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Efficacy of Oral Probiotics As an Adjunct to Scaling and Root

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Efficacy of Oral Probiotics As an Adjunct to Scaling and Root IJEDS Ameet Mani et al 10.5005/jp-journals-10029-1145 ORIGINAL RESEARCH Efficacy of Oral Probiotics as an Adjunct to Scaling and Root Planing in Nonsurgical Treatment Outcome of Generalized Chronic Periodontitis Patients: A Clinico-Microbiological Study 1Ameet Mani, 2Rajiv Saini, 3Sugandha R Saini ABSTRACT INTRODUCTION Aim: This study aims to find out the effects of Probiotics, Mouth acts as a window to a lot of systemic diseases and delivered with a lozenge for its effect on clinical and serves as a port of entry of the various infections that microbiological parameters in subjects with chronic periodontitis can alter and affect the immune status of the person. after scaling and root planing (SRP). The oral cavity has the potential to harbor at least 600 Materials and methods: A total of 40 generalized mild to different bacterial species, and in any given patient, moderate chronic periodontitis subjects were finally enrolled in more than 150 species may be present, surfaces of tooth a double-blind, placebo-controlled, randomized clinical study. Selected subjects after SRP were randomly divided into two can have as many as billion bacteria in its attached bac- groups: Group I (test group) with 20 subjects receiving probiotic terial plaque and good oral hygiene is the fundamental tablet once daily and group II (control group) receiving placebo for oral integrity as it greatly affects the quality of life.1 tablets once daily. Clinical parameters and bacterial count for Periodontitis is a destructive inflammatory disease of the Aggregatibacter actinomycetemcomitans, Porphyromonas supporting tissues of the teeth and is caused by specific gingivalis, Prevotella intermedia, Fusobacterium nucleatum were evaluated at baseline, 2, and 4 months after the microorganisms or group of specific microorganisms medication. resulting in progressive destruction of periodontal liga- ment and alveolar bone with periodontal pocket forma- Results: On comparative evaluation between the two groups, results indicated that group I (probiotic group) tion, gingival recession, or both. The host responds to the exhibited statistically significant reduction in both clinical and periodontal infections with an array of events involving microbiological levels than group II (control group) over the both innate and adaptive immunity.2 Periodontal dis- entire span of the study. eases are recognized as infectious processes that require Conclusion: Our results proved that daily oral supplementation bacterial presence and a host response and are further of probiotics could be a useful adjunct to SRP in chronic affected and modified by other local, environmental, periodontitis patients. and genetic factors. The key organisms that cause peri- Keywords: Hyperbiotics, Periodontitis, Probiotics. odontal disease were anaerobes including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella How to cite this article: Mani A, Saini R, Saini SR. Efficacy of Oral Probiotics as an Adjunct to Scaling and Root Planing intermedia, Tannerella forsythia, Fusobacterium nucleatum, in Nonsurgical Treatment Outcome of Generalized Chronic Peptostreptococcus micros, and Campylobacter rectus.3 Periodontitis Patients: A Clinico-Microbiological Study. Int J Periodontitis has been proposed as having an etiologi- Experiment Dent Sci 2017;6(1):6-13. cal or modulating role in many systemic organ systems Source of support: Nil like cardiovascular, cerebrovascular disease, diabetes, respiratory disease, and adverse pregnancy outcome; Conflict of interest: None several mechanisms have been proposed to explain or support such theories. One of these is based around the 1Professor and In-Charge, 2Associate Professor, 3Lecturer potential for the inflammatory phenomenon of peri- odontitis to have effects by the systemic dissemination 1,2Department of Periodontology and Oral Implantology, Pravara Institute of Medical Sciences, Ahmednagar, Maharashtra, India of locally produced mediators, such as C-reactive protein, β 3Department of Prosthodontics, Pravara Institute of Medical interleukin-1 beta (IL-1 ), IL-6, and tumor necrosis factor Sciences, Ahmednagar, Maharashtra, India alpha (TNF-α). Periodontal diseases are recognized as Corresponding Author: Rajiv Saini, Associate Professor infectious processes that require bacterial presence and Department of Periodontology and Oral Implantology, Pravara a host response which are further affected and modified Institute of Medical Sciences, Ahmednagar, Maharashtra, India by other local, environmental, and genetic factors. The e-mail: [email protected] oral cavity works as a continuous source of infectious 6 IJEDS Efficacy of Oral Probiotics as an