Probiotics in Treatment and Prevention of Periodontal Diseases: A Systemic Review


  • Kakarla Priyanka Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India. Author
  • Kudlur Maheswarappa Sudhir Reader, Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India Author
  • V. Chandra Sekhara Reddy Professor and Head, Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India Author
  • R.V.S Krishna Kumar Reader, Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India Author
  • G. Srinivasulu Senior Lecturer, Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India. Author



Probiotics, Periodontitis, Gingivitis


Aim: Aim of this systematic review was to analyse the available scientific evidence on the effects of probiotics in prevention and treatment of periodontal diseases

Materials and methods: A broad literature search was performed using both electronic database and hand search in library. The important databases like COCHRANE CENTRAL, MEDLINE, GOOGLE SCHOLAR, EMBASE were used for online data search. Hand search was performed in the central library of the institute to identify the relevant articles, articles that satisfied the inclusion criteria with description of randomized clinical trials comparing the administration of probiotics versus placebo or another intervention to prevent or treat periodontal diseases in adult patients were selected.

Results: The initial search resulted in 73 articles; however, 45 of these articles were excluded after reviewing the abstracts because they did not have the proper clinical trial design or because they were duplicates. After analysing the full text from 27 clinical trials, 12 were excluded because they did not fulfil all the selection criteria. Our final review included 15 articles. Included outcome measures were probing pocket depth, bleeding on probing, clinical attachment loss, plaque index and gingival inflammation. Included studies were subjected to critical analysis following the Cochrane Collaboration tool for evaluating the risk of bias.

Conclusion: Probiotics had a beneficial effect on reducing probing pocket depth, gingival inflammation, bleeding on probing when compared with placebo. Lactobacillus was the most commonly used probiotic genus, in which L.reuteri strain had most beneficial effects.


Download data is not yet available.


Teughels W, Essche MV, Sliepen I, Quirynen M. Probiotic and oral health care. Periodontol. 2000; 48: 111-147.

Bonifiat L, Chandad F, Grenier D. Probitics for oral health: Myth or Reality. J Can Dent Assoc. 2009; 75(8): 585-590.

Juneja A, Kakade A. Evaluating the effect of probiotic containing milk on salivary mutans streptococci levels. J Clin Pediatr Dent. 2012; 37(1): 9-14.

Bahl SM. Probiotics in Systemic and Oral Health. J Dentistry. 2012; 2(4): 1-2.

Gupta G. Probiotics and periodontal health. J Med Life.2011; 4(4): 387-394.

Pandit N, Pandit IK, Bali D, Oberoi S. Probiotics and periodontal diseases:The link. Indian J Oral Sci. 2013; 4(3): 114-119.

Isabel1 GC, Kavitha P, Gena T. Oral Probiotics- Over the Counter Periodontal Therapy, Myth or Reality?. J Dentistry. 2012; 2(1): 1-2.

The Cochrane collaborations tool for assessing risk of bias

Caglar E, Kuscu OO, Cildir SK, Kuvvetli SS, Sandalli N. A probiotic lozenge administered medical device and its effect on salivary mutans streptococci and lactobacilli. Int J Paediatr Dent. 2008; 18: 35-39

Riccia DND, Bizzini F, Perilli MG, Polimeni A, Trinchieri V, Amicosante G etal. Anti-inflammatory effects of Lactobacillus brevis (CD2) on periodontal disease. Oral Dis. 2007; 13: 376-385

Mayanagi G, Kimura M, Nakaya S, Hirata H, Sakamoto M, Benno Y etal. Probiotic effects of orally administered Lactobacillus salivarius WB21-containing tablets on periodontopathic bacteria: a double-blinded, placebo controlled randomized clinical trial. J Clin Periodontol. 2009; 36: 506-513

Tsubura S, Mizunuma H, Ishikawa S, Oyake I Okabayashi M, Katoh K etal. The effect of Bacillus subtilis mouth rinsing in patients with periodontitis. Eur J Clin Microbiol Infect Dis. 2009; 28:1353-1356.

Zahradnik RT, Magnusson I, Walker C, McDonell E, Hillman CH, Hillman JD. Preliminary assessment of safety and effectiveness in humans of ProBiora, a probiotic mouthwash. J Appl Microbiol. 2009; 107: 682-590.

Harini PM, Anegundi RT. Efficacy of a probiotic and chlorhexidine mouth rinses: A short-term clinical study. J Indian Soc Pedod Prev Dent. 2010; 28(3): 179-182

Tahmourespour A, Kermanshahi RK. The effect of a probiotic strain (Lactobacillus acidophilus) on the plaque formation of oral Streptococci. Bosn J Basic Med Sci. 2011; 11 (1): 37-40

Marttinen A, Haukioja A, Karjalainen S, Nylund L, Satokari R, Ohman C, et al. Short-term consumption of probiotic lactobacilli has no effect on acid production of supragingival plaque. Clin Oral Invest. 2012; 16:797-803

Dhawan R, Dhawan S. Role of probiotics on oral health: A randomized, double‑blind, placebo‑controlled study. J Interdiscip Dentistry. 2013; 3(2): 71-78

Ericson D, Hamberg K, Bratthall G, Sinkiewicz-Enggren G, Ljunggren L. Salivary IgA response to probiotic bacteria and mutans streptococci after the use of chewing gum containing Lactobacillus reuteri. Pathog Dis. 2013; 68: 82-87

Maekawa T, Hajishengallis G. Topical treatment with probiotic Lactobacillus brevis CD2 inhibits experimental periodontal inflammation and bone loss. J Periodont Res. 2014; 49: 785-791.

