Non-Cochrane · intervention · PM39025745
Efficacy of Probiotic Consumption on Oral Outcomes in Children and/or Adolescents: A Meta-Analysis.
Mayta-Tovalino Frank, Maguiña-Quispe Jorge, Barja-Ore John, et al. · International dental journal · 2024 · PubMed · doi:10.1016/j.identj.2024.06.013
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
11
current version
GRADE rated
6
No studies
0
Included studies
19
linked below
No studies 0 · 0%Ungraded 5 · 45.5%Very low 3 · 27.3%Low 2 · 18.2%Moderate 1 · 9.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and/or adolescents (<18 years) without background systemic disease | 19 RCTs, n=2622: healthy children (n=1378), adolescents (n=27), and children or adolescents (n=182) |
| Intervention | Probiotics, any dose/strain, minimum intake duration 0.2 months | Probiotics by presentation: lozenges (5), milk (9), mouth rinse (2), chewing gum (2), ice cream (1) |
| Comparison | No treatment or placebo | No treatment or placebo; some trials used active controls (chlorhexidine, xylitol, green tea, synbiotic) |
| Outcomes | Primary: number of caries, S. mutans count, S. viridans count, Lactobacillus count (CFU/mL). Secondary: bacterial plaque index, gingival index, salivary pH, bleeding index | Meta-analyzed: number of caries (6 RCTs), S. mutans (11), Lactobacillus (6), plaque index (4), gingival index (3), salivary pH (3). Single-study/narrative: S. viridans (1), bleeding index (1) |
| Study designs | Randomised controlled trials (RCTs) | 19 RCTs (n=2622) |
| Timing | Minimum probiotic intake duration 0.2 months; no restriction on time/period | Follow-up range 0.2 to 108 months |
Search date: March 15, 2023. Databases: Embase; PubMed; Scopus; Web of Science
Questions and results
Probiotics (any strain, dose, or presentation), minimum intake duration 0.2 months vs No treatment or placebo (control)
Population: Children and/or adolescents (<18 years) without background systemic disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gingival index follow-up: mean 3.07 months · Overall (all presentations pooled) Probiotics probably make little to no difference to the gingival index versus control (MD 0.04, 95%CI -0.18 to 0.27; low certainty). Source: Table 2 (GRADE SoF, gingival index row); Results (Figure 3B) · same question in other reviews | MD 0.04 [-0.18, 0.27] | 3 studies · 144 participants | Low Downgraded: risk of bias |
Salivary pH follow-up: mean 1.1 months · Overall (all presentations pooled) Probiotics may make little to no difference to salivary pH versus control (MD -0.12 pH units, 95%CI -0.72 to 0.48; very low certainty). Source: Table 2 (GRADE SoF, salivary pH row); Results (Figure 3C) · same question in other reviews | MD -0.12 [-0.72, 0.48] | 3 studies · 137 participants | Very low Downgraded: risk of bias, inconsistency |
Lactobacillus count (CFU/mL) follow-up: mean 5.2 months · Overall (all presentations pooled) Probiotics may make little to no difference to Lactobacillus count versus control (MD -0.78 CFU/mL, 95%CI -1.65 to 0.09; very low certainty). Source: Table 2 (GRADE SoF, Lactobacillus row); Results (Figure 2C); Abstract · same question in other reviews | MD -0.78 [-1.65, 0.09] | 6 studies · 1143 participants | Very low Downgraded: risk of bias, inconsistency |
Number of dental caries (carious pieces) follow-up: mean 26 months · Overall (all presentations pooled) Probiotics probably make little to no difference to the number of dental caries versus control (MD -0.24 carious pieces, 95%CI -0.72 to 0.23; low certainty). Source: Table 2 (GRADE SoF, dental caries row); Results 'Effect of probiotics on number of caries...' (Figure 2A); Abstract · same question in other reviews | MD -0.24 [-0.72, 0.23] | 6 studies · 1049 participants | Low Downgraded: risk of bias, inconsistency |
Streptococcus mutans count (CFU/mL) follow-up: mean 4.4 months · Overall (all presentations pooled) Probiotics probably reduce Streptococcus mutans count versus control (MD -0.40 CFU/mL, 95%CI -0.57 to -0.24; moderate certainty). Source: Table 2 (GRADE SoF, S. mutans row); Results (Figure 2B); Abstract · same question in other reviews | MD -0.40 [-0.57, -0.24] | 11 studies · 1321 participants | Moderate Downgraded: risk of bias |
