Background
Objective
Methods
Protocol development and registration
Eligibility criteria
Information sources and search strategy
Study selection of studies and data extraction
Risk of bias in individual studies
Summary measures and synthesis of results
Risk of bias across studies and additional analyses
Results
Study selection
Study | Intervention characteristics | Outcomes assessed | Others |
---|---|---|---|
Benic [2019] [29] University of Otago New Zealand | EG: Lozenges [Streptococcus salivarius M18 - 3 × 109 CFU/lozenge] PG: Lozenges without active bacteria Administration: 1 month Dosage: 2 lozenges/d | Gingival inflammation: Gingival index [33] Adverse effects | Sample size calculation: Yes, but not for GI Reliability of measurements: Not reported |
Gizani et al. [2015] [30] University of Athens Greece | EG: Lozenges [Lactobacillus reuteri DSM 17938 and Lactobacillus reuteri ATCC PTA 5289–108 bacteria of each strain] PG: Identical lozenges without active bacteria Administration: from the time of enrollment until debonding (mean ± SD: 17.0 ± 6.8 months) Dosage: 1 lozenge/d; after brushing, before bedtime | Enamel demineralization: Gorelick et al. [34] White Spot Lesion Index assessed photographically Adverse effects | Sample size calculation: Yes Reliability of measurements: Yes |
Habib [2016] [31] University of Toronto Canada | EG: Lozenges [Streptococcus salivarius K12, Lactobacillus paracasei, Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus salivarius, Lactobacillus reuteri - 3 × 109 CFU/lozenge] PG: Identical lozenges without active bacteria Administration: 4 weeks Dosage: loading dose - 2 lozenges, 2 times/d (after breakfast and after dinner) for 1w; maintenance dose; 2 lozenges, 1/d (after breakfast) for next 3 w | Gingival inflammation: Modified Gingival Index [35] Adverse effects | Sample size calculation: Yes Reliability of measurements: Yes |
Kohar et al. [2015] [32] Trisakti University Indonesia | EG1: Lozenges [Lactobacillus reuteri - 2 × 108 CFU/lozenge] EG2: Drink [Lactobacillus casei strain Shirota - 6.5 × 106/bottle] CG Administration: 2 weeks Dosage: 1 lozenge or 65 ml/d, at least 1 h after lunch | Gingival inflammation: Papillary Bleeding Index [36] | Sample size calculation: Not reported Reliability of measurements: Not reported |
Study | Inclusion and exclusion criteria | Analyzed sample [age; gender] |
---|---|---|
Benic [2019] [29] University of Otago New Zealand | Inclusion Criteria: Presence of at least 20 natural teeth; stainless steel brackets Exclusion Criteria: Systemic disease; lingual braces; living in a non-fluoridated area; periodontal disease; taking antibiotics; using non-fluoride/antibacterial toothpaste; dental fluorosis; smoking; using powered toothbrushes; lactose intolerance; allergy to dairy products; physical inability to brush | Age [range]: 10-30y EG: 32 [20F, 12 M] PG: 32 [21F, 11 M] Missing data: No |
Gizani et al. [2016] [30] University of Athens Greece | Inclusion Criteria: Fixed appliances on at least eight maxillary front teeth (incisors, cuspids, and premolars); expected duration of Tx 7–24 m Exclusion Criteria: Individuals under treatment with systemic or local antibiotics up to two weeks before starting the study | Age [mean ± SD]: 15.9 ± 3.9y EG: 42 (23F, 19 M); PG: 43 (33F, 10 M) Missing data: 9 [errors in follow-up photos] |
Habib [2016] [31] University of Toronto Canada | Inclusion Criteria: Healthy; aged 11–18 y; mild to moderate gingivitis; fixed appliances on at least 20 teeth for at least 5 m; complete eruption of teeth #16, 21, 23, 36, 41, 43; no active caries; no use of antimicrobial mouth rinses, probiotics, antibiotics or anti-inflammatory drugs within 1 m before the trial; undergone standard orthodontic bonding procedure Exclusion Criteria: Inability to consent or communicate fluently in English; allergies or sensitivity to lozenge ingredients; immunocompromised; major underlying medical condition or ENT problems; pregnancy; smoking, alcohol consumption; oral diseases or conditions; surgery within the past 45d or the next 90d; use of antibiotics, anti-inflammatory drugs, ongoing or use of probiotics within the past 1 m; nausea, fever, vomiting, bloody diarrhea or severe abdominal pain within the past 1 m; molar bands | Age [mean ± SD; range]: 15.69 ± 1.70y; 11-18y EG: 29 [15.75 ± 1.67y; 13F, 16 M] PG: 29 [15.64 ± 1.75y; 20F, 9 M] Missing data: 1/group [lost from to follow-up] |
Kohar et al. (2015) [32] Trisakti University Indonesia | Inclusion Criteria: Healthy; no medication; aged 18-25y; fixed appliances Tx for at least 1y Exclusion Criteria: Using xylitol gums, mouthwashes, systemic antibiotics; smokers; pregnancy; topical fluoride treatment | Age [range]: 18-25y EG1: 10; EG2: 10; CG: 10 Missing data: No |
Study characteristics
Risk of bias within studies
Results of individual studies
Risk of bias across studies and additional analyses
Quality assessment | No of patients | Effect | Quality | ||||||
---|---|---|---|---|---|---|---|---|---|
Studies | Risk of bias | Inconsistency | Indirectness | Imprecision | Other | Probiotic | Control | ||
Enamel demineralization development | |||||||||
1 | Not serious | Not serious | Not serious | Serious1 | None | 42 | 43 | No difference | ⨁⨁⨁◯ Moderate |
Gingival inflammation development | |||||||||
3 | Not serious | Not serious | Not serious | Seriousa | None | 81 | 71 | No difference | ⨁⨁⨁◯ Moderate |