Probiotics in periodontal treatment – an overview

PD Dr. Kristina Bertl, PhD MSc MBA

The term ‘probiotics’ refers to a preparation that contains viable micro-organisms, such as species of lactobacilli and bifidobacteria, and is intended to have a positive effect on health.

Probiotics are used extensively in medicine and thus also in dentistry, particularly in periodontal treatment. The idea behind using probiotics as part of non-surgical periodontal treatment is that they will have a positive effect on the biofilm that builds up again after mechanical cleaning. In addition, their use is meant to strengthen the immune system. But just how large is the additional effect of using probiotics after non-surgical periodontal treatment?

In 2016, a French research group pooled the available literature on this topic to answer the following question: how large is the clinically measurable effect of using probiotics as an adjunctive to regular mechanical periodontal treatment among patients with chronic periodontitis?

However, only 4 studies were available on this topic in 2016, and only 3 could be statistically analyzed. When pooled, the results of these 3 studies – which had a short follow-up (3 months) – showed that the use of probiotics was of statistically significantly but clinically minimal benefit. Specifically, using probiotics led to an additional improvement in clinical attachment (by approximately 0.4 mm) and to an additional reduction in bleeding scores. Regarding pocket probing depths, the benefit was particularly evident in the case of deeper pocket probing depths.

Accordingly, we will need to wait for results from new long-term studies before a detailed 'verdict’ can be passed regarding the effect of probiotics in periodontal treatment. What can be said, however, is that probiotics – unlike antibiotics! – – generally have virtually no side effects. Caution need only be exercised for seriously ill and severely immunocompromised patients. In such cases, it is advisable to contact the treating doctor before probiotics are prescribed.

Examples of available products in Austria are GUM® PerioBalance® and BioGaia® Prodentis, both of which contain Lactobacillus reuteri.

Reference

1. Martin-Cabezas R, Davideau J-L, Tenenbaum H, Huck O. Clinical efficacy of probiotics as an adjunctive therapy to non-surgical periodontal treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol 2016; 43: 520–530. doi: 10.1111/jcpe.12545.