Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, China.
Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, China.
Eur J Orthod. 2023 Sep 18;45(5):599-611. doi: 10.1093/ejo/cjad046.
The effect of probiotics on oral health maintenance in orthodontic patients remains controversial. The aim of the study is to systematically review and assess the effects of probiotics on the oral health and microbiome of patients undergoing orthodontic treatment.
Databases including PubMed, Web of Science, Cochrane Library, ClinicalTrials.gov, and ProQuest Dissertations & Theses Global databases were searched from their inception until June 2022. Randomised controlled trials that assessed the effects of probiotics on clinical and microbial outcomes in patients undergoing orthodontic treatment were included.
Data screening and collection were performed, and the risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. The meta-analysis evaluated the effects of probiotics on Streptococcus mutans (S. mutans) and Lactobacillus counts. The quality of the evidence from the meta-analyses was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).
A total of 405 records were identified, of which 15 studies were included in the qualitative synthesis and 4 in the meta-analysis. The patients in all the included studies were treated with fixed orthodontic appliances. Results regarding clinical outcomes were controversial; four out of five studies reported no significant changes in plaque in the probiotic group (P > .05), and two out of three studies reported no significant changes in the gingival index (P > .05). Regarding microbial outcomes, the meta-analysis results revealed that probiotics significantly increased the likelihood of reducing the abundance of S. mutans to below 105 CFU/ml (risk ratio: 2.05 [1.54, 2.72], P < .001) and reduced the likelihood of increasing the abundance of S. mutans to beyond 106 CFU/ml (risk ratio: 0.48 [0.28, 0.83], P = .009). However, the quality of evidence according to the GRADE was moderate.
There is insufficient evidence to determine the clinical benefits of probiotics as a supplement for the oral health of patients undergoing orthodontic treatment. However, probiotics may have benefits in reducing the salivary S. mutans counts in orthodontic patients.
PROSPERO (CRD42022366650).
益生菌对正畸患者口腔健康维护的影响仍存在争议。本研究旨在系统回顾和评估益生菌对正畸治疗患者口腔健康和微生物组的影响。
从建库至 2022 年 6 月，检索 PubMed、Web of Science、Cochrane Library、ClinicalTrials.gov 和 ProQuest Dissertations & Theses Global 数据库，纳入评估益生菌对正畸治疗患者临床和微生物结局影响的随机对照试验。
进行数据筛选和收集，并使用 Cochrane RoB 2 工具评估偏倚风险（RoB）。采用荟萃分析评估益生菌对变形链球菌（S. mutans）和乳酸杆菌计数的影响。采用推荐评估、制定与评价（GRADE）对荟萃分析的证据质量进行评估。
共识别出 405 条记录，其中 15 项研究纳入定性综合分析，4 项研究纳入荟萃分析。所有纳入研究的患者均接受固定正畸矫治器治疗。关于临床结局的结果存在争议；五项研究中有四项报告益生菌组菌斑无显著变化（P＞.05），三项研究中有两项报告牙龈指数无显著变化（P＞.05）。关于微生物学结局，荟萃分析结果显示，益生菌显著增加了降低变形链球菌丰度至低于 105 CFU/ml 的可能性（风险比：2.05[1.54，2.72]，P＜.001），并降低了变形链球菌丰度增加至超过 106 CFU/ml 的可能性（风险比：0.48[0.28，0.83]，P=.009）。然而，根据 GRADE 评估，证据质量为中等。
目前尚无足够证据确定益生菌作为正畸治疗患者口腔健康补充剂的临床益处。然而，益生菌可能有助于降低正畸患者唾液中变形链球菌的计数。
PROSPERO（CRD42022366650）。
