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ORIGINAL ARTICLE
Year : 2010  |  Volume : 28  |  Issue : 3  |  Page : 179-182
 

Efficacy of a probiotic and chlorhexidine mouth rinses: A short-term clinical study


1 Assistant Professor, Department of Pediatric Dentistry, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
2 Professor and Head, Department of Pediatric Dentistry, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India

Date of Web Publication11-Dec-2010

Correspondence Address:
P M Harini
Department of Pediatric Dentistry, S.D.M. College of Dental Sciences and Hospital, Sattur, Dharwad - 580 010, Karnataka State
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.73799

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   Abstract 

Introduction: Probiotic technology represents a breakthrough approach to maintaining oral health by utilizing natural beneficial bacteria commonly found in healthy mouths to provide a natural defense against those bacteria thought to be harmful to teeth and gums. However, data are still sparse on the probiotic action in the oral cavity. The review article on probiotics in children published by Twetman and Stecksen- Blicks in 2008 showed only one study of dental interest on probiotics in children. Aim and Objectives: The present study evaluated clinically the efficacy of a probiotic and chlorhexidine mouth rinses on plaque and gingival accumulation in children. The trial design is a double-blind parallel group, 14 days comparative study between a probiotic mouth rinse and a chlorhexidine mouth rinse, which included 45 healthy children in the age group of 6-8 years. Results: The Probiotic and Chlorhexidine groups had less plaque accumulations compared with the Control group at the end of 14 years (P < 0.001 and P < 0.001, respectively). But, unlike the plaque score, there was a significant difference in the Gingival Index between the Probiotic and the Chlorhexidine groups (P = 0.009), Probiotic group being better than the Chlorhexidine group (mean = 0.2300 and 0.6805, respectively). Conclusion: The Probiotic mouth rinse was found effective in reducing plaque accumulation and gingival inflammation. Therefore, probiotic mouth rinse obviously has a potential therapeutic value and further long-term study is recommended to determine its efficacy.


Keywords: Mouth rinses, probiotics, children, chlorhexidine


How to cite this article:
Harini P M, Anegundi R T. Efficacy of a probiotic and chlorhexidine mouth rinses: A short-term clinical study. J Indian Soc Pedod Prev Dent 2010;28:179-82

How to cite this URL:
Harini P M, Anegundi R T. Efficacy of a probiotic and chlorhexidine mouth rinses: A short-term clinical study. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2019 Jun 26];28:179-82. Available from: http://www.jisppd.com/text.asp?2010/28/3/179/73799



   Introduction Top


Antibiotic resistance, with the emergence of multiple-resistant strains, is an increasingly important global problem. This unfortunate development has led scientists to seek other means of combating infectious diseases. Looking back through history, however, one forgotten concept of using bacteria as beneficial to health has been resurrected and has now come under intensive research. [1]

The idea of probiotics dates back to the first decade of 1900s when the Ukranian bacteriologist and Nobel Laureate Metchnikof (1908) studying the flora of the human intestine developed a theory that senility in humans is caused by poisoning of the body by the products of some of these bacteria. To prevent the multiplication of these organisms he proposed a diet containing milk fermented by lactobacilli, which produce large amounts of lactic acid that could increase the life span of humans. The concept of probiotics was thus born and a new field of bacteriology was opened. [2]

The term probiotics, which literally means "for life," was first coined in the 1960s by Lilly and Stillwell. [3]

Definition

As adopted by the International Scientific Association for Probiotics and Prebiotics, "Live microorganisms, which when administered in adequate amounts, confer beneficial effect on the health of the host" [Guarner et al. 2005]. [2]

Probiotic technology represents a breakthrough approach to maintaining oral health by utilizing natural beneficial bacteria commonly found in healthy mouths to provide a natural defense against those bacteria thought to be harmful to teeth and gums. In simple words, the basic principle of probiotics is to use good bacteria to compete against pathogenic bacteria.

Probiotics have been successfully used to control gastrointestinal diseases, to alleviate symptoms of allergy, and in diseases with immunologic pathology. Results from recent studies have shown that the effects of such therapy may influence body functions beyond the intestine. [1]

However, data are still sparse on the probiotic action in the oral cavity.

We could come across only one published study of dental interest that was conducted in children, which studied the effect of consumption of probiotic milk on the dental caries of preschool children. [4]

The present study evaluated clinically the efficacy of a probiotic and chlorhexidine mouth rinses on plaque and gingival accumulation in children.

Objectives

To clinically evaluate the effect of a probiotic and chlorhexidine mouth rinses on

  • Plaque accumulation
  • Gingival inflammation.