Gingival bleeding index 1.5 months · Single study (Borrell 2021); not pooled Only one trial (Borrell 2021) reported the bleeding index, showing slightly more bleeding with probiotics (MD 0.10, 95%CI 0.02 to 0.18); not pooled or GRADE-rated. Source: Results 'Effect of probiotics on the bleeding index'; Table 1 (Borrell 2021, n=27) · same question in other reviews | MD 0.10 [0.02, 0.18] | 1 study · 27 participants | Ungraded |
Bacterial plaque index follow-up: mean 2.3 months · Overall (all presentations pooled) Probiotics may make little to no difference to the bacterial plaque index versus control (MD 0.21, 95%CI -0.55 to 0.96; very low certainty). Source: Table 2 (GRADE SoF, plaque index row); Results (Figure 3A) · same question in other reviews | MD 0.21 [-0.55, 0.96] | 4 studies · 171 participants | Very low Downgraded: risk of bias, inconsistency |
Streptococcus viridans count (CFU/mL) 6 months · Single study (Mishra 2014); not pooled Only one trial (Mishra 2014) reported S. viridans count, showing a higher count with probiotics (MD 0.40 CFU/mL, 95%CI 0.33 to 0.47); not pooled or GRADE-rated. Source: Results 'Effect of probiotics on number of caries, S. mutans, Lactobacillus and S. viridans' (S. viridans sentence); Table 1 (Mishra 2014,… · same question in other reviews | MD 0.40 [0.33, 0.47] | 1 study · 60 participants | Ungraded |
Milk-based probiotic vs No treatment or placebo (control)
Population: Children and/or adolescents (<18 years) without background systemic disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bacterial plaque index Probiotic presentation: milk (vs other presentations; p-interaction=0.01) In a subgroup analysis, milk-based probiotics reduced the bacterial plaque index more than other presentations (MD -0.10, 95%CI -0.20 to -0.00; p-interaction=0.01); not GRADE-rated. Source: Results 'Subgroup analyses'; Supplemental Figure S5 · same question in other reviews | MD -0.10 [-0.20, 0] | NR | Ungraded |
Mouth-rinse probiotic vs No treatment or placebo (control)
Population: Children and/or adolescents (<18 years) without background systemic disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Salivary pH Probiotic presentation: mouth rinse (vs other presentations; p-interaction<0.01) In a subgroup analysis, mouth-rinse probiotics reduced salivary pH (MD -0.40, 95%CI -0.54 to -0.26; p-interaction<0.01); not GRADE-rated. Source: Results 'Subgroup analyses'; Supplemental Figure S7 · same question in other reviews | MD -0.40 [-0.54, -0.26] | NR | Ungraded |
Probiotics (any strain, dose, or presentation), minimum intake duration 0.2 months vs No treatment or placebo (control)
Population: Adolescents (12-18 years) without background systemic disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of dental caries (carious pieces) Population: adolescents (vs children; p-interaction=0.02) In a subgroup analysis, probiotics reduced the number of caries in adolescents (MD -0.60, 95%CI -0.92 to -0.28; p-interaction=0.02); not GRADE-rated. Source: Results 'Subgroup analyses'; Supplemental Figure S8 · same question in other reviews | MD -0.60 [-0.92, -0.28] | NR | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | Yes | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 19
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Alamoudi et al. 2018 Effect of Probiotic Lactobacillus reuteri on Salivary Cariogenic Bacterial Counts among Groups of Preschool Children in Jeddah, Saudi… DOI:10.17796/1053-4625-42.5.2 | this review only | not stated | not extracted yet | not extracted yet |
| Almabadi et al. 2020 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ashwin et al. 2015 Effect of Probiotic Containing Ice-cream on Salivary Mutans Streptococci (SMS) Levels in Children of 6-12 Years of Age: A Randomized… PMID:25859515 | this review only | Streptococcus mutans count (CFU/mL) | not extracted yet | not extracted yet |