Terai T, Okumura T, Imai S, Nakao M, Yamaji K, Ito M. Screening of Probiotic Candidates in Human Oral Bacteria for the Prevention of Dental Disease. J pone. 2015; 10(6): 1-20

Shimauchi H, Mayanagi G, Nakaya S, Minamibuchi M, Ito Y, Yamaki K et al. Improvement of periodontal condition by probiotics with Lactobacillus salivarius WB21: a randomized, double-blind, placebo-controlled study. J Clin Periodontol. 2008; 35: 897-905.

Staab B, Eick S, Knofler G, Jentsch H. The influence of a probiotic milk drink on the development of gingivitis: a pilot study. J Clin Periodontol. 2009; 36: 850-856

Twetman S, Derawi B, Keller M, Ekstrand K, Yucel-lindberg L, Steckse C. Short-term effect of chewing gums containing probiotic Lactobacillus reuteri on the levels of inflammatory mediators in gingival crevicular fluid. Acta Odontol Scand. 2009; 67: 19-24.

Vivekananda MR, Vandana KL, Bhat KG. Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminarymrandomized clinical trial. J Oral Microbiol. 2010; 2: 1-9.

Iniesta M, Herrera D, Montero E, Zurbriggen M, Matos AR, Marın MJ. Probiotic effects of orally administered Lactobacillus reuteri-containing tablets on the subgingival and salivary microbiota in patients with gingivitis. A randomized clinical trial. J Clin Periodontol. 2012; 39: 736-744

Burton JP, Drummond BK, Chilcott CN, Tagg JR, Thomson WM, Hale JDF. Influence of the probiotic Streptococcus salivarius strain M18 on indices of dental health in children: a randomized double-blind, placebo-controlled trial. J Med Microbiol. 2013; 62: 875-884.

Dhawan S, Dhawan R etal. Role of Probiotics on Oral Health - A Randomized, Double Blind, Placebo-Controlled Microbiological Study. J Res Pract Dentist.2013; 2013: 1-9.

Hallstrom H, Lindgren S, Yucel-lindberg T, Dahlen G, Renvert S, Twetman S. Effect of probiotic lozenges on inflammatory reactions and oral biofilm during experimental gingivitis. Acta Odontol Scand. 2013; 71: 828-833

Karuppaiah RM, Shankar S, Raj SK, Ramesh K, Prakash R, Kruthika M etal. Evaluation of the efficacy of probiotics in plaque reduction and gingival health maintenance among school children - A Randomized Control Trial. J Int Oral Health. 2013; (5):33-7.

Piyush Shah M, Gujjari SK, Chandrasekhar VS. Evaluation of the Effect of Probiotic (Inersan®) Alone, Combination of Probiotic with Doxycycline and Doxycycline Alone on Aggressive Periodontitis - A Clinical and Microbiological Study. J Clin Diagn Res. 2013; 7(3): 595-600

Teughels W, Durukan A, Ozcelik O,Pauwels M, Quirynen M, Haytac MC. Clinical and microbiological effects of Lactobacillus reuteri probiotics in the treatment of chronic periodontitis: a randomized placebo-controlled study. J Clin Periodontol. 2013; 40: 1025-1035

Vicario M, Santos A, Violant D, Nart J, Giner L. Clinical changes in periodontal subjects with the probiotic Lactobacillus reuteri Prodentis: A preliminary randomized clinical trial. Acta Odontol Scand. 2013; 71: 813-819.

Ince G, Gursoy H, DirikanIpcxi S, Cakar G, Emekli-Alturfan E, Yılmaz S. Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis. J Periodontol. 2015; 86(6): 746-754

Tekce M, Ince G, Gursoy H, Ipci SD, Cakar G, Kadir T etal. Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: a 1-year follow-up study. J Clin Periodontol. 2015; 42: 363-372

Toiviainen A, Jalasvuori H, Lahti E, Gursoy U, Salminen S, Fontana M etal. Impact of orally administered lozenges with Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 on the number of salivary mutans streptococci, amount of plaque, gingival inflammation and the oral microbiome in healthy adults. Clin Oral Invest. 2015; 19:77-83.

Lee KB, Lee HG, Choi YJ. Proteomic analysis of the effect of bile salts on the intestinal and probiotic bacterium Lactobacillus reuteri. J Biotechnology.2008; 147: 14-19.