JICDRO is a UGC approved journal (Journal no. 63927)

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Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 41-44

Clinical efficacy of probiotic mouthwash in the treatment of gingivitis patients in Himachal population

Department of Periodontics, Himachal Dental College, Sundernagar, Himachal Pradesh, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Puja Thakur Malhotra
Department of Periodontics, Himachal Dental College, Sundernagar, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-0754.207386

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This study was conducted to analyze the changes in gingival health in patients treated with probiotic containing mouth rinse. Thirty volunteers between 20 and 35 years were randomly divided into two groups. While one group was given placebos, the other was given probiotic mouth rinse for 14 days. The volunteers were instructed to swish the mouth rinse for 60 s twice a day. Intergroup comparison of the plaque scores (baseline-14 days) showed there was statistically significant difference in the mean plaque scores between the placebos group (0.14) (P ≤ 0.05) and the test group (0.42) (P ≤ 0.05) and a statistically significant difference in the mean gingival scores from baseline-14 days between the placebos group (0.9) (P ≤ 0.05) and the test group (0.38) with (P ≤ 0.05). Despite the short period for which the probiotics mouthwash was used by the patients, substantial improvement in gingival health of patients was observed in the study.

Keywords: Clinical efficacy, gingivitis, placebos, probiotics

How to cite this article:
Jindal V, Mahajan N, Goel A, Kaur R, Mahajan A, Malhotra PT. Clinical efficacy of probiotic mouthwash in the treatment of gingivitis patients in Himachal population. J Int Clin Dent Res Organ 2017;9:41-4

How to cite this URL:
Jindal V, Mahajan N, Goel A, Kaur R, Mahajan A, Malhotra PT. Clinical efficacy of probiotic mouthwash in the treatment of gingivitis patients in Himachal population. J Int Clin Dent Res Organ [serial online] 2017 [cited 2022 Jul 3];9:41-4. Available from: https://www.jicdro.org/text.asp?2017/9/1/41/207386

   Introduction Top

The oral cavity is a rather intricate environment that harbors a diverse array of bacterial species with each environment within, supporting distinct yet overlapping communities of hundreds of species. It is estimated that more than 500 different species are capable of colonizing the adult mouth and that any individual typically harbors 150 or more different species.[1] Furthermore, the microbiota of the tongue surface is one of the most complex niches in human ecology, and approximately one-third of the bacterial population in the oral cavity is found on the tongue and not on other oral sites.[2] The balance of all these microorganisms can easily be disturbed and a prevalence of pathogenic organisms can lead to various oral health problems including dental caries, periodontitis, and halitosis.

Various studies done in the past have shown that probiotics can tilt the balance of the oral flora toward the beneficial species, reducing gingivitis.[3] The term “probiotic” is derived from the Greek word meaning “for life.”[4] This term was first used in 1965, by Lilly and Stillwell for describing substances secreted by one organism which stimulates the growth of another.[5] By the turn of 20th century Nobel Prize, Laureate Ilye Metchnikoff was the first to state the role of beneficial bacteria on health and proposed that Bulgarian people had a longer longevity due to fermented milk containing viable bacteria.[6] As defined by the World Health Organization, probiotics have been defined as “Live microorganisms, if administered in adequate amounts, confer a health benefit on the host”.[7]

The concept of replacing pathogenic bacteria with beneficial bacteria has gained much acceptance in recent years where antibiotic resistance is an increasing global problem. Given the potent paradigm shift that this phenomenon of oral probiotics can give rise to the field of periodontal healthcare, probiotics might offer an opportunity as an alternative approach in reducing bacterial mediated oral diseases as gingivitis. Considering this, the present study was conducted to evaluate the clinical effect of short-term administration of probiotic product darolac as a mouth rinse in reducing plaque and gingivitis.

   Materials and Methods Top

This comparative double-blind prospective study was conducted on sample size of thirty gingivitis patients. The patients were selected from Himachal population. Approval for the study was obtained from the Ethical Committee. All data were reviewed to confirm criteria for inclusion and exclusion. The eligible patients who satisfied the inclusion criteria of 20–35 years of age with no recent antibiotic therapy (within 4 weeks) were included in the study. The exclusion criteria included patients suffering from any systemic illness or using any other commercially available mouth rinse, probiotic products, or any other oral hygiene aids other than routine teeth brushing. Patients undergoing orthodontic treatment were also excluded from the study. All participants were informed about the nature of the study and their informed consent was taken.

The participants and the examiner were blinded regarding the product allocation. The mouth rinse and the placebo (distilled water) were prepared in similar 50 ml bottles by one of the study coordinators, who marked the code number of each bottle and kept the record. Commercially available probiotic product Darolac (Aristo pharmaceuticals, India, 23 A, Shah Industrial Estate, Off Veera Desai Road, Andheri West, Mumbai 400053, Maharashtra, India) containing 1 g powder of 1.25 billion freeze-dried combination, of a mixture of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum, and Saccharomyces boulardii was used. Each sachet powder was dissolved in 20 ml of distilled water measured with a measuring cup and used as a mouth rinse. The placebos mouth rinse was prepared using distilled water.

