Does Probiotic Therapy Improve Periodontal Treatment Outcomes in Smoking Patients? A Systematic Review of Randomized Clinical Trials.

This review aimed to assess the efficacy of probiotics on clinical parameters in smoking patients with periodontal diseases. An electronic search was carried out, without date or language restrictions, in the PubMed, Web of Science, Embase, and Scopus databases for identification of clinical trials whose population consisted of smokers with gingivitis or periodontitis, undergoing probiotic therapy associated to non-surgical periodontal therapy, and that carried out evaluation of periodontal clinical parameters. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. Among the 162 studies identified, four were eligible for qualitative synthesis. Eight probiotic species were identified, predominantly Lactobacilli, with L. reuteri being the most prevalent. These probiotics were administered in tablet or lozenge form. Probiotics, in combination with non-surgical periodontal therapy, demonstrated reductions in gingival index, probing pocket depth, and bleeding on probing. Furthermore, probiotics exhibited efficacy comparable to antibiotics in grade C periodontitis treatment. Risk of bias was deemed low across all studies. Within the limitations of this review, it can be concluded that probiotic therapy appears to confer benefits to non-surgical periodontal therapy in smoking patients.