The Importance of Limosilactobacillus reuteri in Administration to Diabetics with Gingivitis

Bacteriotherapy of Periodontal Disease with “Friendly” Strains

Diabetic patients are more prone to infections such as periodontal diseases. Gingivitis is a very common complication in diabetics. It is a non-destructive inflammatory disease of periodontal tissues; however, prolonged inflammation can lead to more severe and destructive forms of periodontal inflammatory diseases. It has been proven that the presence of dental plaque plays a crucial role in their development and progression.

However, it is a reversible condition that can be reversed primarily by improving oral hygiene; modifying the oral microbiome can also play a supportive role. Bacteriotherapy with the concept of using a “friendly” bacterial strain to replace pathogenic bacteria has emerged as an interesting option due to the increasing incidence of antibiotic resistance. Probiotics traditionally used in medicine are now also used to try to control and treat periodontal diseases.

Chosen Probiotics

The aim of the study conducted jointly by several university facilities in Italy and Spain was to evaluate whether a specific combination of probiotics (Limosilactobacillus reuteri DSM 17938 and Limosilactobacillus reuteri ATCC PTA 5289) is useful in the occurrence of gingivitis in diabetic patients.

The chosen types of lactobacilli were selected based on their – proven by studies – properties. L. reuteri DSM 17938 produces the natural antimicrobial reuterin. It has been shown that this reduces periodontal pathogens in vivo. Similarly, it has been proven that L. reuteri ATCC PTA 5289 has in vitro anti-inflammatory effects inhibiting the production of tumor necrosis factor-alpha (TNF-α).

Methodology and Course of the Study

The study included 80 adult patients diagnosed with controlled type 2 diabetes and gingivitis. Those who had used antibiotics in the last six months, pregnant women, smokers, patients with dental implants, other systemic diseases, and orthodontically treated individuals were excluded.

The enrolled individuals were randomized into 2 groups – test and control. They did not undergo any professional tooth cleaning but were educated by a specialist on proper oral hygiene practices, including cleaning interdental spaces, and were provided with suitable tools. The test group received bacteriotherapy (L. reuteri).

The presence of plaque (PI) and bleeding on probing (BOP) was measured in participants. A periodontal probe CP15 was used to monitor BOP, while a fluorescein plaque detector was used for PI, with measurements conducted by an experienced dental hygienist. Data were collected at the start of the study and after 30 days.

Results

Group 1 (test group) had an average baseline PI of 35 ± 8 %. After 30 days, a reduction to 12 ± 3 % was observed, indicating a statistically significant decrease (p < 0,005). The average baseline BOP was 52 ± 7 %, after 30 days it was 15 ± 2 %. The result was statistically significant (p < 0,001).

Group 2 had an average baseline PI of 34 ± 6 %, after 30 days it was 26 ± 4 %, indicating a statistically significant decrease (p < 0,005). The average baseline BOP was 51 ± 5 %, after 30 days it was 33 ± 7 %. Here too, a statistically significant decrease was observed (p < 0,005).

It can thus be concluded that a more pronounced reduction in symptoms was present in the test group for both PI and BOP, and the difference between the groups was statistically significant (p < 0,05).

Conclusion

The study demonstrated that merely improving hygiene leads to a significant reduction in manifestations of gingivitis, but the adjunct administration of a probiotic containing L. reuteri strains helps even more significantly in improving gum health. Therefore, the additional therapy with L. reuteri can be considered a suitable option for diabetic patients with gingival inflammation.

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Source: Sabatini S., Lauritano D., Candotto V. et al. Oral probiotics in the management of gingivitis in diabetic patients: a double blinded randomized controlled study. J Biol Regul Homeost Agents 2017; 31 (2; Suppl. 1): 197–202.