Effect of probiotic Lactobacillus reuteri as an adjunct to nonsurgical treatment on halitosis of patients with periodontitis: a randomised placebo - controlled trial

doctoral thesis

• Title (croatian): Učinak probiotika Lactobacillus reuteri kao dodatne terapije uz nekirurško liječenje na halitozu u bolesnika s parodontitisom: randomizirano placebom kontrolirano ispitivanje
• Author: Larisa Musić
• Mentor: Darije Plančak (mentor)
• Committee member: Darko Božić (predsjednik povjerenstva)
• Committee member: Marinka Mravak-Stipetić (član povjerenstva)
• Committee member: Nataša Beader (član povjerenstva)
• Committee member: Ivan Puhar (član povjerenstva)
• Committee member: Ana Badovinac (član povjerenstva)
• Committee member: Domagoj Vražić (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Department of Periodontology); Zagreb
• Defense date and country: 2021-02-09, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Periodontology
• Universal decimal classification (UDC): 616.31 - Stomatology

Abstract

Intra-oral halitosis is caused by the production of malodorous compounds, a by-product of bacterial metabolic activity. The anaerobic gram-negative bacteria that is causative to periodontitis are also known as contributors to halitosis. Probiotics were evaluated for their effect on halitosis and as an adjunct to nonsurgical treatment, respectively. This study was conducted to evaluate the impact of probiotic L. reuteri on halitosis in a group of subjects with periodontitis when used as an adjunct to nonsurgical treatment. Thirty adult subjects with diagnosed periodontitis and halitosis [at least: organoleptic score (OLS)≥1 + volatile sulphur compounds (VSC) >160 ppb] were evaluated at baseline for parameters of halitosis (OLS judged on a scale 0-5, the concentration of VSC measured with Halimeter), clinical periodontal parameters, tongue coating, microbiological sampling and psychometric testing [Oral Health Impact Profile – 14 (OHIP-14) and Halitosis Associated Life-quality Test (HALT)]. After undergoing nonsurgical periodontal treatment, they were randomised into two groups. They were instructed to use lozenges containing probiotics (combination of two Lactobacillus strains: L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289) or placebo,
twice per day for 28 days. At 1 month, OLS, VSC and tongue coating were evaluated. At three months, all parameters were re-evaluated. OLS, VSC, clinical periodontal parameters, tongue coating, OHIP-14 and HALT values significantly reduced in both groups. Both groups had a significant reduction of P. gingivalis, T. forsythia, T. denticola, P. micros, P. intermedia. Unlike in the test group, no statistically significant reduction was observed in the total bacterial count (TBC). No significant differences were observed for OLS and VSC values after three months. However, secondary (OLS≥2) and composite [(OLS)≥1 + (VSC)
>160 ppb] parameters of residual halitosis were marginally significant (p=0.068), with better outcomes in the probiotic group. There was a significantly greater magnitude of PPD reduction (p<0.0001) and CAL gain (p<0.0001) in the probiotic group. They also had significantly lower OHIP-14 scores (p=0.043) compared to the test group. The results indicate that the administration of L. reuteri as an adjunct treatment could confer additional benefits in terms of halitosis reduction, improvements in periodontal parameters, change in microbial composition and quality of life.

Abstract (english)

Uvod: Intraoralna halitoza uzrokovana je proizvodnjom spojeva neugodnog olfaktornog karaktera koji nastaju kao nusproizvod metaboličke aktivnosti bakterija. Anaerobne gramnegativne bakterije, koje su ujedno i uzročnici parodontitisa, također su poznate po produkciji navedenih spojeva. Utjecaj probiotika na halitozu i kao dodatka nekirurškom parodontološkom liječenju evaluirano je znanstvenim istraživanjima. Ovo je istraživanje provedeno s ciljem procjene utjecaja probiotika L. reuteri na halitozu u skupini ispitanika s parodontitisom kao dodatne terapije uz nekirurško liječenje.
Materijali i metode: 30 odraslih ispitanika s dijagnosticiranim parodontitisom i halitozom [uključni kriteriji: organoleptički rezultat (OLS) ≥1 + lakohlapljivi sumporni spojevi (VSC)> 160 ppb] evaluirano je na početku istraživanja za parametre halitoze (OLS procijenjen na skali 0-5, koncentracija VSC izmjerenih Halimeterom), kliničke parodontološke parametre,
obloženost jezika, mikrobiološki nalaz i psihometrijsko ispitivanje [Oral Health Impact Profile - 14 (OHIP-14) i Halitosis Associated Life-quality Test (HALT)]. Nakon nekirurškog parodontološkog liječenja, randomizirani su u dvije skupine. Upućeni su u korištenje pastila koje sadrže probiotike (kombinacija dva soja Lactobacillus: L. reuteri DSM 17938 i L. reuteri
ATCC PTA 5289) ili placeba, dva puta dnevno tijekom 28 dana. Nakon 1 mjeseca procijenjeni su OLS, VSC i obloženost jezika. Nakon tri mjeseca svi su parametri ponovno procijenjeni.
Rezultati: Vrijednosti OLS, VSC, klinički parodontološki parametri, obloženost jezika, OHIP14 i HALT značajno su smanjeni u obje skupine nakon provedene terapije. Obje su skupine imale značajno smanjenj broj P. gingivalis, T. forsythia, T. denticola, P. micros, P. intermedia. Za razliku od kontrolne skupine, nije zabilježeno statistički značajno smanjenje ukupnog broja bakterija (TBC) u testnoj skupini. Nisu primijećene značajne razlike za vrijednosti OLS i VSC nakon 1 i 3 mjeseca između grupa, međutim sekundarni (OLS≥2) i kompozitni [(OLS) ≥1 + (VSC)> 160 ppb] parametri rezidualne halitoze bili su marginalno značajni (p = 0,068), s boljim ishodima u probiotičkoj skupini. U toj skupini zabilježena je i značajno veće smanjenje PPD-a (p <0,0001) i dobitak CAL-a (p <0,0001). Također su imali značajno niže vrijednosti OHIP-14
(p = 0,043) nakon 3 mjeseca u usporedbi s kontrolnom skupinom.
Zaključak: Rezultati ukazuju na to da bi primjena probotika L. reuteri kao dodatne terapije mogla pružiti dodatne koristi u smislu eliminacije halitoze, poboljšanja parodontoloških parametara, promjene subgingivnog mikrobnog sastava i kvalitete života pojedinca.

• Keywords: Periodontitis; *Lactobacillus reuteri; Halitosis; Tongue
• Keywords (croatian): parodontitis; Lactobacillus reuteri; halitoza; jezik
• Language: english
• URN:NBN: urn:nbn:hr:127:817040
• Promotion: 2021-09-02
• Study programme: Title: dental medicine; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo, polje dentalna medicina (doktor/doktorica znanosti, područje biomedicine i zdravstvo, polje dentalna medicina)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Repository: University of Zagreb School of Dental Medicine Repository
• Created on: 2021-09-14 11:16:44