Objective: This review was designed to explore the use of probiotics in prevention or treatment of periodontitis. Methods: A search was performed using MEDLINE and bibliographies from previous reviews in order to identify any randomised controlled animal and human probiotic interventions in periodontitis. Results: Five studies using probiotics in animal models of periodontitis and eight clinical studies using probiotics in patients with chronic periodontitis were analysed. The analysis of the animal models showed reduction in periodontal pathogens and bleeding on probing when probiotics were used in adjunction to mechanical debridement and significant increase in alveolar bone levels and bone density in the probiotic groups when compared with placebo. Some of the results of the clinical studies indicated decreased clinical parameters (gingival inflammation, bleeding on probing, plaque index) and decreased pro-inflammatory markers levels in saliva or gingival crevicular fluid in treated periodontitis patients when compared with controls or placebo. Other results included decreased periodontal pocket depth and clinical attachment loss for scaling and root planing plus probiotic treatment versus scaling and root planing alone or placebo and also reduction in Porphyromonas gingivalis numbers and the total viable count and proportion of obligate anaerobic bacteria. Conclusions: Within the limitations of this review, the results are encouraging, supporting the notion that there is a place for probiotics in the treatment of periodontitis. Future independent studies are needed to investigate specifi c probiotic strains, doses, delivery methods, treatment schedules, mechanisms of action, safety and how to maintain the results of the probiotic interventions.
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