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Table of Contents   
ORIGINAL RESEARCH  
Year : 2022  |  Volume : 33  |  Issue : 2  |  Page : 184-187
Evaluation of the efficacy of plaque reduction and gingival health among 6-12 years old school children before and after a short term daily intake of probiotic lozenge - A comparative study


1 Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, SBV, Puducherry, India
2 Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, SBV, Puducherry, India
3 Consultant Pedodontist, C2, Mansions Palm Grove Apartment, Nanthancode P.O., Trivandrum, Swathi Dental Clinic, Kollam, Kerala, India
4 Consultant Pedodontist, Vinu Dental Clinic, Gobichettipalayam, Tamil Nadu, India

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Date of Submission13-Mar-2020
Date of Decision26-Apr-2022
Date of Acceptance19-Sep-2022
Date of Web Publication13-Oct-2022
 

   Abstract 


Context: Probiotics are defined as live microorganisms which when delivered in adequate amounts provides health benefit in the host. Dietary supplements like lozenge seem to be the easy and acceptable vehicle for ingestion of probiotics in young children. Aim: To assess the efficacy of probiotics in plaque reduction and gingival health among 6-12 years school children before and after short term daily intake of Probiotic lozenge. Settings and Design: This Comparative study was conducted among 60 children in the age group 6–12 years. Thirty children in experimental group; who were given lozenge containing probiotic bacteria twice daily, one in the morning and another in the evening after brushing for one month. The placebo lozenge group also followed the same protocol. Statistical Analysis Used: SPSS version 21. Results: The Probiotic lozenge group was found to have statistically significant reduction in plaque scores when compared to that of the placebo group with P < 0.001 and there was also a significant improvement in gingival health. Conclusion: An effective reduction in plaque accumulation and gingival inflammation was found with the use of probiotic lozenges and hence proved the therapeutic value of the same.

Keywords: Probiotics, Gingival heath, plaque reduction, lozenge

How to cite this article:
Kavitha M, Prathima G S, Anusha D, Kengadaran S, Gayathri K, Vinothini V. Evaluation of the efficacy of plaque reduction and gingival health among 6-12 years old school children before and after a short term daily intake of probiotic lozenge - A comparative study. Indian J Dent Res 2022;33:184-7

How to cite this URL:
Kavitha M, Prathima G S, Anusha D, Kengadaran S, Gayathri K, Vinothini V. Evaluation of the efficacy of plaque reduction and gingival health among 6-12 years old school children before and after a short term daily intake of probiotic lozenge - A comparative study. Indian J Dent Res [serial online] 2022 [cited 2022 Nov 29];33:184-7. Available from: https://www.ijdr.in/text.asp?2022/33/2/184/358441



   Introduction Top


The oral cavity is a complex ecosystem, with diverse microbiota in it, considered to be difficult therapeutic target.[1] Of the different methods of plaque control chemical method as an adjunct works best which includes antibiotics, enzymes, biguanides, metallic salts, etc.[2]

Though these methods have been proved to be effective, many shortcomings have been found in effective plaque control methods like inefficiency to prevent further colonization of microbes, staining of teeth. These led to the development of gentle and effective plaque control agent.[3]

One of the novel self-administered strategies is by manipulation of resident microorganisms by the ingestion of probiotic organism. In probiotics with the administration of beneficial bacteria, it may compete with pathogens for adhesion sites to antagonize these pathogens and re-establish a stable and diverse microbial community in the oral biofilm.[3],[4]

Bacterial strains that have been tested for probiotic action in the oral cavity include lactobacilli species (Lactobacillus acidophilus, Lactobacillus rhamnosus Scientific Name Search  GG, Lactobacillus johnsonii, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus gasseri, Lactobacillus reuter, Lactobacillus paracasei), Bifidobacterium species (Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis,  Bifidobacterium animalis Scientific Name Search N-173 010) and others (Streptococcus salivarius, Weissellacibaria). Ideally, it has been suggested that exposure of probiotics in early life may facilitate a permanent oral health promotion.[5]

Hence, probiotic vehicle should be suitable for all ages especially for young children without any consequences. Several appropriate vehicles of administration of probiotic strains have been proposed such as ice cream,[6] toothpaste,[7] cheese,[8] yogurt,[9] tooth powder,[10] mouthwash,[11] curd,[3] lozenge[4] and chewing gum.[12] It is evident from the previous studies that it could cause both systemic and local effects due to the direct contact between the probiotic bacteria and the oral tissues. Specially formulated devices and pacifier with slow release of the microbial strain have also been tried to prevent the oral diseases in children.[13]

