Title The Use of Oral Probiotics in Adjunct to Non-surgical Periodontal Treatment Is More Effective in Treating Chronic Periodontitis Than Non-surgical Periodontal Treatment Alone
Clinical Question Are oral probiotics in adjunct to non-surgical periodontal treatment more effective in treating chronic periodontitis than non-surgical periodontal treatment alone?
Clinical Bottom Line The results of meta-analysis support the use of oral probiotics in adjunct to non-surgical periodontal treatment (NSPT) as more effective in treating chronic periodontitis than non-surgical periodontal treatment alone.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26970230Martin-Cabezas/ 2016130 patients/4 studies (100 patients/3 studies for meta-analysis) having chronic periodontitis without systemic diseasesMeta-Analysis
Key resultsWith the use of oral probiotics in adjunct to NSPT, meta-analysis showed there was a statistically significant difference in clinical attachment level (CAL) gain (-0.42 mm; 95% CI −0.68, −0.16; p = .002), reduction of bleeding on probing (BOP) (-14.66; 95% CI −24.49, −4.83; p= 0.003) and reduction of periodontal pocket depth (PPD) for moderate (-0.18; 95% CI −0.28, −0.07; p= 0.001) and deep pockets (-0.67; 95% CI −0.85, −0.49; p < 0.001). A Q statistic was used to determine heterogeneity with the p value of <0.1 indicating heterogeneity. Using the I² test, a value >40% is considered heterogeneous. The heterogeneity among studies was significant for CAL (67%), BOP (97%), and overall PPD (94%), but not significant for PPD reduction at 3 months in moderate pockets (29%) and deep pockets (0%).
Evidence Search ("probiotics"[MeSH Terms] OR "probiotics"[All Fields]) AND ("periodontitis"[MeSH Terms] OR "periodontitis"[All Fields])
Comments on
The Evidence
"All the studies included in this systematic review were considered with a low risk of bias" (Martin-Cabezas, 2016). The authors suggest that PPD was studied for the whole mouth and not specifically for “at risk” sites such as sites with furcations. Improvements on specific sites may have given more accurate data to determine the effectiveness of treatments. The authors did not have a large number of long-term studies to choose from. Perhaps the limited amount of data available may have provided inaccurate results. A high heterogeneity among included studies was found for all the study outcomes except for the PPD reduction at 3 months for moderate and deep pockets. The high heterogeneity may effect the results.
Applicability The use of oral probiotics in adjunct to NSPT as short-term treatment for patients with chronic periodontitis would be clinically beneficial for the patient in regard to CAL gain, BOP reduction, and PPD reduction for moderate and deep pockets. It may reduce the need for surgical treatment, thus minimizing risk and cost. Their use may also lower the use of antibiotics for treatment, thus lowering antibiotic resistance among individuals.
Specialty (General Dentistry) (Periodontics)
Keywords chronic periodontitis; non-surgical treatment; periodontal treatment outcomes; probiotics; L. reuteri; scaling and root planing
ID# 3096
Date of submission 11/29/2016
E-mail reyesvj@livemail.uthscsa.edu
Author Vanessa Reyes
Co-author(s) Sierra Arredondo
Co-author(s) e-mail ArredondoSS@livemail.uthscsa.edu
Faculty mentor Carol A. Nguyen, MPH, MS
Faculty mentor e-mail NGUYENC@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available