Adjunct to SRP in Nonsurgical Treatment Outcome of Generalized Chronic Periodontitis Patients agents, and its condition often reflects the progression the host animal by improving its intestinal microbial of systemic pathologies.4 Recent advances in research balance.”13 World Health Organization (WHO) describes technology have allowed researchers to study bacteria in probiotics as “live microorganisms which, when their natural environment. Dental biofilm forms via an administered in adequate amounts in food or as dietary ordered sequence of events, resulting in structured and supplement confer a health benefit on the host.”14 This functionally organized species-rich microbial community term has been derived from the Greek language which and modern molecular biological techniques have identi- means “for life.” The term probiotic, as an antonym fied about 1,000 different bacterial species in the dental to the term antibiotic, was first used by Lilly and biofilm, twice as many as can be cultured. Stillwell in 1965 to describe substances secreted by one Dental plaque biofilm cannot be eliminated. However, microorganism which stimulates the growth of another.15 the pathogenic nature of the dental plaque biofilm can The concept of probiotics was brought forward in the first be reduced by reducing the bioburden (total microbial decade of 1900 by a Ukrainian bacteriologist and Nobel load and different pathogenic isolates within that Laureate Metchnikoff16 who observed that bacteria in the dental plaque biofilm) and maintaining a normal flora fermented milk competed with the microorganisms that with appropriate oral hygiene methods.5 The ecological are injurious to health. plaque hypothesis suggests that selective pressure Recent studies have demonstrated a beneficial health in environmental conditions can change the balance impact of specific probiotic bacteria in humans, leading to between oral health and disease. As bacteria can also several new recommendations for probiotic use to boost influence their environment, and both synergistic and entire immune system including oral health. The oral antagonistic interactions are suggested for bacteria in cavity has recently been suggested as a relevant target dental plaque, the environmental pressure described in for probiotic applications. In the oral cavity, probiotics the ecological plaque hypothesis could be introduced adhere to dental tissues as a part of biofilm, acting as a partly by bacteria.6 A logical approach to the prevention protective lining for oral tissues against oral diseases. of periodontal disease is through excellent supragingival Such a biofilm keeps bacterial pathogens off the oral plaque control. The toothbrush plays an important role tissues by filling a space which could have served as for personal oral hygiene and effective plaque removal.7 niche for pathogens in future and competing with Such control is not generally achieved by mechanical the cariogenic bacteria and periodontal pathogens.17 oral hygiene procedures alone. Thus, there is a clear Hence, this randomized double-blind placebo controlled rationale for the use of antiplaque agents to augment clinical study was aimed to evaluate the efficacy of mechanical means. Several alcohol-based antiplaque Hyperbiotics PRO-Dental oral lozenges with conventional agents are available in the market and the most common oral hygiene measure in treatment of mild to moderate is chlorhexidine gluconate, but with scientifically proven chronic periodontitis patients in terms of clinical and side effects associated with chlorhexidine gluconate, i.e., microbiological parameter outcomes. temporary loss of taste; staining of teeth, restorations, and mucosa; dryness and soreness of mucosa; bitter taste; MATERIALS AND METHODS 8,9 and slight increase in supragingival calculus formation. Patient Selection However, changing paradigms in the pathogenesis of periodontal diseases and with the evolution of technology, The present study was conducted in the Department of novel adjunctive antimicrobial approaches, such as Periodontology and Oral Implantology, Pravara Institute probiotics, photodynamic therapy, ozone therapy, anti- of Medical Sciences, Loni, Ahmed Nagar, Maharashtra, oxidants and local drug delivery, have emerged within India. It was a randomized, double-blinded placebo- the scientific and clinical literature in recent years.10 controlled clinical study. After an informed consent, a Due to the emergence of antibiotic resistance and total 40 mild to moderate generalized chronic periodon- frequent recolonization of treated sites with pathogenic titis patients between the ages of 18 and 55 years were bacteria,11,12 there is need for new treatment paradigms in enrolled in the study and divided under two categories. periodontal disease management. Enormous attention is Each group comprised
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