   Materials and Methods Top


The pilot study consisted of 45 healthy children in the age group of 6-8 years attending the outpatient department of the Department of Pediatric Dentistry, SDM College of Dental Sciences and Hospital, Sattur, Dharwad. Informed oral and written consent was obtained from the parents of the children.

Inclusive criteria

  • Healthy children without any known systemic illness
  • No recent history of use of antimicrobial agents or any other drugs [up to within 4 weeks]


Exclusive criteria

  • Children using any other oral hygiene aids other than routine teeth brushing.


The trial design is a double-blind parallel group, 14 days comparative study between probiotic and chlorhexidine mouth rinses. During the entire study period, the participants continued to exercise their self-performed oral hygiene measures.

The participants were divided into 3 groups [Group A, B, and C] with 15 children in each group as follows:

Group A: Control group (mint water)

Group B: Probiotic group

Group C: Chlorhexidine group

The mouth rinses were dispensed through other staff of the department due to the double-blind design of the investigation. Baseline scores of Plaque Index (PI) (Turesky et al., 1970) and Gingival Index (GI) (Loe and Silness, 1963) were taken from all the participants followed by a full mouth prophylaxis.

The designated mouth rinses were dispensed to the respective groups. Group A received mint water, group B received the probiotic mouth rinse, and group C received chlorhexidine mouth rinse. They were instructed to rinse once daily about 30 min after tooth brushing with 15 mL of the solution (1:1 dilution for chlorhexidine) for 60 s followed by expectoration of the residual mouth rinse. The parents were asked to supervise the children during the use of mouth wash. On day 14, all subjects returned for clinical measurements.


   Results Top


The mean baseline scores of PI and GI were similar for all the 3 groups.

The mean PI values for all the 3 groups were 0 after scaling and polishing was done for all tooth surfaces. A PI score of 0 represented a tooth surface that was entirely free of clinically detectable plaque.

Tests of within-subjects effects for PI for the 3 groups showed a P value < 0.001. Thus, the differences in the mean PI for all the 3 groups were significant.

At day 14 when comparison with the baseline data was made, there was a significant increase in the mean PI scores of the Control group when compared with that of Probiotic and Chlorhexidine groups (P < 0.001 and P < 0.001, respectively).

Comparison of the mean plaque scores between the groups is represented in [Figure 1].
Figure 1 :Comparison of mean PI scores between the test groups

Click here to view


The degree of increment of mean plaque scores were more pronounced in the control group compared with that of the Probiotic and Chlorhexidine groups.

Probiotic and Chlorhexidine groups had less plaque accumulations compared with the control group.

However, there were no significant differences in the mean plaque accumulations between the Probiotic and Chlorhexidine groups on examination on the 14th day.

Tests of within-subjects effects for GI for the 3 groups showed a P value < 0.001. Thus, the differences in mean GI for all the 3 groups were significant.

On day 14 when comparison with the baseline data was made, there was a significant decrease in the mean GI scores of Probiotic and Chlorhexidine groups when compared with that of the Control group (P < 0.001 and P < 0.001, respectively).

Comparison of the mean GI scores between the groups is represented in [Figure 2].
Figure 2 :Comparison of mean GI scores between the test groups

Click here to view


But, unlike the PI score, there was a significant difference in the GI between the Probiotic and the Chlorhexidine groups (P = 0.009), Probiotic group being better than the Chlorhexidine group (mean = 0.2300 and 0.6805, respectively).


   Discussion Top


Chemical agents have been increasingly used as adjunct to mechanical plaque control. They are intended to augment and not to replace mechanical plaque control.

Chlorhexidine gluconate is today a thoroughly studied and the most effective antiplaque and antigingivitis agent. In oral use as a mouth rinse, chlorhexidine has been reported to have a number of local side effects. These side effects are brown discoloration of the teeth and tongue, oral mucosal erosion and taste perturbation. Several side effects associated with its use have stimulated the search for alternative antiplaque agents.

Antibacterial mouth rinses act by nonspecifically reducing the levels of both friendly and harmful oral bacteria. In contrast, probiotic has been developed utilizing natural beneficial bacteria to promote a healthy balance of microorganisms in the mouth. [5]

Probiotic technology represents a breakthrough approach to maintaining oral health by utilizing natural beneficial bacteria commonly found in healthy mouths to provide a natural defense against those bacteria thought to be harmful to teeth and gums. [1]

The advantages of using a probiotic mouth rinse are that it contains friendly commensals, there is no issue of antibiotic resistance, and there are no known/proven toxicities caused due to their use.

