Microbiological and clinical effects of probiotics and antibiotics on nonsurgical treatment of chronic periodontitis: a randomized placebo- controlled trial with 9-month follow-up

Abstract

ObjectiveThe aim of this double-blind, placebo-controlled and parallel- arm randomized clinical trial was to evaluate the effects of Lactobacillus rhamnosus SP1-containing probiotic sachet and azithromycin tablets as an adjunct to nonsurgical therapy in clinical parameters and in presence and levels of Tannerella forsythia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Material and MethodsForty-seven systemically healthy volunteers with chronic periodontitis were recruited and monitored clinically and microbiologically at baseline for 3, 6 and 9 months after therapy. Subgingival plaque samples were collected from four periodontal sites with clinical attachment level ≥1 mm, probing pocket depth ≥4 mm and bleeding on probing, one site in each quadrant. Samples were cultivated and processed using the PCR technique. Patients received nonsurgical therapy including scaling and root planing (SRP) and were randomly assigned to a probiotic (n=16), antibiotic (n = 16) or placebo (n = 15) group. L. rhamnosus SP1 was taken once a day for 3 months. Azithromycin 500mg was taken once a day for 5 days.ResultsAll groups showed improvements in clinical and microbiological parameters at all time points evaluated. Probiotic and antibiotic groups showed greater reductions in cultivable microbiota compared with baseline. The placebo group showed greater reduction in number of subjects with P. gingivalis compared with baseline. However, there were no significant differences between groups.ConclusionsThe adjunctive use of L. rhamnosus SP1 sachets and azithromycin during initial therapy resulted in similar clinical and microbiological improvements compared with the placebo group.

Clinical Effects of Probiotic or Azithromycin as an Adjunct to Scaling and Root Planing in the Treatment of Periodontitis Stage III: A Pilot Randomized Controlled Clinical Trial

“…As for the use of azithromycin, the present results in general failed to show a clear clinical advantage over SRP and placebo. These ndings are in accordance with previously published data where a clinical bene t of azithromycin in conjunction with SRP could not be determined [22,37,38]. This lack of additional bene t of azithromycin is in direct contrast with the conclusions of a recent systematic reviews with meta-analysis [39].…”

Probiotics, including nisin‐based probiotics, improve clinical and microbial outcomes relevant to oral and systemic diseases

“…As a result of these improved clinical parameters, some studies found a decreased need for periodontal surgery . By contrast, 2 studies found no significant improvements in clinical parameters with adjunctive probiotic therapy in chronic periodontitis patients . One study that evaluated adjunctive probiotics in treating gingivitis patients found significant improvements only in sites with higher gingival index scores .…”

“…42,43 By contrast, 2 studies found no significant improvements in clinical parameters with adjunctive probiotic therapy in chronic periodontitis patients. 47,52 One study that evaluated adjunctive probiotics in treating gingivitis patients found significant improvements only in sites with higher gingival index scores. 54 Thus, similar to the studies on monotherapy, there is significant heterogeneity in the adjunctive probiotic studies in terms of mode of delivery, treatment duration, and specific probiotic strains, concentrations, and doses being delivered.…”

Severity of Candida‐associated denture stomatitis is improved in institutionalized elders who consume Lactobacillus rhamnosus SP1

“…It should be noted that the L. rhamnosus SP1 probiotic strain has been previously used in clinical trials with excellent results. In these trials, a decrease in the prevalence of dental caries in pre‐school children and an improvement of clinical parameters of chronic periodontitis in adults were observed. The results obtained in the present study reveal a significant decrease in the prevalence and clinical severity of Candida ‐associated DS and a drastic reduction in Candida salivary counts in institutionalized older people.…”