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Meta-Analysis
. 2025 Apr 4;25(1):490.
doi: 10.1186/s12903-025-05888-5.

Clinical effects of probiotics on the treatment of gingivitis and periodontitis: a systematic review and meta-analysis

Cristina Benavides-Reyes  1 , Inmaculada Cabello  2 , Antonio Magán-Fernández  3 , Miguel Rodríguez-Barranco  4   5   6 , Sıla Nur Usta  7 , Francisco Mesa  3
Affiliations
Meta-Analysis

Clinical effects of probiotics on the treatment of gingivitis and periodontitis: a systematic review and meta-analysis

Cristina Benavides-Reyes et al. BMC Oral Health. .

Abstract

Aims: This study aimed to evaluate the impact of probiotics as an adjunct to periodontal therapy on clinical outcomes in patients with gingivitis and periodontitis through a meta-analysis of available evidence.

Materials and methods: A detailed bibliographic search on four databases (PubMed, Scopus, Cochrane and EMBASE) was conducted with a language restriction. The collected data were assessed according to the predefined eligibility criteria and randomized clinical trials reporting the effects of probiotics on plaque index (PI), bleeding on probing (BOP) and pocket probing depth (PPD) compared to control or placebo groups were selected and analysed. The risk of bias assessment was conducted using SYRCLE's RoB- 2 tool. The GRADEpro tool was used to determine the overall quality of evidence.

Results: Twenty-four studies (10 about gingivitis and 14 about periodontitis) were included in the meta-analysis. In the gingivitis studies, lower but non-significant PI and BOP were found in the probiotic group. In periodontitis, lower PI (95%-CI [- 0.54; - 0.15], p = 0.001) were reported in the probiotic group, and this difference was greater in studies with longer follow-up. Lower BOP (95%-CI [- 0.58; - 0.05], p = 0.021) was also reported, but this difference was only significant in studies with a shorter follow-up (95%-CI [- 0.86; - 0.11], p = 0.012). Meta-analysis for PPD showed lower, but non-significant, values (95%-CI [- 0.53; + 0.03], p = 0.077). However, this difference became significant when assessing studies with shorter follow-up (95% CI [- 0.77; - 0.07], p = 0.019).

Conclusions: The meta-analysis provides evidence suggested that probiotics can serve as a beneficial adjunct to periodontal treatment in patients with periodontitis, particularly in improving clinical outcomes such as plaque index and bleeding on probing. The results from gingivitis studies highlight the need for further investigation to better understand the impact of probiotics in the early stages of periodontal disease. These findings emphasize the importance of future research with standardized protocols and longer follow-up periods to confirm and expand on the clinical utility of probiotics in periodontal therapy.

Keywords: Gingivitis; Meta-analysis; Periodontitis; Probiotics; Systematic review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram depicting the potential mechanisms of action of probiotics on the periodontal epithelium
Fig. 2
Fig. 2
PRISMA Flow diagram of the identification and selection process
Fig. 3
Fig. 3
Results from the risk of bias assessment
Fig. 4
Fig. 4
Forest-plots of the results of the meta-analysis, subdivided in studies for gingivitis and periodontitis, for plaque index (A), bleeding on probing (B) and probing pocket depth (C)
Fig. 5
Fig. 5
Forest-plot of the results of the meta-analysis for plaque index in the periodontitis studies, subdivided into studies with short follow-up time (less than or equal to 8 weeks) and studies with long follow-up time (more than 8 weeks)
Fig. 6
Fig. 6
Forest-plot of the results of the meta-analysis for bleeding on probing in the periodontitis studies, subdivided into studies with short follow-up time (less than or equal to 12 weeks) and studies with long follow-up time (more than 12 weeks)
Fig. 7
Fig. 7
Forest-plot of the results of the meta-analysis for probing pocket depth in the periodontitis studies, subdivided into studies with short follow-up time (less than or equal to 12 weeks) and studies with long follow-up time (more than 12 weeks)
See this image and copyright information in PMC

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