Unlocking the potential of probiotic administration in caries management: a systematic review

Abstract

Background The use of prebiotics and/or probiotic bacteria with the potential to modulate the oral ecosystem may play an important role in the prevention and management of dental caries. To assess the evidence of the potential of pre/probiotics both in the prevention and treatment of dental caries, and therefore as adjuvant approaches in caries management, we focused on the PICO question “In individuals with caries, after probiotic administration, is there an improvement in outcomes directly related to caries risk and development?". Methods An extensive systematic search was conducted in electronic databases PubMed, Web of Science, Scopus and Cochrane, to identify articles with relevant data. This systematic review included trials complying the following inclusion criteria: studies performed in Humans; published in English; including the observation of patients with caries, with clear indication of the probiotic used and measurement of outcomes directly involved with the cariogenic process, including quantification of bacteria with cariogenic potential. To evaluate methodological quality of the studies, the critical assessment tool Joanna Briggs Institute was used. Results Eight hundred and fifty articles, potentially relevant, were identified. Following PRISMA guidelines 14 articles were included in this systematic review. Outcomes related to improvement of caries risk and development parameters were salivary counts of S. mutans and Lactobacillus, salivary pH and buffer capacity, new caries and caries activity, reduction of the cariogenic organisms content, assessed through sequencing approaches and salivary concentration of antimicrobial peptides. The probiotic most often referred with beneficial results in dental caries outcomes is Lacticaseibacillus rhamnosus being the most recommended to be included in clinical studies related to oral health. Regarding the most used administration vehicle, in studies with positive effects on the caries management, probiotic supplemented milk is considered the best administration vehicle. Conclusions Evidence suggests a beneficial effect of probiotic supplemented milk (Lacticaseibacillus rhamnosus) as an adjuvant for caries prevention and management. However, comparable evidence is scarce and better designed and comparable studies are needed.