Effectiveness of Probiotic Yogurt in Moderate Gingivitis: A Randomized Clinical Trial

 

Anju Chandran¹, Amitha Ramesh², Sudhir Rama Varma³, Raksha Potdar⁴, Prabhu Natarajan⁵, Mohammed Amjed Alsaegh⁶

¹BDS A B Shetty Memorial Institute of Dental Sciences NITTE (Deemed to be University)

² Professor Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences NITTE

(Deemed to be University)

³Clinical Assistant Professor, Department of Clinical Sciences, Ajman University, Ajman UAE

⁴Postgraduate Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences NITTE

(Deemed to be University)

⁵Associate Professor, Department of Periodontics, University of Science and Technology of Fujairah, UAE

⁶Assistant Professor Department of Oral and Craniofacial Sciences College of Dental Medicine,

University of Sarjah

 

ABSTRACT:

Introduction: Probiotics are microbes that positively influence health an individual when ingested in appropriate quantities. This study is done to assess the variation in salivary buffering capacity and salivary pH in moderate gingivitis patients before and after probiotic intake. Aim and Objective: To assess the role of probiotics on buffering capacity and salivary pH. To study the effect of probiotics in controlling gingivitis.

Methodology: A study group of 10 subjects between the age group of 25 - 35 years with moderate gingivitis. Gingival Index was recorded. pH and buffering capacity of the saliva is determined using GC saliva buffer kit before and after probiotic intake. Results: There was significant improvement in gingival health after 14 days consumption of probiotic yogurt. However, there is no significant difference between gingival index, buffering capacity and pH before and after probiotic consumption. Conclusion: There was significant improvement in gingival health after 14 days consumption of probiotic yogurt. Long term research and clinical trials are required to reveal whether the probiotics can be used for preventing or treating oral diseases.

 

 

 

INTRODUCTION: 

The term probiotics was first introduced in 1953 by Werner Kollath to describe organic and inorganic food supplements which restore health to patients suffering from malnutrition.¹

 

Probiotics are living microbes, or microbes containing foods, that positively influence the health of the host when ingested in appropriate quantities.² World Health Organization (WHO) have stated probiotics as “live microorganism which when administered in adequate amounts confer a health benefit on host.³ Various different microorganisms can be classified as probiotics. Lactobacillus and Bifidobacterium genera are the most common strains found.⁴  

 

Lactobacillus occupies the major population of the beneficiary microorganisms present inside the body.⁵ Lactic acid bacteria convert sugars and other carbohydrates into lactic acid.⁶ Lactic acid bacteria are characterized by their tolerance in which other bacteria are unable to grow and thereby ensuring food safety.⁷ They have the ability to adapt varied selective pressure both inside and outside of the intestinal environment with their metabolic activities, growth rate and carbohydrate metabolism.⁸ Dairy products especially yogurt is the major source of probiotics, when included as part of daily diet will help in promoting good health.⁹ Continuous usage of antibiotics in the human body will have the chance of damaging the normal flora. The consumption of antagonists of antibiotics using lactic acid bacteria and the antibacterial activity of such friendly microorganisms considered as an important attribute for the maintenance of healthy microbial balance in the gut.¹⁰

 

Saliva is a clear, slightly acidic mucoserous exocrine secretion.¹¹ Resting pH of mouth is approximately 6.7 – 7.3, this near neutral values are maintained by saliva. pH range of 6.2-7.6 is considered normal with the average pH being 6.7.  The saliva helps maintain the pH by two different mechanisms.¹²

 

Gingivitis is the inflammation of the gingival tissue; nonresolution of this inflammation leads to inflammation of the periodontium (periodontitis).¹³ Streptococcus sanguis and Fusobacterium naviforme are associated with gingival health.

 

This study aims to assess the variation in salivary buffering capacity and salivary pH in moderate gingivitis patients before and after probiotic intake.

 

MATERIAL AND METHODS:

Materials:

Saliva collection cup, pH strips, probiotic yogurt supplemented with Lactobacillus Acidophilus and Bifidobacterium Lactis.

 

Saliva-Check buffer kit manufactured by General corporation: It is a tool used for patient education, preventive treatment planning also for choosing appropriate measures for the betterment of patient’s oral health. Saliva-Check buffer kit helps check the risk of caries, saliva thickness, flow and resting pH and its buffering capacity.

 

Methods:

Participant selection:

A study group of 10 subjects between the age group of 25 - 35 years with moderate gingivitis was selected from the Department of Periodontics, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore. Informed consent was obtained from all participants.

 

 

Inclusion criteria:

·       Subject with a minimum complement of 20 teeth.

·       Subject with Gingival Index score of 1.1-2.0 (Moderate Gingivitis)

·       Subject with a written informed consent form only.

 

Exclusion criteria:

·       Presence of any other systemic disease.

·       History of Tobacco chewing or smoking.

·       Pregnant or lactating mother.

·       Use of medication like NSAIDS, antibiotics or any drug known to influence periodontal tissues in the past 6 months.

·       Any habit present (smokers/pan chewers)

·       Subjects who are allergic to curd

 

Screening  examination:

·       Gingival Index (Loe and Silness) was recorded.

·       pH and buffering capacity of the saliva was determined using GC saliva buffer kit before and after probiotic intake.

 

Determination of Buffering capacity and Salivary pH

Saliva Collection:

·       Unstimulated salivary samples were taken from the subjects, between 10 am to 12 am, minimum 1 hour after breakfast.

