de Oliveira Adriana Miranda, Lourenço Talita Gomes Baêta, Colombo Ana Paula Vieira
Division of post-graduate Periodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Oral Microbiology Laboratory, Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Periodontol. 2022 Jan;93(1):31-44. doi: 10.1002/JPER.21-0078. Epub 2021 Jun 19.
The oral-gut axis may be a route linking periodontal and systemic diseases. Probiotics could be an alternative for the treatment of microbial dysbiotic conditions, including periodontitis. This randomized placebo-controlled clinical trial evaluated the short-term efficacy of systemic probiotics adjunctive to subgingival instrumentation (SI) in promoting a better restoration of the oral-gut microbiotas and greater periodontal clinical outcome.
Systemically healthy adults with untreated periodontitis were recruited from a Dental School setting and allocated to receive SI plus placebo (n = 24) or probiotics (n = 24), one capsule/day for 30 days. Subgingival biofilm and stool were obtained at baseline and 2-months post-therapy for microbiological analyses by checkerboard and 16S rRNA gene sequencing. Differences in all parameters between placebo (n = 23) and probiotics (n = 19) groups were assessed by non-parametric tests.
Most subgingival species and α-diversity decreased after therapies (P <0.05), whereas gut composition/diversity were slightly or not affected by treatments. In parallel, significant clinical improvement (P <0.05) was similar between groups, although a trend for a higher proportion of poor responders in the placebo (60.8%) than the probiotic group (31.5%) was observed (P = 0.07). Strong correlations between oral and fecal species were found (P <0.01), and distinct species related to poor response for different therapies (P <0.05). Patients were classified into five periodontitis oral-gut microbial clusters, which correlated differently with attachment loss after therapies (P <0.05).
Systemic probiotics combined with SI did not provide short-term additional clinical or microbiological benefits in the treatment of periodontitis; however, response to therapies seemed to correlate with distinct oral-gut microbial profiles.
口腔-肠道轴可能是连接牙周疾病和全身疾病的一条途径。益生菌可能是治疗包括牙周炎在内的微生物生态失调状况的一种替代方法。这项随机安慰剂对照临床试验评估了全身应用益生菌辅助龈下器械治疗（SI）在促进口腔-肠道微生物群更好恢复以及改善牙周临床结局方面的短期疗效。
从一所牙科学院招募患有未经治疗的牙周炎的全身健康成年人，将其分为两组，分别接受SI加安慰剂（n = 24）或益生菌（n = 24）治疗，每天1粒胶囊，持续30天。在基线和治疗后2个月采集龈下生物膜和粪便，通过棋盘法和16S rRNA基因测序进行微生物分析。通过非参数检验评估安慰剂组（n = 23）和益生菌组（n = 19）之间所有参数的差异。
治疗后大多数龈下菌种和α多样性降低（P < 0.05），而肠道菌群组成/多样性受治疗影响较小或未受影响。同时，两组之间的临床改善情况均显著（P < 0.05），尽管观察到安慰剂组（60.8%）中反应不佳者的比例高于益生菌组（31.5%）的趋势（P = 0.07）。发现口腔和粪便菌种之间存在强相关性（P < 0.01），并且不同治疗方法的反应不佳与不同的菌种有关（P < 0.05）。患者被分为五个牙周炎口腔-肠道微生物群簇，治疗后这些群簇与附着丧失的相关性不同（P < 0.05）。
全身应用益生菌联合SI在治疗牙周炎方面未提供短期额外的临床或微生物学益处；然而，治疗反应似乎与不同的口腔-肠道微生物谱相关。
