Avsikten med studien var att undersöka om dagligt användande av ett probiotiskt kosttillskott innehållande Lactobacillus reuteri kunde ge positiva effekter på patienter med måttlig eller svår gingivit. I försöket testades placebotuggummi mot 2 olika L. reuteri formuleringar (LR-1 och LR-2) innehållande 100 miljoner laktobaciller per tuggummi. Tuggummi togs 2 gånger per gång, på morgonen och på kvällen efter tandborstning. Studien var dubbelblind, randomiserad och löpte över 2 veckor. Totalt deltog 59 patienter. Två tandytor på varje patient utvaldes och gingival index och plack index mättes för varje yta, både startdagen och efter 2 veckor. För att minimera risken för observatörsberoende bedömning av index utfördes alla bedömningar på en och samma dag av en enda observatör, både vid start och avslut. Tandytorna fotograferades också för att ge ytterligare konsistens i bedömningen. Efter bedömning av index, rengjordes samtliga tandytor och patienterna instruerades av tandhygienist om korrekt tandborstning och behovet av dagligt användande av tandtråd. Salivprover togs både före och efter test behandling för att avgöra skillnader i laktobacillpopulationen över tiden. 20 patienter rendomiserades till LR-1, 21 till LR-2 och 18 till placebo. Gingival index förbättrades signifikant i samtliga grupper över de 14 dagarna. LR-1 formuleringen var dessutom signifikant överlägsen placebo. Plackindex var också signifikant förbättrat över tiden i de båda reuteri-grupperna- LR-1 koloniserades i 65% av patienterna och LR-2 i 95%.
The primary aim of this study was to assess if the probiotic Lactobacillus reuteri could be effective in the treatment of gingivitis and further to evaluate the influence of the probiotic on plaque and the lactobacilli population in the saliva. A randomised, placebo-controlled, double blind study was performed over 2 weeks. Fifty-nine petients with moderate to severe gingivitis were included and given one of two different Lactobacillus reuteri formulations (LR-1 or LR-2) at a dose of 2E+08 CFU per day, or a corresponding placebo. At baseline (day 0) gingival index and plaque index were measured on two surfaces and saliva for lactobacilli determination was collected. The patients were instructed how to brush and floss efficiently and study treatment was started. The patients returned on day 14 for final assessment of gingivitis and plaque and saliva was collected. 20 patients were randomised to LR-1, 21 to LR-2 and 18 to placebo. Gingival index fell significantly in all 3 groups (p<0.0001). LR-1, but not LR-2 improved more than placebo (p<0.0001). Plaque index fell significantly in LR-1 (p<0.05) and in LR-2 (p<0.01) between day 0 and day 14 but there was no significant change in the placebo group. At day 14, 65% of the patients in LR-1 were colonised with Lactobacillus reuteri and 95% in the LR-2 group. Lactobacillus reuteri was efficacious in reducing both gingivitis and plaque in patients with moderate to severe gingivitis.
People have exploited fermentation by lactobacilli for centuries as a means of preparing and preserving foods. Several different bacterial species are today used as probiotic bacteria in different products both for human and animal applications. By definition probiotic bacteria are “live microorganisms which when administered in adequate amounts confer a health benefit on the host”. The most commonly used bacteria for the probiotic concept are found within the lactic acid bacteria (LAB) group. One of several genera included in the LAB group is Lactobacillus. One species of Lactobacillus, Lactobacillus reuteri has been studied extensively and certain strains have been shown to be probiotic i.e. health promoting with diverse beneficial effects, and thus it was interesting to further investigate the properties of these bacteria. To put this thesis work into context, the field of probiotic research is described and examples of proven probiotic effects are discussed. The overall aim was to investigate L. reuteri and its microbial action in the microbiota of humans and its relationship to health and disease. L. reuteri was shown to be a natural component of human milk. It was found in approximately one in seven nursing mothers living in geographically widely separated countries. Breast milk may be considered as a natural synbiotic and evidence from these results suggest that L. reuteri is one of the beneficial components in this regard. L. reuteri was also proven to be effective in reducing both gingivitis and dental plaque in patients with moderate to severe gingivitis, suggesting an improvement in periodontal health. Bacterial antagonism through the probiotic administration in the oral cavity might have contributed to the observed alleviation of symptoms and clinical manifestations of periodontal disease. It was shown that L. reuteri supplementation of pregnant mothers and their offspring during the first year of life resulted in detection of L. reuteri in breast milk and infant stool. Administration of L. reuteri resulted in the presence of L. reuteri in saliva, but no significant effect on supra- or subgingival microbiota was observed. The significant increase in plaque index in the control group with no significant change in the test group may however indicate a probiotic effect of L. reuteri in this study population of healthy individuals.