Probiotic Bifidobacteria in Managing Periodontal Disease: A Systematic Review

Although various probiotic organisms have been evaluated for their utility in the manage-ment of periodontitis, their strain-specific mechanisms of action are still unclear. We aimed to systematically review the effect of bifidobacterial probiotics on periodontopatho-gens and host immune responses in periodontal diseases. An electronic search of articles published until June 2022 in Medline, PubMed, Web of Science, and Cochrane Library data-bases was performed. Randomised controlled trials (RCTs) and in vitro and animal studies were assessed, and the data regarding antimicrobial properties, immunomodulation, and clinical outcomes were analysed. A total of 304 studies were screened, but only 3 RCTs and 6 animal and in vitro studies met the inclusion criteria. The use of different strains of bifi-dobacteria led to (1) a reduction of key players of the red complex periodontopathogens; (2) reduced levels of pro-inflammatory cytokines (eg, interleukin [IL]1-b and IL-8) and higher levels of anti-inflammatory cytokines (IL-10); (3) enhanced levels of osteoprotegerin and reduced levels of receptor activator of nuclear factor kappa-B ligand; and (4) a reduction of the dental plaque, bleeding on probing, alveolar bone loss, and clinical attachment loss. Bifidobacterial probiotic adjuvant supplementation, especially with Bifidobacterium animalis subspecies lactis, appears to help improve clinical periodontal parameters and develop a healthy plaque microbiome through microbiological and immunomodulatory pathways. Further human and animal studies are warranted prior to the therapeutic use of bifidobac-teria in the routine management of periodontal infections. (c) 2022 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

This review examines the effect of bifidobacterial probiotics on periodontopathogens and host immune responses. The use of different strains of bifidobacteria was found to reduce periodontopathogens, decrease inflammation, and improve clinical parameters. However, further research is needed before the therapeutic use of bifidobacteria in periodontal infections.