Henrique Soares Kaio, Firoozi Parsa, Maria de Souza Glaciele, Beatriz Lopes Martins Olga, Gabriel Moreira Falci Saulo, Rocha Dos Santos Cassio Roberto
Department of Dentistry, School of Biological and Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua da Glória,N. 187 Centro, Diamantina, Minas Gerais, Brazil.
Student Research Committee, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran.
Int J Dent. 2023 Jan 23;2023:4013004. doi: 10.1155/2023/4013004. eCollection 2023.
To critically evaluate the available literature and conduct a systematic review of recent randomized controlled trials to assess the effectiveness of probiotics compared to chlorhexidine mouthwash in enhancing periodontal health.
Five databases were searched electronically, as well as the gray literature. Using the Cochrane risk-of-bias tool for randomized clinical trials, the risk of bias was examined. The weighted mean difference (WMD) method was used to calculate the effect sizes. Heterogeneity was assessed using and statistics. The GRADE approach was adopted to assess the certainty of the evidence. To assess the robustness of the findings, sensitivity analysis and publication bias assessment were undertaken.
A total of 1850 studies were initially identified. Sixteen clinical trials were eligible for qualitative synthesis, and ten were included in the meta-analysis. In terms of the gingival index, in total, no statistically significant difference was observed between chlorhexidine and probiotics within 4 weeks (WMD -0.03, 95% CI: -0.09∼0.04, = 0.3885). Similar to GI, no statistically significant difference was observed between chlorhexidine and probiotics regarding the plaque index within 4 weeks (WMD 0.11, 95% CI: -0.05∼0.28, = 0.1726). No statistically significant difference was observed between chlorhexidine and probiotics in all time intervals regarding oral hygiene index-simplified (WMD -0.01, 95% CI: -0.05∼0.04, = 0.7508). The robustness of these findings was confirmed by sensitivity analysis and publication bias assessments.
Based on the findings, probiotics were an acceptable alternative to conventional chlorhexidine in improving periodontal health. High-quality studies with rigorous methodology should be conducted to assess the optimum doses of probiotics for clinical implications.
严格评估现有文献，并对近期随机对照试验进行系统评价，以评估益生菌与洗必泰漱口水相比在促进牙周健康方面的有效性。
通过电子检索五个数据库以及灰色文献。使用Cochrane随机临床试验偏倚风险工具检查偏倚风险。采用加权平均差（WMD）方法计算效应量。使用I²和Q统计量评估异质性。采用GRADE方法评估证据的确定性。为评估研究结果的稳健性，进行了敏感性分析和发表偏倚评估。
初步确定了1850项研究。16项临床试验符合定性综合分析的条件，10项纳入荟萃分析。在牙龈指数方面，总体而言，在4周内洗必泰与益生菌之间未观察到统计学上的显著差异（WMD -0.03，95%CI：-0.09∼0.04，I² = 0.3885）。与牙龈指数相似，在4周内洗必泰与益生菌在菌斑指数方面未观察到统计学上的显著差异（WMD 0.11，95%CI：-0.05∼0.28，I² = 0.1726）。在所有时间段内，洗必泰与益生菌在简化口腔卫生指数方面未观察到统计学上的显著差异（WMD -0.01，95%CI：-0.05∼0.04，I² = 0.7508）。敏感性分析和发表偏倚评估证实了这些研究结果的稳健性。
基于研究结果，益生菌是改善牙周健康的传统洗必泰的可接受替代品。应开展方法严谨的高质量研究，以评估益生菌的最佳临床应用剂量。
