Effect of probiotic chewing tablets on early childhood caries--a randomized controlled trial

Trifa Hedayati-Hajikand, Ulrika Lundberg, Catarina Eldh, Svante Twetman, Trifa Hedayati-Hajikand, Ulrika Lundberg, Catarina Eldh, Svante Twetman

Abstract

Background: To evaluate the effect of probiotic chewing tablets on early childhood caries development in preschool children living in a low socioeconomic multicultural area.

Methods: The investigation employed a randomized double-blind placebo-controlled design. The study group consisted of 138 healthy 2-3-year-old children that were consecutively recruited after informed parental consent. After enrollment, they were randomized to a test or a placebo group. The parents of the test group were instructed to give their child one chewing tablet per day containing three strains of live probiotic bacteria (ProBiora3) and the placebo group got identical tablets without bacteria. The duration was one year and the prevalence and increment of initial and manifest caries lesions was examined at baseline and follow-up. All parents were thoroughly instructed to brush the teeth of their off-springs twice daily with fluoride toothpaste.

Results: The groups were balanced at baseline and the attrition rate was 20%. Around 2/3 of the children in both groups reported an acceptable compliance. The caries increment (Δds) was significantly lower in the test group when compared with the placebo group, 0.2 vs. 0.8 (p < 0.05). The risk reduction was 0.47 (95% CI 0.24-0.98) and the number needed to treat close to five. No differences were displayed between the groups concerning presence of visible plaque or bleeding-on-brushing. No side effects were reported.

Conclusions: The results suggested that early childhood caries development could be reduced through administration of these probiotic chewing tablets as adjunct to daily use of fluoride toothpaste in preschool children. Further studies on a possible dose-response relationship seem justified

Trial registration: ClinicalTrials.gov Identifier: NCT01720771 . First received: October 31, 2012.

Figures

Fig. 1
Fig. 1
Flow chart of available, eligible and randomized children, indicating the reasons for dropping out

References

    1. Sanders ME. Probiotics: definition, sources, selection, and uses. Clin Infect Dis. 2008;46(Suppl 2):S58–61. doi: 10.1086/523341.
    1. Teughels W, Van Essche M, Sliepen I, Quirynen M. Probiotics and oral health care. Periodontol 2000. 2008;48:111–47. doi: 10.1111/j.1600-0757.2008.00254.x.
    1. Twetman S, Keller MK. Probiotics for caries prevention and control. Adv Dent Res. 2012;24:98–102. doi: 10.1177/0022034512449465.
    1. Laleman I, Teughels W. Probiotics in the dental practice: A review. Quintessence Int. 2015;46:255–64.
    1. Näse L, Hatakka K, Savilahti E, Saxelin M, Pönkä A, Poussa T, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res. 2001;35:412–20. doi: 10.1159/000047484.
    1. Stecksén-Blicks C, Sjöström I, Twetman S. Effect of long-term consumption of milk supplemented with probiotic lactobacilli and fluoride on dental caries and general health in preschool children: a cluster-randomized study. Caries Res. 2009;43:374–81. doi: 10.1159/000235581.
    1. Petersson LG, Magnusson K, Hakestam U, Baigi A, Twetman S. Reversal of primary root caries lesions after daily intake of milk supplemented with fluoride and probiotic lactobacilli in older adults. Acta Odontol Scand. 2011;69:321–7. doi: 10.3109/00016357.2011.568962.
    1. Keller MK, Nøhr Larsen I, Karlsson I, Twetman S. Effect of tablets containing probiotic bacteria (Lactobacillus reuteri) on early caries lesions in adolescents: a pilot study. Benef Microbes. 2014;5:403–7. doi: 10.3920/BM2013.0089.
    1. Laleman I, Detailleur V, Slot DE, Slomka V, Quirynen M, Teughels W. Probiotics reduce mutans streptococci counts in humans: a systematic review and meta-analysis. Clin Oral Investig. 2014;18:1539–52. doi: 10.1007/s00784-014-1228-z.
    1. Yli-Knuuttila H, Snall J, Kari K, Meurman JH. Colonization of lactobacillus rhamnosus GG in the oral cavity. Oral Microbiol Immunol. 2006;21:129–31. doi: 10.1111/j.1399-302X.2006.00258.x.
    1. Twetman S, Stecksén-Blicks C. Probioics and oral health effects in children. Int J Paediatr Dent. 2008;18:3–10.
    1. Stensson M, Koch G, Coric S, Abrahamsson TR, Jenmalm MC, Birkhed D, et al. Oral administration of Lactobacillus reuteri during the first year of life reduces caries prevalence in the primary dentition at 9 years of age. Caries Res. 2014;48:111–7. doi: 10.1159/000354412.
    1. Hasslöf P, West CE, Videhult FK, Brandelius C, Stecksén-Blicks C. Early intervention with probiotic Lactobacillus paracasei F19 has no long-term effect on caries experience. Caries Res. 2013;47:559–65. doi: 10.1159/000350524.
    1. Tinanoff N, Reisine S. Update on early childhood caries since the Surgeon General’s Report. Acad Pediatr. 2009;9:396–403. doi: 10.1016/j.acap.2009.08.006.
    1. Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M. Preventing dental caries in children <5 years: systematic review updating USPSTF recommendation. Pediatrics. 2013;132:332–50. doi: 10.1542/peds.2013-1469.
    1. Wennhall I, Mårtensson EM, Sjunnesson I, Matsson L, Schröder U, Twetman S. Caries-preventive effect of an oral health program for preschool children in a low socio-economic, multicultural area in Sweden: results after one year. Acta Odontol Scand. 2005;63:163–7. doi: 10.1080/00016350510019900.
    1. Taipale T, Pienihäkkinen K, Alanen P, Jokela J, Söderling E. Administration of Bifidobacterium animalis subsp. lactis BB-12 in early childhood: a post-trial effect on caries occurrence at four years of age. Caries Res. 2013;47:364–72. doi: 10.1159/000348424.
    1. Schwendicke F, Dörfer CE, Schlattmann P, Page LF, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and Meta-Analysis. J Dent Res. 2015;94:10–18. doi: 10.1177/0022034514557546.
    1. Honkala E. Primary oral health care. Med Princ Pract. 2014;23(Suppl 1):17–23.
    1. Kay E, Locker D. A systematic review of the effectiveness of health promotion aimed at improving oral health. Community Dent Health. 1998;15:132–44.
    1. Hillman JD, McDonell E, Cramm T, Hillman CH, Zahradnik RT. A spontaneous lactate dehydrogenase deficient mutant of Streptococcus rattus for use as a probiotic in the prevention of dental caries. J Appl Microbiol. 2009;107:1551–8. doi: 10.1111/j.1365-2672.2009.04333.x.
    1. Cagetti MG, Mastroberardino S, Milia E, Cocco F, Lingström P, Campus G. The use of probiotic strains in caries prevention: a systematic review. Nutrients. 2013;5:2530–50. doi: 10.3390/nu5072530.
    1. Zahradnik RT, Magnusson I, Walker C, McDonell E, Hillman CH, Hillman JD. Preliminary assessment of safety and effectiveness in humans of ProBiora3, a probiotic mouthwash. J Appl Microbiol. 2009;107:682–90. doi: 10.1111/j.1365-2672.2009.04243.x.
    1. Cannon M, Trent B, Vorachek A, Kramer S, Esterly R. Effectiveness of CRT at measuring the salivary level of bacteria in caries prone children with probiotic therapy. J Clin Pediatr Dent. 2013;38:55–60. doi: 10.17796/jcpd.38.1.b481624264142082.

Source: PubMed

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