One of the oral supplement in which probiotic organisms can be added and supplied daily is lozenge.[14] A lozenge is a small, typically medicated tablet intended to be dissolved slowly in the mouth, so that the duration of contact of probiotic strains in the oral cavity will be more. The possible impact of probiotic lozenge on plaque reduction and gingival health is less explored and therefore the aim of the study is to evaluate the efficacy of probiotic lozenge on plaque accumulation and gingival health in 6–12-year-old school children before and after a short-term daily intake of probiotic lozenge.


   Subjects and Methods Top


This Comparative study was conducted among 6–12 years old children from orphanage of Puducherry. Permission to conduct the study among the children was obtained from the Director of Orphanage. This study was approved by the Institutional review board and ethical committee, Reference No: IGIDSIEC2016NDP019PGKMPPD. Consent from the Guardian and child's assent was obtained.

Sample size calculation

Sample size was estimated based on results of a previous study conducted by Karuppaiah RM et al.[3] using a sampling software, (G power version 3.1.9.1, Heinrich- Heine- Universitat-D Usseldorf, Germany) minimum sample size was calculated to be 25 patients in each group (Power 90% and error at 5%). Anticipating 10% drop out rate, sample size was increased to 30 patients in each group and the sample size was calculated as 60.

Selection of subjects

After screening 60 children were selected in the age group of 6–12 years with no active carious and periodontal diseases. Children who are under antibiotic treatment and probiotic usage, children with special health care needs, hereditary lactose intolerance were excluded.

Blinding and randomization

Random sequence was generated by using block randomization method by the independent investigator and sequential allocation was done. The allocation sequence was concealed from primary investigator in sequentially named pouches. Accordingly the primary investigator allocated the subject as per the sequentially named pouches to the Probiotic and Placebo group.

Oral prophylaxis and recording index

All 60 participants were provided with complete oral prophylaxis one week prior to the intervention. Gingival index and plaque index were recorded as baseline data at 1st day of the intervention and at 30th day as Post-intervention data. The gingival index and plaque index was recorded using Loe and Silness P, Silness and Loe H, respectively, solely for the purpose of assessing gingival health and plaque accumulation.[15]

Allocation of subjects

Accordingly 60 subjects both male and female were randomly divided into two groups of 30 each. Group A Probiotic lozenge containing Streptococcus fecalis T-1110 (30 million), Clostridium butyricum TO-A (2 million), Bacillus mesentricus TO-A (1 million), Lactobacillus sporogenes (50 million) with non-cariogenic, sweet tasting Isomaltase as base with orange flavour. Group B Placebo lozenge which were identical in size and composition, colour, taste but without addition of probiotic strain. Both the lozenges were provided by Tablets Mart India.

These Probiotic lozenge and placebo lozenge were given twice per day for 30 days for the cases and control group. The primary investigator visited the hostel daily in the morning and evening to distribute the lozenges to the children as per the coding for 30 days. The participants were instructed to let the lozenge slowly melt in the mouth after brushing. During the intervention period of about 1 month, the subjects were motivated to brush their teeth twice daily.

Statistical tools

Statistical analyses were performed using the SPSS Statistics program (version 21.0, SPSS, Chicago, IL, USA).


   Results Top


[Table 1] depicts the comparison of the mean gingival and plaque index scores before and after treatment among subject in Probiotic lozenge Group. There was a statistically significant reduction in both gingival (pre-treatment 1.74 ± 0.42, post-treatment 1.01 ± 0.21) and plaque index scores (pre-treatment 2.05 ± 0.44, post-treatment 1.02 ± 0.27) among the subjects in Probiotic Lozenge Group (P value <0.05), [Graph 1].
Table 1: Comparison of the mean gingival and plaque index scores before and after treatment among subject in Probiotic Lozenge Group

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[Table 2] depicts the comparison of the mean gingival and plaque index scores before and after treatment among subject in Placebo Lozenge group. There was no statistically significant reduction in both gingival (pre-treatment 1.77 ± 0.50, post-treatment 1.75 ± 0.43) and plaque index scores (pre-treatment 1.59 ± 0.70, post-treatment 1.67 ± 0.64) among the subjects in Placebo Lozenge group (P value >0.05) [Graph 2].
Table 2: Comparison of the mean gingival and plaque index scores before and after treatment among subject in Placebo Lozenge Group

