title: Probiotics for managing caries and periodontitis: Systematic review and meta-analysis.
abstract: OBJECTIVE
  Probiotics might be beneficial to prevent or treat caries, gingivitis or periodontitis. We aimed to appraise trials assessing probiotics for managing caries and periodontal disease.
  
  
  METHODS
  We included randomized controlled trials comparing the efficacy of probiotics versus (placebo) control with regards to Streptococcus mutans [SM], lactobacilli [LB], periodontal pathogens numbers, gingivitis, oral hygiene, caries incidence/experience increment, or periodontitis. Meta-analysis and trial-sequential-analysis were performed.
  
  
  METHODS
  Three electronic databases (Medline, Embase, Central) were screened.
  
  
  METHODS
  50 studies (3247 participants) were included. Studies were mainly performed in children and used lactobacilli (45); bifidobacteria (12) or other genus (3). Probiotics significantly increased the chance of reducing SM (OR: 2.20, 95% CI: 1.23/3.92) or LB (OR: 2.84; 1.34/6.03)<10(4)CFU/ml. Such reduction was confirmed for SM counts (standardized mean differences: -1.18, 95% CI: -1.64/-0.72), but not LB (SMD: 0.33; 0.15/0.52). For periodontal pathogens, no significant difference was found. Probiotics significantly reduced bleeding-on-probing (SMD: -1.15; -1.68/-0.62) and gingival index (SMD: -0.86; -1.52/-0.20), but not plaque index (SMD: -0.34; -0.89/0.21). Caries incidence was not significantly reduced (OR: 0.60; 0.35/1.04), neither was caries experience (SMD: -0.26; -0.55/0.03) or CAL (SMD: -0.46; -0.84/0.08). In contrast, probing-pocket depths (SMD: -0.86; -1.55/-0.17) were significantly reduced. Data was quantitatively insufficient for conclusive findings, and risk of bias was high.
  
  
  CONCLUSIONS
  Current evidence is insufficient for recommending probiotics for managing dental caries, but supportive towards managing gingivitis or periodontitis. Future studies should only record bacterial numbers alongside accepted disease markers or indicators.
  
  
  CONCLUSIONS
  Probiotic therapy could be used for managing periodontal diseases. For caries, further studies should ascertain both efficacy and safety.
authors.affiliation: Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gruner
authors.affiliation: Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Paris
authors.affiliation: Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany, Aßmannshauser Str. 4-6, 14197 Berlin, Germany. Electronic address: falk.schwendicke@charite.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Schwendicke
mesh_terms: D003731:Dental Caries / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D010518:Periodontitis / Q000188:drug therapy* / Q000517:prevention & control*; D019936:Probiotics / Q000008:administration & dosage* / Q000009:adverse effects
keywords: Bacteria; Caries; Dental hygiene; Evidence-based dentistry/health care; Gingivitis; Periodontal disease(s)/periodontitis