Use of adjuncts in periodontal treatment for patients with diabetes

Background + Aims

• Probiotics are live microorganisms that may benefit health by influencing bacteria and the body’s inflammatory response. Researchers have investigated whether they improve the results of periodontal treatment, but findings have been mixed.
• The study aimed to:
  • Assess whether an L. reuteri probiotic provides additional benefits when combined with professional cleaning below the gum line in patients with diabetes and periodontitis.

Materials + Methods

• This 6-month, randomised, triple-blinded, placebo-controlled trial was conducted at Complutense University of Madrid, Spain.
• 40 adults with untreated stage II–III periodontitis participated:
  • 19 received probiotics
  • 21 received placebo tablets.
  • 38 had type 2 diabetes and 2 had type 1 diabetes.
• Everyone received oral hygiene instruction and subgingival instrumentation (professional removal of plaque and hardened deposits below the gum line).
• Participants took either 2 probiotic tablets daily or matching tablets without live bacteria for 3-months.
• Assessments were performed before treatment and at 3- and 6-months.
• The main outcome was probing depth (the depth of the space between the gum and tooth)
• Other outcomes included bleeding, plaque, bacterial measurements and glycated haemoglobin (HbA1c)

Results

• Both groups improved with average probing depth reductions by approximately 0.9 mm with probiotics and 0.8 mm with placebo at 6-months, without a statistically significant difference between groups.
• Other periodontal improvements did not demonstrate an overall advantage from adding the probiotic.
• The probiotic did not produce a consistent additional improvement in the bacteria measured below the gum line.
• HbA1c fell from 7.1% to 6.5% in the probiotic group and from 7.0% to 6.9% in the placebo group. The adjusted between-group difference at six months was −0.5% (p=0.035).
  • After excluding participants with protocol deviations, such as taking antibiotics or other probiotics, the HbA1c difference was smaller and not statistically significant (−0.3%; p=0.290).
• No serious adverse events were reported, although one probiotic participant reported abdominal pain at 3-months.

Limitations