| Borrell Garcia et al. 2021 The use of Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 on oral health indexes in a school population: A pilot randomized clinical… PMID:34325540 | this review only | not stated | not extracted yet | not extracted yet |
| Burton et al. 2013 Influence of the probiotic Streptococcus salivarius strain M18 on indices of dental health in children: a randomized double-blind,… DOI:10.1099/jmm.0.056663-0 | this review only | not stated | not extracted yet | not extracted yet |
| Duraisamy et al. 2021 Role of probiotics and synbiotics on inhibiting Streptococcus mutans level in saliva of children: A randomized controlled trial DOI:10.4103/jisppd.jisppd_270_21 | this review only | Streptococcus mutans count (CFU/mL) | not extracted yet | not extracted yet |
| Hasslof et al. 2013 Early Intervention with Probiotic <b><i>Lactobacillus paracasei </i></b>F19 Has No Long-Term Effect on Caries… DOI:10.1159/000350524 | this review only | Number of dental caries (carious pieces) | not extracted yet | not extracted yet |
| Janiani et al. 2012 Comparative evaluation of the antimicrobial effects of probiotic milk and probiotic powder on the salivary Streptococcus mutans counts and… DOI:10.17219/dmp/139731 | this review only | not stated | not extracted yet | not extracted yet |
| Kaur et al. 2018 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Krupa et al. 2022 Antimicrobial efficacy of Xylitol, Probiotic and Chlorhexidine mouth rinses among children and elderly population at high risk for dental… PMID:35968060 | this review only | Streptococcus mutans count (CFU/mL) | not extracted yet | not extracted yet |
| Manikandan et al. 2020 Effect of Green Tea Extract Mouthrinse and Probiotic Mouthrinse on Salivary pH in a Group of Schoolchildren: An In Vivo Study. PMID:33149495 | this review only | Salivary pH | not extracted yet | not extracted yet |
| Manmontri et al. 2019 Reduction of Streptococcus mutans by probiotic milk: a multicenter randomized controlled trial DOI:10.1007/s00784-019-03095-5 | this review only | not stated | not extracted yet | not extracted yet |
| Mishra et al. 2014 Antimicrobial and plaque inhibitory potential of herbal and probiotic oral rinses in children: A randomized clinical trial DOI:10.4103/0970-9290.142543 | this review only | Streptococcus viridans count (CFU/mL) | not extracted yet | not extracted yet |
| Pahumunto et al. 2018 Reducing mutans streptococci and caries development by<i>Lactobacillus paracasei</i>SD1 in preschool children: a randomized… DOI:10.1080/00016357.2018.1453083 | this review only | Number of dental caries (carious pieces) | not extracted yet | not extracted yet |
| Sakhare et al. 2018 A comparative evaluation of probiotic formulations in prevention of dental caries DOI:10.4103/jisppd.jisppd_236_21 | this review only | Salivary pH | not extracted yet | not extracted yet |
| Staszczyk et al. 2022 Effect of a Short-Term Intervention with Lactobacillus salivarius Probiotic on Early Childhood Caries-An Open Label Randomized Controlled… PMID:36231747 | this review only | Number of dental caries (carious pieces) | not extracted yet | not extracted yet |
| Teanpaisan et al. 2015 Effect of Long-Term Consumption of Lactobacillus paracasei SD1 on Reducing Mutans streptococci and Caries Risk: A Randomized… PMID:29567924 | this review only | Number of dental caries (carious pieces) | not extracted yet | not extracted yet |
| Villavicencio et al. 2018 Effects of a food enriched with probiotics on Streptococcus mutans and Lactobacillus spp. salivary counts in preschool children: a cluster… PMID:29768525 | this review only | not stated | not extracted yet | not extracted yet |
| Wattanarat et al. 2020 Significant elevation of salivary human neutrophil peptides 1-3 levels by probiotic milk in preschool children with severe early childhood… DOI:10.1007/s00784-020-03606-9 | this review only | not stated | not extracted yet | not extracted yet |