When the participants volunteered for the study and before they received a bottle containing mouth rinse and instruction for use, baseline plaque index Silness and Loe (1964) and gingival index Loe and Silness (1963), in which the gingivae scored on a 4-point scale from 0 (absence of inflammation) to 3 (severe inflammation) were noted.

Each participant was given one of the test products with a given code according to the assigned group. Twenty milliliters of mouth rinse were dispensed for each individual using a measuring cup and participants were instructed to swish the mouth rinse for 60 s and then expectorate. The procedure was performed twice daily, for the first time in the morning, and to be repeated before retiring to bed at night for the next 14 days. During the intervention period, no influence on personal oral hygiene procedure was exerted, the participants were encouraged to maintain routine oral hygiene and also instructed to maintain strict compliance. A day after the 14 days of intervention, gingival and plaque indices were recorded using same indices by same examiner. Clinical monitoring was performed by single examiner at baseline and 14th day.

The monitoring of compliance was assessed by instructing the participants to return the old bottles containing mouth rinses who received a new bottle of mouth rinse. Record of the allocation list was kept with one of the study coordinators. The mouth rinses were decoded after the completion of the study. Data were collected and analyzed.

   Results Top

Fifty-two patients between the ages of 21 and 34 years (mean age 28 years) were screened for their eligibility to participate in this study. Twelve patients did not meet the inclusion criteria, and ten did not complete the study protocol. Twenty patients received probiotic mouth rinse (test group) and twenty patients received placebo mouth rinse (control group). At the end of the study, a total of thirty participants of both the control and test group could be evaluated for the results. After 14 days, the test (15/20) and the control (15/20) groups were analyzed for the various parameters.

On the basis of statistical analysis, following results were drawn. Intragroup comparison of plaque scores from baseline to 14th day showed an increase in the mean plaque score for the control group that was not statistically significant, with the mean difference of 0.14 (P ≤ 0.05) and a statistically significant reduction in the mean plaque score for the test group with a mean difference of 0.42 (P ≤ 0.05). Intragroup comparison of gingival scores from baseline to 14 days showed there was no statistically significant increase in the mean gingival score in placebo with mean differences of 0.1 (P > 0.05) and a statistically significant reduction in the mean plaque score for the test group with a mean difference of 0.38 (P ≤ 0.05).

On intergroup comparison of the plaque scores (baseline-14 days), there was a statistically significant difference in the mean plaque scores between the placebos group 0.14 (P ≤ 0.05) and the test group 0.42 (P ≤ 0.05) and there was a statistically significant difference in the mean gingival scores (baseline-14 days) between the placebo group −0.9 (P ≤ 0.05) and the test group 0.38 with (P ≤ 0.05) as shown in [Table 1] and [Table 2], respectively.
Table 1: Intergroup comparison of mean palque score from baseline to 14 days

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Table 2: Intergroup comparison of mean gingival score from baseline to 14 days

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   Discussion Top

The present study was done to analyze the changes in gingival health in patients treated with probiotic containing mouth rinse. The results of the study showed that the administration of probiotic containing L. acidophilus, L. rhamnosus, B. Longum, and S. boulardii, when used as an adjunct to participants' mechanical oral hygiene procedures, provided a better clinical improvement compared with placebo over a period of 14 days. Parallel to the clinical improvements, plaque and gingival index scores also showed significant improvements in the test participants. The outcome of the study revealed significant reductions in plaque and gingival index in the test group at 14 days. A statistically significant reduction in the mean plaque score for the test group was found on the 14th day when compared to baseline.

In our study, the choice of the probiotic used was based on the constituent bacteria present in the product, and its beneficial effect on the gingival tissues. Among the various selection criteria for probiotic, adhesion of the beneficial bacterium to the tooth surface was considered of primary importance that further favored the expression of probiotic activity. 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 these studies have revealed that among probiotics strains L. rhamnosus GG exhibited the highest values of adhesion, comparable to those of the early tooth colonizer Streptococcus sanguinis.[8] Some probiotic bacteria were also found to have immunostimulatory activity on oral epithelial tissues. Studies in the gastrointestinal tract have revealed that active and heat inactivated L. acidophilus PZ, induced remarkable expressions of human β-defensin (hBD-2) in Caco-2 cells. In the oral cavity, hBD-2 is expressed in oral epithelium in normal uninflamed gingival tissue presumably because of the high level of exposure to commensal microorganisms. Studies have also revealed positive affect and reduction in periodontal inflammation by the administration of two probiotic tablet forms Bifidumbacterina and Acilact b available on the Russian market.[9]

The data in our study compare favorably with that from the study performed by Shimauchi et al. 2008 reporting statistically significant decreases in gingivitis index and plaque index when compared with baseline values when probiotics were used.[10] In contrast, the study by Staab et al. 2009 showed a statistically significant increase in gingivitis index when compared with baseline values.[11] Further, various studies done in the past such as one study by Cildir et al. 2009 have also reported a significant decrease in bleeding upon probing when compared with baseline values on probiotic use.[12]