·       Buffering capacity of the saliva along with salivary pH was assessed using Saliva check buffer TM kit.

 

Assessment of the pH:

Salivary pH was measured by dipping the pH strip in the salivary sample collected. After 10 seconds the colour of the strip was checked and compared with the testing chart provided by the manufacturer. Baseline value was measured during the screening and then after 14 days of probiotic intake the pH was re-evaluated. (Fig1)

 

Fig 1: pH testing Chart

 

Assessment of Buffering Capacity:

The buffering capacity of the saliva was assessed before and after probiotic intake by using a buffer test strip. One drop of saliva was dropped on the test pad using a pipette, then the strip was turned 90 degree to soak up the excess saliva on the absorbent paper. This prevented the swelling up of the test pad by excess saliva which would have affected the results. (Fig 2)

Colour indications were as follows:

Green = 4 points  

 

Buffering Ability

Green/ Blue = 3 points

Blue = 2 points

Blue/ Red = 1 point

Red = 0 points

 

Fig 2: Buffering Ability   

 

Probiotic Intake:   

The participants were given 110 g of probiotic yogurt supplemented with Lactobacillus Acidophilus and Bifidobacterium Lactis daily for a period of 14 days. Each participant was instructed to have the yogurt between breakfast and lunch time and not to eat or brush for at least 1 hour after yogurt consumption. ⁸

 

Statistical Analysis:

Sample size calculation is based on 5% level of significance,80%power and effect size of 1. Total sample size required is 10 using G*power sample size software. Data will be analysed using Paired T test or Wilcoxon sign rank test.

 

RESULTS:

This study shows, there was significant improvement in gingival health after 14 days consumption of probiotic yogurt. However, there was no significant difference between gingival index, buffering capacity and pH before and after probiotic consumption.

 

According to paired T- test there is no significant difference in gingival index before and after probiotic consumption in moderate gingivitis patients. The p value is 0.168. (Table-1)

 

The pH before and after probiotic consumption calculated according to paired T-test shows no significant difference in pH before and after with a p value of 0.168. (Table-2)

 

 

Gingival Index-Paired T-Test (Table-1)

	N	Mean	Std. Deviation	t	P	Lower	Upper
GI before	10	1.30	.483	1.500	0.168	-.102	.502
GI after	10	1.10	.316		Ns

 

pH-Paired T-Test (Table-2)

	N	Mean	Std. Deviation	t	P	Lower	Upper
PH before	10	6.60	.516	-1.500	0.168	-.502	.102
PH after	10	6.80	.632		Ns

 

Crosstabs McNemar chi- square test (Table-3)

Buffering capacity  before * Buffering capacity after Cross tabulation
			BC after		Total
			High	Low
BC before	High	Count	1	0	1
		% of Total	10.0%	0.0%	10.0%
	Low	Count	0	9	9
		% of Total	0.0%	90.0%	90.0%
Total		Count	1	9	10
		% of Total	10.0%	90.0%	100.0%

P =1 According to McNemar Chi-square test, there is no significant difference in buffering capacity before and after (P=1) probiotic yogurt consumption.

 

DISCUSSION:

Various studies have shown the effects of probiotics on general and oral health. In our study we used gingival index, assessment of salivary pH and buffering capacity before and after probiotic consumption for the evaluation of oral health.

 

In this study we have focused on the effects of probiotic yogurt on buffering capacity, salivary pH and gingival health. The results obtained showed that there is difference in gingival index score before and after probiotic consumption however the values weren’t statistically significant (Table-1). The results are similar to a study conducted by R. Muthu Karuppaiah et al which demonstrated statistically insignificant reduction in gingival inflammation by probiotics.¹¹

 

This study also shows a comparison of pH before and after consumption of probiotic yogurt for a period of 14 days (Table-2). Though, there was slight increase in the pH after the probiotic consumption, the results obtained doesn’t show statistically significant difference in the pH before and after probiotic consumption. The result is similar to the study conducted by Kamalaksharappa et al which demonstrated statistically insignificant difference in pH with probiotic supplementation.¹²

 

This study shows a comparison of buffering capacity, before and after probiotic consumption after a period of 14 days (Table-3) shows that there is no significant difference in buffering capacity before and after probiotic consumption.

 

This study shows that there was significant improvement of gingival health after consumption of probiotic yogurt for a period of 14 days. However, there is no significant difference between pH, gingival index and buffering capacity before and after probiotic yogurt consumption was observed.

 

CONCLUSION:

The interest in oral probiotics and its effect on health has been evolving since the past few decades. In this study, there was significant improvement in gingival health after probiotic yogurt consumption for a period of 14 days. But then, there is no statistically significant difference in buffering capacity, salivary pH and gingival index before and after probiotic consumption.

 

Various health benefits of probiotics are well documented¹⁴. Even though the effect of probiotics on oral health is not well understood, the use of probiotics should not be restricted for this reason.

 

AUTHOR CONTRIBUTION:

Research, Investigation (Anju Chandran, Amitha Ramesh), Conceptualization (Anju Chandran, Amitha Ramesh), Writing (Raksha Potdar, Sudhir Varma) Resources (Prabhu Natarajan, Mohammed Amjed Alsaegh)

 

FUNDING:

This research was funded by NITTE Deemed to be University Grant number NUSR218-112.

 

INFORMED CONSENT STATEMENT: 

Informed Consent was obtained from all the participants for the research as well as for its publication.

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

 

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Accepted on 30.08.2021           © RJPT All right reserved

Research J. Pharm. and Tech 2023; 16(1):241-244.