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Background To evaluate the efficacy of probiotics in the treatment of gingivitis. Methods MEDLINE, EMBASE and CENTRAL were searched up to May 2019. Randomized controlled clinical trials (RCTs) and/or controlled clinical trials were considered. Studies consisting of ≥10 patients per group clinically diagnosed with gingivitis were selected that compared the efficacy of probiotics in any form with placebo. The primary outcome measure was bleeding on probing (BOP) and gingival index (GI), while the secondary outcome measure was plaque index (PI). Forest plots were created reporting weighted mean difference (WMD) of outcomes with 95% confidence intervals (CI). Results A total of 10 double‐blind placebo‐parallel RCTs were included. All studies showed that probiotic administration was effective in the treatment of gingivitis at follow‐up. The mean percentage of BOP ranged from 11.87% to 21.7% in the probiotics group and from 15% to 33% in the placebo groups at follow‐up, respectively. Considering the effects of Lactobacillus reuteri, the overall mean difference for GI (WMD = −0.48, 95% CI = −1.69 to 0.72, P = 0.42) and PI (WMD = 0.18, 95% CI = −0.23 to 0.61, P = 0.37) did not show any statistical significance between probiotic and placebo groups. Conclusions The outcomes of this review show weak evidence to support the use of probiotics in reducing inflammatory periodontal parameters in gingivitis. Significant heterogeneity and limited available data may reduce the impact of these conclusions.

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Background A low pH environment is created due to the production of acids by oral biofilms that further leads to the dissolution of hydroxyapatite crystal in the tooth structure significantly altering the equilibrium. Although the overall bacterial counts may not be eradicated from the oral cavity, however, synthesis of engineered anti-bacterial materials are warranted to reduce the pathogenic impact of the oral biofilms. The purpose of this study was to synthesize and characterize chlorhexidine (CHX)-loaded mesoporous silica nanoparticles (MSN) grafted with poly-L-glycolic acid (PGA) and to test the in vitro drug release in various pH environments, cytotoxicity, and antimicrobial capacity. In addition, this study aimed to investigate the delivery of CHX-loaded/MSN-PGA nanoparticles through demineralized dentin tubules and how these nanoparticles interact with tooth dentin after mixing with commercial dentin adhesive for potential clinical application. Results Characterization using SEM/TEM and EDX confirmed the synthesis of CHX-loaded/MSN-PGA. An increase in the percentage of drug encapsulation efficiency from 81 to 85% in CHX loaded/MSN and 92–95% in CHX loaded/MSN-PGA proportionately increased with increasing the amount of CHX during the fabrication of nanoparticles. For both time-periods (24 h or 30 days), the relative microbial viability significantly decreased by increasing the CHX content (P < 0.001). Generally, the cell viability percentage of DPSCs exposed to MSN-PGA/Blank, CHX-loaded/MSN, and CHX-loaded/MSN-PGA, respectively was > 80% indicating low cytotoxicity profiles of experimental nanoparticles. After 9 months in artificial saliva (pH 7.4), the significantly highest micro-tensile bond strength value was recorded for 25:50 CHX/MSN and 25:50:50 CHX/MSN-PGA. A homogenous and widely distributed 50:50:50 CHX-loaded/MSN-PGA nanoparticles exhibited excellent bonding with the application of commercially available dentin adhesive. Conclusions A pH-sensitive CHX release response was noted when loaded in MSN grafted PGA nanoparticles. The formulated drug-loaded nanocarrier demonstrated excellent physicochemical, spectral, and biological characteristics. Showing considerable capacity to penetrate effectively inside dentinal tubules and having high antibacterial efficacy, this system could be potentially used in adhesive and restorative dentistry.

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