Given the above-discussed background, one of the shortcomings of this study may be the short period for which the effect of probiotics administration was assessed. Studies done in the past have supported the fact that to be able to have probiotic effects in the mouth, a bacterium must adhere to oral surfaces and become part of the biofilm.[9] The results of one such study done for 14 days revealed that L. rhamnosus (bacterium forming one of the constituents in the probiotic used in the present study) might not easily colonize the oral cavity.[3] In this light, it may be considered that for a probiotic to effect a shift away from periodontopathogens would require its continuous administration. A remarkable study performed by Teughels et al. (2011) on Beagle dogs reported a statistically significant lower bleeding upon probing for pockets that received multiple applications of probiotics for 12 weeks when compared with scaled and root-planed pockets alone (30% vs. 45%, respectively). In this study, no oral hygiene was provided to the dogs.[13]

As the use of probiotic mouth rinse for 2 weeks showed a significant improvement of plaque and gingival status, it seems plausible that prolonged administration of probiotic preparations may have a preventive role against development of plaque and gingivitis.

   Conclusion Top

The present study aimed to evaluate the effects of prolonged administration (2 weeks) of probiotics on periodontal health. The results showed a significant improvement of plaque and gingival status in patients. Thus, although the question of selection of probiotic strains, the exact molecular mechanisms of their action, dosage of probiotic administration for each indication and the applied methodology of the studies needs to be addressed, results from present study and a few done in past have shown that probiotics could be effective in improving periodontal health by manipulating the periodontal microbiota.

Financial support and sponsorship

The probiotic sachets (Darolac) used in the study were provided by Aristo pharmaceuticals.

Conflicts of interest

There are no conflicts of interest.

   References Top

Moore WE, Moore LV. The bacteria of periodontal diseases. Periodontol 2000 1994;5:66-77.  Back to cited text no. 1
Faveri M, Feres M, Shibli JA, Hayacibara RF, Hayacibara MM, de Figueiredo LC. Microbiota of the dorsum of the tongue after plaque accumulation: An experimental study in humans. J Periodontol 2000 2006;77:1539-46.  Back to cited text no. 2
Purunaik S, Thippeswamy HM, Chavan SS. To evaluate the effect of probiotic mouthrinse on plaque and gingivitis among 15-16 year old school children of Mysore city, India – Randomized controlled trial. Glob J Med Res J Dent Otolaryngol 2014;14:1-6.  Back to cited text no. 3
Haukioja A. Probiotic lactobacilli and bifidobacteria in the mouth – In vitro studies on saliva-mediated functions and acid production. Med Odontol 2009.  Back to cited text no. 4
Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics – Approaching a definition. Am J Clin Nutr 2001;73 2 Suppl: 361S-4S.  Back to cited text no. 5
Mackowiak PA. Recycling Metchnikoff: Probiotics, the intestinal microbiome and the quest for long life. Front Public Health 2013;1:52.  Back to cited text no. 6
Ince G, Gürsoy H, Ipçi SD, Cakar G, Emekli-Alturfan E, Yilmaz S. Clinical and biochemical evaluation of lozenges containing Lactobacillus reuteri as an adjunct to non-surgical periodontal therapy in chronic periodontitis. J Periodontol 2015;86:746-54.  Back to cited text no. 7
Yli-Knuuttila H, Snäll J, Kari K, Meurman JH. Colonization of Lactobacillus rhamnosus GG in the oral cavity. Oral Microbiol Immunol 2006;21:129-31.  Back to cited text no. 8
Stamatova I, Kari K, Vladimirov S, Meurman JH.In vitro evaluation of yoghurt starter lactobacilli and Lactobacillus rhamnosus GG adhesion to saliva-coated surfaces. Oral Microbiol Immunol 2009;24:218-23.  Back to cited text no. 9
Shimauchi H, Mayanagi G, Nakaya S, Minamibuchi M, Ito Y, Yamaki K, et al. Improvement of periodontal condition by probiotics with Lac tobacillus salivarius WB21: A randomized, double-blind, placebo-controlled study. J Clin Periodontol 2008;35:897-905.  Back to cited text no. 10
Staab B, Eick S, Knöfler G, Jentsch H. The influence of a probiotic milk drink on the development of gingivitis: A pilot study. J Clin Periodontol 2009;36:850-6.  Back to cited text no. 11
Cildir SK, Germec D, Sandalli N, Ozdemir FI, Arun T, Twetman S, et al. Reduction of salivary mutans streptococci in orthodontic patients during daily consumption of yoghurt containing probiotic bacteria. Eur J Orthod 2009;31:407-11.  Back to cited text no. 12
Teughels W, Loozen G, Quirynen M. Do probiotics offer opportunities to manipulate the periodontal oral microbiota? J Clin Periodontol 2011;38 Suppl 11:159-77.  Back to cited text no. 13


  [Table 1], [Table 2]

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