on teeth and gingivae. Mouthwashes are most common topical solutions against plaque formation. Although there are many antimicrobial agents in use, only a few have shown clinical effectiveness. Furthermore, their long-term use may lead to several side effects. Therefore, utilizing natural antimicrobial agents such as probiotics may be an effective way to overcome the problem. The purpose of the present investigation was to design a mouthwash formulation containing probiotic extract. Methods: Standard strains of 4 main oral pathogenic bacteria, Streptococcus mutans, Streptococcus salivarus, Actinomyces viscosus, and Actinomyces neoslandi were utilized to evaluate the product antimicrobial activity. Lactobacillus casei was cultured in standard medium and its antibacterial effectiveness was evaluated by the spot-test. Each pathogen suspension was inoculated separately on plates containing specific media. Lyophilized probiotic extract (LPE) was prepared in a specific temperature condition and poured in wells. After incubation, the samples growth inhibition zone was measured. Mouthwash formulations containing different concentrations of LPE, Glycerin, and Sorbitol were prepared and based to their physic-chemical properties as well as their long-term stability. The best formulation was chosen and flavorant and sweetener were added. Well-diffusion method was utilized and their mean diameters of growth inhibition was recorded and compared to that of chlorhexidine and a blank Glycerin-Sorbitol solution as positive and negative controls, respectively. Minimum inhibitory concentrations of each formulation were investigated by the macro-dilution method and the formulation with maximum antibacterial activity was determined. Results: Well-diffusion experiment showed that chlorhexidine mouthwash is stronger than 1% - 4% containing LPE formulations, while there was no significant difference between 5% LPE formulation and the positive control (P > 0.05). There was no growth in the inhibition zone. For negative control, MIC studies proved that 5% LPE and chlorhexidine formulations were similar and their maximum and minimum activities were A. neoslandi and S. salivarous, respectively. Conclusions: The findings in the present study proved that the 5% LPE formulation is as effective as the chlorhexidine solution and may be utilized as a natural safe mouthwash.

Effects of new probiotic mouthwash in patients with diabetes mellitus and cardiovascular diseases.

To evaluate the impact of a new formulation of probiotic mouthwash (PM), using Biocult strong® dissolved in neutral mouthwash. Forty-two patients with cardiovascular disease (CVD) or type 1 and type 2 diabetes were enrolled. Plaque Control Record (PCR) and Bleeding on Probing (BOP) were assessed at baseline and after two weeks of PM or positive control treatment in intervention group (IG) and control group (CG). Food intake was estimated by 3-day diet record. BOP was significantly reduced in all treatments and samples, except for IG in CVD sample (p=0.15). PCR decreased significantly in all treatments and samples (p<0.01). No significance was obtained for BOP and IP in the time x group interaction. Food intake was not significantly different between IG and CG in all samples. Nutrients such as fats and simple carbohydrates were correlated with BOP in patients who received positive control, rather than PM, indicating a lack of food influence on BOP and PCR in IG. PM treatment was effective in relation to the reduction of PCR and BOP. Probiotics represent a good, but additional, tool for prophylaxis, because they cannot completely substitute the classic oral hygiene methods. Moreover, one week of treatment was not sufficient to draw firm conclusions about the efficacy of the treatment itself.