Probiotics for managing caries and periodontitis: Systematic review and meta-analysis

ObjectivesProbiotics might be beneficial to prevent or treat caries, gingivitis or periodontitis. We aimed to appraise trials assessing probiotics for managing caries and periodontal disease.DataWe included randomized controlled trials comparing the efficacy of probiotics versus (placebo) control with regards to Streptococcus mutans [SM], lactobacilli [LB], periodontal pathogens numbers, gingivitis, oral hygiene, caries incidence/experience increment, or periodontitis. Meta-analysis and trial-sequential-analysis were performed.SourcesThree electronic databases (Medline, Embase, Central) were screened.Study selection50 studies (3247 participants) were included. Studies were mainly performed in children and used lactobacilli (45); bifidobacteria (12) or other genus (3). Probiotics significantly increased the chance of reducing SM (OR: 2.20, 95% CI: 1.23/3.92) or LB (OR: 2.84; 1.34/6.03) <104 CFU/ml. Such reduction was confirmed for SM counts (standardized mean differences: −1.18, 95% CI: −1.64/-0.72), but not LB (SMD: 0.33; 0.15/0.52). For periodontal pathogens, no significant difference was found. Probiotics significantly reduced bleeding-on-probing (SMD: −1.15; −1.68/-0.62) and gingival index (SMD: −0.86; −1.52/-0.20), but not plaque index (SMD: −0.34; −0.89/0.21). Caries incidence was not significantly reduced (OR: 0.60; 0.35/1.04), neither was caries experience (SMD: −0.26; −0.55/0.03) or CAL (SMD: −0.46; −0.84/0.08). In contrast, probing-pocket depths (SMD: −0.86; −1.55/-0.17) were significantly reduced. Data was quantitatively insufficient for conclusive findings, and risk of bias was high.ConclusionCurrent evidence is insufficient for recommending probiotics for managing dental caries, but supportive towards managing gingivitis or periodontitis. Future studies should only record bacterial numbers alongside accepted disease markers or indicators.Clinical significanceProbiotic therapy could be used for managing periodontal diseases. For caries, further studies should ascertain both efficacy and safety.