BioGaia’s oral health probiotic reduces pregnancy gingivitis

Background: Pregnancy causes hormonal changes that increase the risk of developing gingivitis, which half of all pregnant women will experience. Research have suggested that women with pregnancy gingivitis may be more likely to deliver babies prematurely or with low birth weight than mothers with healthy gums.

This was a double blind, placebo-controlled study in 45 women with pregnancy gingivitis, but otherwise healthy, enrolled at the beginning of the third trimester. Participants were examined toevaluate the extent of gingivitis and plaque index, and instructed to continue with their usual brushing habits. They were randomly provided with a supply of lozenges to be consumed twice daily until birth, each containing 2×10^8 cfu of Lactobacillus reuteri Prodentis (L. reuteri ATCC PTA 5289 + DSM 17938, n=24)), or the equivalent placebo lozenges (n=21).

Within two days after birth (approximately seven weeks after enrolment), the participants were re-evaluated. Both gingival index and plaque index of the Prodentis group were significantly reduced compared to baseline, and compared to the placebo group (p<0.0001). Within the placebo group there were no significant changes versus baseline. Gingival index was categorized as 0 (no inflammation) in approximately 79% and 37% of the subjects in the probiotic and placebo group, respectively.

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Conclusion: The conventional methods to maintain oral health during pregnancy are brushing, flossing and seeing a dentist or a dental hygienist. L. reuteri Prodentis lozenges may be a useful adjunct in the control of pregnancy gingivitis.

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L. reuteri Prodentis shown to reduce Candida in the elderly

This was a double-blind, randomised, placebo-controlled trial in 215 elderly persons (mean age 88 years) living in 20 nursery homes in southern Sweden.

The study objective was to investigate the effect of a daily intake of the probiotic L. reuteri Prodentis (L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289) on the prevalence and counts of oral Candida in frail elderly patients living in nursery homes.

Patients were given two lozenges per day of either Lactobacillus reuteri Prodentis (n=95) or placebo (n=103) for 12 weeks.

Primary outcome was measured as prevalence and amount of Candida growth. Secondary outcomes was measured as levels of dental plaque and gingival inflammation.

There was a statistically significant reduction of 53% in the prevalence of high Candida counts in saliva in the L. reuteri Prodentis group but not in the placebo group, and the difference was statistically significant in both saliva and plaque (P < 0.05).

Daily use of L. reuteri Prodentis lozenges may reduce the prevalence of high oral Candida counts in frail elderly nursing home residents. This indicates that probiotic lozenges may be beneficial for patients at risk for oral candidosis.

Conclusions
Daily use of L. reuteri Prodentis lozenges may reduce the prevalence of high oral Candida counts in frail elderly nursing home residents. This indicates that probiotic lozenges may be beneficial for patients at risk for oral candidosis.

Effects of L. reuteri Prodentis in the treatment of chronic periodontitis

This double-blinded, placebo-controlled clinical trial aimed to evaluate the clinical and microbiological effects of lozenges containing L. reuteri Prodentis as an adjuvant treatment to initial periodontal therapy used twice a day for 3 weeks and to assess whether L. reuteri can colonise the periodontal pockets of chronic periodontitis patients.

A total of 40 patients were selected and randomly divided into 2 groups. Each patient had at least 2 teeth with one approximal site each with a probing depth (PD) of 5-7 mm and gingival index (GI) of ≥2 in each quadrant. Group 1 received scaling and root planing (SRP) plus lozenges containing L. reuteri Prodentis (10^8 CFU), and Group 2 received SRP plus placebo.

The plaque index (PI), GI, bleeding on probing (BoP), PD, and relative attachment level were measured. Microbiological sampling was performed at baseline and on days 21, 90, 180 and 360 and were analysed by culturing.

After treatment, the measured PI, GI, BoP, and PD as well as the total viable cell counts and the proportions of obligate anaerobes were significantly (p<0.05) lower in Group 1 compared with Group 2 at all time points. Similar observations were made for the total viable cell counts and the proportions of obligate anaerobes with the exception of day 360. In Group I, significantly fewer patients required surgery on ≥3 sites.