Unlike adults who have an already established oral microflora, in children the microbial ecosystem is in the process of being established. An early installation and colonization of probiotics in the oral environment would be the first step for an anticipated long-term effect, but there are limited data available to support this event. Therefore, it seems especially important to carry out studies on infants because it is very likely that the chance of a permanent colonization of probiotics increases with a regular exposure from early childhood. [6]

However, in oral medicine this area of research is still in the cradle. A thorough search of the literature revealed only one published study in relation to oral health in children.

The single study carried out in early childhood reported a significant caries reduction in 3- to 4-year-old children after 7 months of daily consumption of probiotic milk. [4]

Probiotics in the form of mouth rinse has been tested among adults in one study. The results of this clinical trial showed that rinsing with probiotic mouth rinse resulted in a significant reduction of plaque accumulation and gingival inflammation. [5]

The purpose of this 14-day parallel group double-blind study was to compare plaque accumulation and gingival inflammation in the 3 groups of subjects who used mint water (control), Chlorhexidine mouth rinse, and a Probiotic mouth rinse, respectively.

The present study was designed as a parallel group study, where 3 different groups of subjects received 3 different mouth rinses under similar conditions. In the crossover study designs, each participant receives each of the treatments in a randomized order. The drawback of within-subject or crossover study designs is contamination or carryover. It is entirely possible that some effect of the treatment used in one period might persist and alter the response observed in later treatment periods. Hence, a parallel group study design was chosen in this study.

In this study, it was observed that there was a significant difference in the mean PI and mean GI between the Control, Chlorhexidine, and Probiotic mouth rinses groups after 14 days compared with the baseline (P < 0.001).

Probiotic and Chlorhexidine groups caused less plaque accumulations compared with the Control group.

However, there were no significant differences in the mean plaque accumulations between the Probiotic and Chlorhexidine groups on the 14th day examination.

But, unlike PI score, there was significant difference in the GI between the Probiotic and the Chlorhexidine groups (P = 0.009), Probiotic group being better than the Chlorhexidine group (mean = 0.2300 and 0.6805, respectively).

From the present study, it was observed that the Probiotic mouth rinse had a significant inhibitory effect on plaque accumulation and gingival inflammation. Thus, it can be proposed that Probiotic mouth rinse had a potential therapeutic value in reducing plaque accumulation and gingivitis.

The findings of our clinical study are in agreement with a previous study. [5] However, the results of the 2 studies cannot be truly compared because the other study was conducted among adults and not in children. Also, the study designs were different for both the studies.

The antiplaque activity of the Probiotic mouth rinse may be achieved in various ways, such as reducing the adhesion of bacteria to the tooth surface, inhibiting the growth and proliferation of microorganisms on the tooth surface, inhibiting the formation of the intercellular plaque matrix, modifying plaque biochemistry to reduce the formation of cytotoxic product, and modifying plaque ecology to a less pathogenic flora. [5]

The proposed mechanisms of the action of Probiotics in the oral cavity are as follows:

The pretreatment debridement at day 0 may have been influenced by the findings of this study, especially the reduction in the gingivitis that was seen in all the 3 groups. This finding is in agreement with the findings of other studies. [5],[7]


   Conclusion Top


The Probiotic mouth rinse tested was effective in reducing plaque accumulation and gingival inflammation. Therefore, the Probiotic mouth rinse has a potential therapeutic value and further long-term study is recommended to determine its efficacy.

 
   References Top

1.Meurman JH. Probiotics: Do they have a role in oral medicine and dentistry? Eur J Oral Sci 2005;113:188-96.   Back to cited text no. 1
    
2.Meurman JH, Stamatova I. Probiotics: Contribution to oral health. Oral Dis 2007;13:443-51.  Back to cited text no. 2
    
3.Senok AC, Ismaeel AY, Botta GA. Probiotics: Facts and myths. Clin Microbiol Infect 2005;11:958-66.   Back to cited text no. 3
    
4.Nδse L, Hatakka K, Savilahti E, Saxelin M, Pφnkδ A, Poussa T, et al. Effect of long term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in mil on dental caries and caries risk in children. Caries Res 2001;35:412-20.   Back to cited text no. 4
    
5.Noordin K, Kamin S. The effect of probiotic mouth rinse on plaque and gingival inflammation. Annal Dent Univ Malaya 2007;14:19-25.   Back to cited text no. 5
    
6.Twetman S, Stecksen-Blicks C. Probiotics and oral health effects in children. Int J Paediatr Dent 2008;18:3-10.   Back to cited text no. 6
    
7.Wennstrom J, Lindhe J. The effects of mouth rinses on parameters characterizing human periodontal disease. J Clin Periodontol 1986;13:86-93.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]


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