Clinical and Microbiological Effect of L. reuteri in the Treatment of Chronic Periodontitis

Bacterial Colonization and Periodontal Disease

Bacterial colonization of the oral cavity is a crucial factor in the development of periodontal diseases. The presence of pathogens and the absence of beneficial bacteria are key from an etiological standpoint. However, although this fact is well known, therapy usually focuses on the first mentioned factor – the reduction of periopathogens. This primarily involves subgingival treatment (SRP – scaling and root planing) and instructions for dental hygiene.

Although SRP significantly reduces the amount of pathogens, periopathogens quickly recolonize treated areas. The intervention, therefore, has only a temporary effect, even when combined with antiseptic preparations or antibiotics. In this context, the administration of health-promoting bacteria can be considered a potentially beneficial approach in both the treatment and prevention of periodontitis. This hypothesis forms the basis of the study, which aimed to assess the effect of administering lozenges containing Lactobacillus reuteri in adult patients with chronic periodontitis.

Methodology and Study Course

A randomized double-blind placebo-controlled study evaluated the clinical and microbiological effect of SRP compared to the combination of SRP with probiotic lozenges. The observation period lasted 12 weeks and, following the initial examination and treatment of patients, controls were conducted at 3-week intervals. The initial examination included the assessment of periodontal pocket depth on probing (PPD – probing pocket depth), gingival recession (REC), and bleeding on probing (BOP), which were evaluated at various sites on each tooth, as well as the calculation of gingival index (GI) and plaque index (PI).

A total of 30 participants were randomized into two groups of 15: one group used placebo lozenges twice daily for 12 weeks after the initial subgingival therapy, and the other group used lozenges containing L. reuteri Prodentis (1 × 10⁸ CFU) with strains DSM 17938 and ATCC PTA 5289. All patients used the same toothpaste during the observation period. Controls at 3, 6, and 9 weeks after the initial examination included microbial sample collection and clinical evaluation using PI and GI. At the final control, participants underwent a comprehensive assessment of all determined parameters. The main parameter observed in the presented study was PPD.

Results

PPD values, which were similar for both groups at the beginning of the observation, decreased in both the probiotic and placebo lozenge groups after 12 weeks (p < 0.05). A more detailed analysis of this parameter showed that a significant reduction in deep periodontal pockets was observed in the group using probiotic lozenges (average reduction in PPD of deep pockets after 12 weeks was 2.88 ± 0.35 mm vs. 2.25 ± 0.27 mm; p < 0.001).

Regarding REC and BOP, no significant differences were found between the groups in these parameters after 12 weeks of observation. The condition of patients in the probiotic group required surgical treatment for fewer teeth compared to the placebo group (15.74 ± 23.34% vs. 25.17 ± 18.38% of teeth; p = 0.067). In terms of microbiological analysis, a significant reduction in Porphyromonas gingivalis was noted in the samples obtained from the probiotic group (p < 0.05), even after 9 weeks. A significant reduction in Prevotella intermedia was also noted in the plaque samples from the probiotic group compared to the placebo group.

Summary and Conclusion

The study results suggest that lozenges containing L. reuteri are a beneficial adjunctive therapy for patients with chronic periodontitis, as they contribute to the reduction of deep periodontal pockets. Only 26.7% of individuals in the probiotic group were considered to be at high risk of disease progression at the end of the observation period, compared to 66.7% in the placebo group. Microbiological evaluation of both groups showed fewer significant differences and mainly concerned the presence of P. gingivalis.

The study authors consider the effect of probiotic lozenges containing L. reuteri Prodentis to be clinically relevant but caution that the results cannot be generalized to all probiotics or other methods of their administration.

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Source: Teughels W., Durukan A., Ozcelik O., et al. Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study. J Clin Periodontol 2013; 40 (11): 1025–1035, doi: 10.1111/jcpe.12155.