The Effectiveness of Probiotics on Oral Health During Adult Orthodontic Treatment With Fixed Appliances: A Two-Arm...

Fixed orthodontic appliances interfere with daily oral care procedures, causing more plaque accumulation and thus increasing the risk of periodontal diseases. Probiotics have been suggested to maintain oral health using beneficial bacteria. However, the evidence to determine the clinical benefits of probiotics as a supplement to oral health in orthodontic patients is still insufficient. This trial aimed to investigate the protective effect of probiotics on oral health and prevent the development of inflammation of the gingiva and periodontal tissues during orthodontic treatment using fixed orthodontic appliances.

This was a single-blinded, single-center, two-arm randomized controlled trial conducted between March 2023 and June 2024. A total of 50 patients (13 males (26%) and 37 females (74%) with a mean age of 21.33±2.04) who required a non-extraction-based treatment using fixed orthodontic appliances were enrolled and randomly divided into two groups: the probiotics group (PG) who underwent orthodontic treatment with probiotic tablets of Lactobacillus reuteri and the control group (CG) who underwent orthodontic treatment without probiotics. The following periodontal parameters were recorded: plaque index (PI), gingival index (GI), papillary bleeding index (PBI), and probing depth (PD). These indices were assessed three times: before the start of orthodontic treatment (T0) and after three months (T1) and after six months (T2) of applying fixed appliances.

The mean values for PI, GI, PBI, and PD were statistically significantly lower in the PG compared to the CG at both time points T2 and T3 (p<0.05). In the PG, there was a significant difference in the PI between time points T0 and T1 (p<0.001), but there was no significant difference between T1 and T2 (p=0.074). The GI, PBI, and PD differences were also insignificant (p>0.05). Conversely, all studied periodontal parameters significantly increased during the assessment periods in the CG (p<0.001).

Using probiotic lozenges that contain Lactobacillus reuteri, alongside regular teeth brushing, during the first six months of fixed orthodontic treatment in adults can help maintain good oral hygiene. This approach reduces plaque buildup and helps prevent the onset of clinical signs associated with periodontal disease.