Conclusion
The results of this study demonstrated that the adjunctive usage of L. reuteri Prodentis lozenges improved the clinical and microbiological outcomes compared with the placebo-controlled group. L. reuteri Prodentis lozenges may be a useful adjuvant agent to slow recolonisation and improve clinical outcomes of chronic periodontitis.

Effects of Lactobacillus reuteri Prodentis in the treatment of chronic periodontitis

The aim of this randomised, placebo-controlled study was to evaluate the effects of the probiotic Lactobacillus reuteri Prodentis as an adjunct to scaling and root planing in chronic periodontitis patients. 30 chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy start. All patients received one-stage full mouth disinfection and scaling and root planing before being randomly assigned to either two lozenges per day of Lactobacillus reuteri Prodentis (L. reuteri Prodentis, 2×10^8 CFU, n=15) or placebo (n=15).

By the end of the study 53% fewer sites in patients with deep pockets and supplemented by Lactobacillus reuteri Prodentis was in need for surgery compared to placebo (18.3% compared to 34.4%, p<0.019). A site was considered as in need for surgery if the pocket depth was ≥6 mm or ≥5 mm and bleeding.

Significantly less patients with deep pockets in need for surgery

At week 12 all clinical parameters were significantly reduced in both groups while there was significantly more pocket depth reduction (p<0.001) and attachment gain (p<0.007) in deep pockets in the group that had received Lactobacillus reuteri Prodentis.

After the intervention period it was also concluded that 67% of the patients in the placebo group fell into the high-risk category for disease progression, while the corresponding figure for patients supplemented by Lactobacillus reuteri Prodentis was 27% (p<0.027). In the published article the authors point out that these figures are comparable to what is reported in different studies using a combination of two different antibiotics as an adjunct to scaling and root planing.

At week 12 all clinical parameters were significantly reduced in both groups while there was significantly more pocket depth reduction (p<0.001) and attachment gain (p<0.007) in deep pockets in the group that had received Lactobacillus reuteri Prodentis.

Significantly larger reductions in P. gingivalis numbers (p<0.05) were found in the subgingival, supragingival and saliva samples in the group supplemented by Lactobacillus reuteri Prodentis over the study period compared to placebo.

Significantly more reduction of pocket depth with Lactobacillus reuteri Prodentis

Significantly more reduction of pocket depth with Lactobacillus reuteri Prodentis

Significantly more attachment gain with Lactobacillus reuteriProdentis

Oral administration of Lactobacillus reuteri Prodentis lozenges could be a useful adjunct to scaling and root planing in patients with chronic periodontitis.

Conclusions
Oral administration of Lactobacillus reuteri Prodentis lozenges could be a useful adjunct to scaling and root planing in patients with chronic periodontitis.

Clinical changes in periodontal subjects with Lactobacillus reuteri Prodentis

20 systemically healthy, non-smoking subjects with initial-to-moderate chronic periodontitis were enrolled in this 1-month double-blind, placebo-controlled, randomized clinical trial. Subjects were randomly assigned to receive tablets containing Lactobacillus reuteri Prodentis or placebo once a day for 30 days. Clinical parameters were collected at baseline and 30 days posttreatment.

Periodontal clinical parameters were improved in the test group after a 30-day intervention. The test group demonstrated a statistically significant reduction (p < 0.05) in all the periodontal parameters included in the study (plaque index, bleeding on probing and pocket probing depths), while the control group treated with placebo did not show any statistically significant change in periodontal parameters.

These data indicate that oral administration of Lactobacillus reuteri Prodentis improved the short-term clinical outcomes in non-smoking patients with initial-to-moderate chronic periodontitis.

Conclusions
These data indicate that oral administration of Lactobacillus reuteri Prodentis improved the short-term clinical outcomes in non-smoking patients with initial-to-moderate chronic periodontitis.

Short-term consumption of probiotic lactobacilli has no effect on acid production of supragingival plaque

Acidogenicity and the levels of mutans streptococci (MS) in dental plaque after the use of Lactobacillus rhamnosus GG (LGG) and Lactobacillus reuteri were determined. The study had a randomised, double-blind, crossover design.

