Assessment of a Probiotic to Treat Gingivitis in Pediatric Patients

Assessment of Therapeutic Potential of a Novel Dental Probiotic in Pediatric Patients Affected by Gingivitis

This study investigates the efficacy of a proprietary probiotic formulation comprising 6 strains of bacteria in reducing inflammation and gingivitis in pediatric patients between 11 and 18 years old undergoing orthodontics treatment. Patients will be recruited based on a prior diagnosis of mild to moderate gingivitis by gingival index score. Participants in this study will be randomly assigned to receive either the probiotic treatment or a placebo, both in the form of a dissolving lozenge; for which the placebo is exactly the same shape, texture, taste, and composition as the probiotic treatment, but does not contain the active probiotic ingredients. The lozenges are to be taken orally at a certain prescribed regimen for 28 days. Participants will be assessed for gingivitis scores, gum bleeding scores, plaque scores, overall periodontal health, and for precarious areas at baseline, 14, and 28 days. They will also be assessed for the same measures at day 56, following a 28-day wash-out phase. Plaque and saliva samples will be collected at all timepoints for in vitro analyses of changes in microbial pathogens and/or inflammatory cytokines.

Study Overview

• Status: Completed
• Conditions: Inflammation; Gingivitis
• Intervention / Treatment: Dietary supplement: Probiotic formulation

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5S 2J7
      • University of Toronto Orthodontics Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 11 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion criteria:

• Are male or female between the ages of 11 to 18 years
• Have mild to moderate gingivitis as determined by dentist (GI of at least 1 to a maximum of 2)
• Are undergoing fixed orthodontic therapy on both arches with attachments on at least 20 teeth including bonded 1st molars for a minimum of 5 months.
• Have fully erupted teeth #16, #21, #23, #36, #41, and #43
• Are caries inactive prior to study initiation.
• Are in a healthy systemic condition
• Have not used any antimicrobial mouth rinses, probiotics (unrelated to the study), antibiotics or anti-inflammatories medications with one month prior to and during the study
• Whose legal guardian has given informed consent to participate in the study and must be able to communicate in English

Exclusion Criteria:

• Unable to make informed consent
• Subjects with allergies to milk or milk products, gluten or soy or any other ingredients present in the lozenge
• Immune compromised
• Major underlining medical condition
• Pregnancy
• History of smoking or alcohol consumption
• Have major dental conditions such as periodontal disease, dental caries and/or xerostemia or systemic diseases which could directly or indirectly affect plaque formation
• Use of medications within 1 month (antibiotics, anti-inflammatory, mouth rinses) that can influence the outcome.
• Ongoing or recent (within 1 month) use of probiotics unrelated to the study
• Have within the past 30 days experienced any nausea, fever, vomiting, bloody diarrhea or severe abdominal pain

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Probiotic formulation; Probiotic dissolving lozenge, at least 1 billion total CFU, taken at a certain prescribed regimen for 28 days.	Dietary supplement: Probiotic formulation
Placebo Comparator: Placebo; Placebo dissolving lozenge, with the exact same appearance as the treatment lozenge (including flavour, colour, shape and texture), and formulated with all the same ingredients except for the live bacteria, taken for 28 days at the same prescribed regimen as the probiotic lozenge.	Dietary supplement: Probiotic formulation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in gingivitis	Gingivitis will be assessed by gingival index: 0 - Absence of gingival inflammation; - Mild inflammation: slight change in colour, little change in texture of any portion of but not the entire marginal or papillary gingival unit; - Mild inflammation: criteria as above, but involving the entire marginal or papillary gingival unit; - Moderate inflammation: glazing, redness, edema, and/or hypertrophy of the marginal or papillary gingival unit; - Severe inflammation: marked redness, edema, and/or hypertrophy of marginal or papillary gingival unit; spontaneous bleeding, congestion or ulceration.	0, 14, 28, and 56 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduced plaque	Reduction in levels of plaque as measured by a plaque index: 0 - No plaque in the gingival area; - A film of plaque adhering to the free gingival margin and adjacent area of the tooth, which can not be seen with the naked eye. Only seen by running a probe across the tooth surface; - Moderate accumulation of plaque deposits within the gingival pocket, on the gingival margin and/ or adjacent tooth surface, which can be seen with the naked eye; - Abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface	0, 14, 28, and 56 days
Reduction in inflammation	Reduction in salivary cytokines IL-1, IL-6, IL-8, TNF-A, IL-12 and an increase in IL-10, and IL-13 as measured by immunofluorometric assay.	0, 14, 28, and 56 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in S. mutans	Reduced levels of S. mutans in plaque and saliva	0, 14, 28, and 56 days

Collaborators and Investigators

• Sponsor: Lawson Health Research Institute
• Collaborators: University of Toronto; University of Western Ontario, Canada; Integra Medical Inc.; Ontario Centres of Excellence
• Investigators: Principal Investigator: Peter Cadieux, PhD, University of Western Ontario, Canada; Study Director: Siew-Ging Gong, BDS, MS, MA, PhD., University of Toronto, Canada

Study record dates

Study Major Dates

• Study Start: August 1, 2014
• Primary Completion (Actual): December 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: September 26, 2013
• First Submitted That Met QC Criteria: September 26, 2013
• First Posted (Estimate): October 7, 2013

Study Record Updates

• Last Update Posted (Estimate): August 19, 2015
• Last Update Submitted That Met QC Criteria: August 17, 2015
• Last Verified: August 1, 2015

More Information

Terms related to this study

• Keywords: inflammation; gingivitis; plaque; orthodontics
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Stomatognathic Diseases; Periodontal Diseases; Mouth Diseases; Gingival Diseases; Inflammation; Gingivitis
• Other Study ID Numbers: LG-001; 185428 (Other Identifier: Health Canada, Natural Health Products Directorate); OCE VIP #20964 (Other Grant/Funding Number: Ontario Centres of Excellence)