Effects of Lactobacillus reuteri-containing lozenges on healing after surgical removal of mandibular third molars: a randomised controlled trial

Abstract

We investigated the effect of probiotic supplements on oral wound healing, swelling, pain and discomfort after surgical removal of mandibular third molars. A second aim was to evaluate if the intervention could influence the concentrations of oxytocin in saliva. Sixty-four consecutive volunteers (18-34 years) were enrolled to a double-blind randomised placebo-controlled trial with two parallel arms. Following surgery, the patients were asked to take three lozenges per day containing two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo for two weeks. The clinical healing and extra-oral swelling were scored two weeks post-operatively. Samples of wound exudate were cultivated for the presence of Staphylococcus aureus and β-haemolytic streptococci. Salivary oxytocin concentrations were analysed from pre- and post-surgery samples using ELISA technique. Compliance and the subjective perception of swelling, pain and discomfort were reported daily through visual analogue scales in a logbook. All patients except three completed the protocol and the postoperative course was uneventful in most cases. Minor extra-oral swellings were noted in five patients, but none required antibiotic treatment. At the 2-week follow-up, there were no significant differences in clinical wound healing index, extra-oral swelling, bacterial growth or salivary oxytocin levels between the groups. The self-reported data unveiled, however, a significantly reduced sense of swelling, in particular during the second week after surgery in the probiotic test group (P<0.05). Likewise, significantly fewer nights with disturbed sleep and fewer days with sick-leave from work were reported among the participants in the test group (P<0.05). No differences were found in the post-operative use of analgesics. In conclusion, we found no significant influence of probiotic supplements on objective wound healing after surgical extraction of impacted mandibular third molars. However, since the patients’ perceived significant post-operative ameliorations, further studies are needed to explore the patient’s value of the intervention.

Does Probiotic Consumption Enhance Wound Healing? A Systematic Review

“…Table 1 presents the characteristics, objectives, intervention protocols, and main outcomes of the seven studies included in this review [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. The studies were published between 2014 [ 24 ] and 2019 [ 25 ], and were carried out in Egypt [ 26 ], Italy [ 27 ], the United States [ 28 ], Iran [ 29 ], Pakistan [ 24 ], Denmark [ 30 ], and Sweden [ 25 ]. Three studies assessed the effect of oral/enteral probiotic therapy on burn healing [ 24 , 26 , 28 ].…”

“…El-Ghazely et al, Tahir et al and Mayes et al assessed aspects related to skin grafting [ 24 , 26 , 28 ]. Six studies were randomised clinical trials [ 25 , 26 , 27 , 28 , 29 , 30 ], and one conducted by Tahir et al was a placebo-controlled, non-randomised clinical trial [ 24 ]. The seven studies included in this review enrolled a total of 348 subjects of both sexes (225 males).…”

“…Regarding the type of wounds, the studies included burn wounds [ 24 , 26 , 28 ], surgical wounds [ 27 ], diabetic foot ulcers [ 29 ], and oral mucosal wounds [ 25 , 30 ]. The intervention protocols were Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) [ 25 , 30 ], L. fermentum and L. delbruekii [ 26 ], L. rhamnosus GG (ATCC 53103) [ 27 ], L. rhamnosus GG [ 28 ], L. acidophilus , L. casei , L. fermentum and Bifidobacterium bifidum [ 29 ], L. acidophilus LA-5, Bifidobacterium BB-12, Streptococcus thermophilus STY-31, and L. delbrueckii ssp. bulgaricus LBY-27 [ 24 ].…”

“…bulgaricus LBY-27 [ 24 ]. The prescription of probiotics in these studies varied with respect to the doses and administration forms, such as sachets [ 24 , 26 ], drops [ 27 ], nasoduodenal feeding tube [ 28 ], capsules [ 29 ], and lozenges [ 25 , 30 ]. The frequency of probiotic therapy in the studies was 1–3 times/day, and the treatment period varied according to the duration of antibiotic use [ 27 ], length of hospitalisation [ 24 ], the time required to achieve 95% wound healing [ 28 ], or the defined research protocol [ 25 , 26 , 29 , 30 ].…”

Probiotics in Oral Health and Disease: A Systematic Review

“…Walivaara et al [115] evaluated the effects of L. reuteri supplements administered 3 times a day for 2 weeks on the healing of wounds after surgical extraction of lower third molars. Probiotic had no effect on the healing process as determined by extra-oral swelling, level of salivary oxytocin, and presence of bacteria.…”