Thirteen volunteers used tablets containing LGG or a combination of Lactobacillus reuteri SD2112 and PTA 5289 for 2 weeks. At baseline and at the end of each tablet period, all available supragingival plaque was collected. Lactic acid production was determined from a fixed volume (8 μl) of fresh plaque and the rest of the plaque was used for culturing MS and lactobacilli. The retention of probiotics to the plaque was assessed using PCR techniques. No probiotic-induced changes were found in the acidogenicity of plaque. Also, MS counts remained at the original level. The number of subjects with lactobacilli in plaque increased in the Lactobacillus reuteri group (p = 0.011) but not in the LGG group. PCR analysis of plaque revealed the presence of LGG in four and Lactobacillus reuteri in six subjects after the use of the probiotic.

Conclusion
The use of the lactobacilli did not affect the acidogenicity or MS levels of plaque. Short-term consumption of LGG and Lactobacillus reuteri appeared not to influence the acidogenicity of plaque.

Effect of chewing gums containing Lactobacillus reuteri on oral malodour

A study with the objective of evaluating the effects of chewing gums containing probiotic bacteria on oral malodour.

Twenty-five healthy young adults with self reported malodorous morning breath, who did not suffer from periodontal disease or dry mouth, completed this randomized double-blind placebo-controlled, crossover trial. The design included run-in and washout periods, interspersed by two intervention periods of 14 days each. The subjects were instructed to chew one gum in the morning and one in the evening. The gums contained either two strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289, 2×10^8 CFU/gum) or placebo.

The outcome measures were (i) organoleptic scoring (0–5) by a certified test panel, (ii) concentration of volatile sulphur compounds (VSC) measured using a Halimeter and (iii) concentration of VSC after a cysteine rinse to create a standardized malodour. Registrations were made at baseline and after each intervention period. The median organoleptic score was similar (score 2) in both groups at baseline. After 14 days of treatment the organoleptic scores were significantly lower in the probiotic group compared with the placebo group (p < 0.05). Assessments of the VSC levels displayed no significant differences between the groups, either before or after rinsing with L-cysteine.

Conclusion
Probiotic gum containing Lactobacillus reuteri may have some beneficial effect on oral malodour assessed by organoleptic scores. The results indicate that the probiotic gum may affect bacteria that produce malodourous compounds other than volatile sulphur compounds.

Effects of Lactobacillus reuteri in patients with gingivitis

A placebo-controlled, parallel study with the objective to investigate the effects of an orally administered probiotic on the oral microbiota. The study was conducted in 40 gingivitis subjects during 8 weeks. Treatment consisted on the administration of a daily tablet, either containing Lactobacillus reuteri or placebo. Unstimulated saliva and subgingival samples were collected and analysed by culture and PCR. Clinical and microbiological outcome variables were compared between and within groups.

There were no significant changes between and within the groups in the clinical variables. In saliva, total anaerobic counts after 4 weeks (p = 0.021) and counts of Prevotella intermedia after 8 weeks (p = 0.030), showed reductions in the test group. In subgingival samples, significant reductions in the changes baseline to 4 weeks were observed for P. gingivalis counts (p = 0.008). With PCR, Lactobacillus reuteri ATCC-PTA-5289 was more frequently detected than Lactobacillus reuteri DSM-17938.

Conclusions
The effect of Lactobacillus reuteri administered in tablets resulted in a reduction in the number of selected periodontal pathogens in the subgingival microbiota, without an associated clinical impact.

A novel delivery system of probiotic drop and its effect on dental caries

This randomised, double-blind, and placebo-controlled study investigated the effects of the probiotic bacterium Lactobacillus reuteri on the levels of salivary mutans streptococci and lactobacilli in cleft lip/palate children.

The study product was an oil emulsion containing Lactobacillus reuteri DSM 17938 and Lactobacillus reuteri ATCC PTA 5289 (≥ 2×10^8 CFU/5 drops), or an equivalent placebo oil formulation. 19 operated cleft lip/palate children aged 4–12 years were included.

The experimental period consisted of four consecutive periods. During periods 2 and 4 (25 days each, respectively), the children were administered 5 drops per day of either of the study products in a crossover design. Periods 1 and 3 were washout periods. The counts of salivary mutans streptococci and lactobacilli were evaluated. There were no statistically significant (p>0.05) reductions of either salivary mutans streptococci or lactobacilli after 25 days of consumption of any of the drops.

Conclusions
The novel drop formulation with Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 may not reduce the levels of salivary mutans streptococci and lactobacilli in cleft lip/palate children.