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Effect of probiotic Lactobacillus reuteri as an adjunct to nonsurgical treatment on halitosis of patients with periodontitis - a preliminary randomised controlled trial.

Background and Aim: Intraoral halitosis is caused by microbial degradation of oral organic substrates, resulting in volatile compounds. Periodontitis may present as one of the oral conditions causative to halitosis. The aim of this randomised controlled trial was to assess the effect of probiotic Lactobacillus reuteri as an adjunct to nonsurgical periodontal treatment on halitosis of patients with periodontitis. Methods: 30 systemically healthy patients with generalised periodontitis stage II-IV and halitosis (OLS≥1 and VSC >160 ppb) were included in this trial. All patients were treated with nonsurgical periodontal treatment, after which they were randomly assigned to a test group, using probiotic lozenges for 28 days/twice per day (ProDentis®, BioGaia AB, Lund, Sweden) or a control group using placebo lozenges. Halitosis was assessed by organoleptic judgement and with a device (Halimeter®, Interscan Corporation Chatsworth, CA, USA) at baseline, after 1 month and 3 months. Tongue coating (WTCI)was assessed at baseline, after 1 month and 3 months. Clinical periodontal parameters, PPD, CAL, REC, FMBS and FMPS, were recorded at baseline and 3 months. Results: Both groups showed significant halitosis reduction, tongue coating reduction and improvements in periodontal parameters at 3 months. No significant inter-group differences could be detected for halitosis parameters at 1 and 3 months. A composite outcome for residual halitosis, defined as OLS≥1 and VSC >160 ppb present at 3 months, showed a marginally significant difference between the probiotic and control group (0% vs 20%, respectively, p=0.068) with greater nullification of halitosis in the probiotic group. The probiotic group showed small but significantly greater PPD reduction and CAL gain (p < 0.0001).Conclusions: Within the limitations of this study, it can be concluded that causative periodontal treatment is effective in halitosis reduction, and probiotics could provide additional benefit.

Lactobacillus reuteri ; probiotics ; halitosis ; periodontitis ; nonsurgical periodontal treatment

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