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Placebo Lozenge group had higher gingival and plaque index scores compared to Probiotic lozenge group. The differences were found to be statistically significant. There was a statistically significant reduction in both gingival (pre-treatment 1.74 ± 0.42, post-treatment 1.01 ± 0.21) and plaque index scores (pre-treatment 2.05 ± 0.44, post-treatment 1.02 ± 0.27) among the subjects in Probiotic Lozenge group. However, there was no statistically significant reduction in both gingival (pre-treatment 1.77 ± 0.50, post-treatment 1.75 ± 0.43) and plaque index scores (pre-treatment 1.59 ± 0.70, post-treatment 1.67 ± 0.64) among the subjects in Placebo lozenge group.


   Discussion Top


The present study was done in 6–12 year old children to evaluate the efficacy of plaque reduction and gingival health before and after a short-term intake of probiotic lozenge, this age group was selected in order to achieve positive compliance. The study population was selected from hostel to avoid subjective bias in the outcome such as intake of naturally available probiotics such as curd and pickle.[4]

In this study probiotics is used one of the adjunct for brushing in plaque reduction. Probiotics in the form of lozenge can be used as an ideal vehicle for delivery, as it can be dissolved in the oral cavity thereby there will be local action of probiotics in the oral cavity rather.[14] For better acceptability of lozenge, orange flavour with isomaltase sugar free base is added and to avoid “drop out” the principal investigator visited the hostel throughout the study for intervention.

Among the various selection criteria for probiotic, adhesion of the beneficial bacterium to the tooth surface was considered of primary importance that further favoured the expression of probiotic activity.[12] Various studies have been done in the past to assess the adhesion by measuring the attachment of bacteria to saliva-coated hydroxyapatite and oral epithelium and revealed that among probiotics strains L. rhamnosus GG exhibited the highest values of adhesion, comparable to those of the early tooth colonizer Streptococcus sanguinis.[5],[15],[16]

Bifiliac lozenge (Prebiotics and Probiotics) which contains Streptococcus faecalis, Clostridium butyricum, Bacillus mesentericus, Lactobacillus sporogenes was used in the present study. The combination of probiotic strains used in our study was similar to those used by Dhawan et al. in 2013.[17] The treatment dosing regimen was two lozenges per day, one in the morning and one in the night after tooth brushing as per the coding, which was well tolerated by the individuals and this indicates that it is a suitable vehicle for probiotic delivery.

In the present study, there was a steep reduction in baseline values of the plaque and gingival index scores in probiotic group when compared with that of placebo group, and the results were in agreement with the previous studies.[3],[6],[18]

As the use of probiotic lozenge for a month showed a significant improvement in plaque reduction and gingival status, it seems that prolonged administration of probiotic preparations may have a preventive role against development of plaque and gingivitis.[6] This may be due to the anti-plaque activity of Probiotics such as inhibiting the growth of microorganisms, reducing the adhesion of bacteria to the tooth surface, inhibiting the formation of the intercellular plaque matrix, reducing the formation of cytotoxic products by modifying plaque film and ecology to a less pathogenic flora.[18]

In our study, the reduction in plaque accumulation and gingivitis could also be due to the reinforcement of the principal investigator daily for lozenge intake after brushing which is known as Hawthrone effect.[9] In contrast, few studies showed increase in plaque and gingival score as compared to baseline values.[9],[20]

Finally, it can also be assumed that some reduction might be seen due to the daily intake and duration of contact of probiotics in the oral cavity which increases the overall oral clearance. Our study, therefore, confirms the anti-inflammatory and plaque inhibitory actions of probiotic lozenge, although the exact mechanism is still unclear.


   Conclusion Top


Probiotics administration in young children reduced the amount of plaque accumulation and gingival inflammation. Oral supplements such as probiotic lozenge can be used as an adjunct in prevention of gingival diseases in children since it is a suitable, safe method for maintaining gingival health.

Limitations

Future long-term research with larger sample size is required to determine the preventive role of probiotics against gingival and periodontal diseases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Dr. Muthukrishnan Kavitha
Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Puducherry, SBV
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_232_20

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