Oral probiotics: a useful adjunct in the management of halitosis : a pilot study

Aim. Probiotics have been proposed as useful adjuncts in the management of halitosis and the results of studies investigating their use have been equivocal; probiotics are not universally accepted as a proven method to control oral malodor. The aim of this pilot study was to evaluate the modifications of the organoleptic quality of morning breath and the concentrations of oral VSC following the oral treatment with lozenges of Lactobacillus reuteri DSM 17938 in a cohort of bad breath patients. Methods. Patients were recruited among those referred for bad breath treatment to the Unit of Oral Hygiene and Prevention of the Dental Clinic; they were investigated for systemic diseases and examined to rule out periodontitis and other oral diseases and conditions. The following clinical features and indexes were recorded at baseline: dental conditions, plaque index, PSR, tongue coating index, subjective evaluation of the quality of the breath using a reference VAS (Visual Analogue Scale) with indices ranging from 0 to 10 (0 worst breath, acceptable 6, 10 good), breath organoleptic score and measurement of the concentration of oral VSC through the use of Interscan Halimeter®. For statistic purposes, the continuous VSC data were recoded as a discrete VSC score ranging from 0 to 3 in relation to the measured ppb value. After professional oral hygiene instructions, the patients were informed and randomly divided into two groups: group A underwent professional scaling and prescription of probiotic lozenges containing 108 CFU of Lactobacillus reuteri DSM17938; they were instructed to dissolve in the mouth one lozenge per day for seven days following the evening oral hygiene practice. Patients of the B group were prescribed the same course of probiotics lozenges without the professional hygienic phase. On the eighth day, the patients were re-examined recording PRS, plaque index, tongue coating and re-evaluated for subjective and organoleptic bad breath and VSC concentration. Results. 28 patients were recruited and investigated, aged between 18 and 61 (mean age 36.6 yrs), 14 females and 14 males. Patients in group A and group B showed similar values in the oral conditions and indexes recorded at baseline. Both groups showed reduction of bad breath parameters after the treatment; the mean reduction of relevant parameters i.e. subjective, organoleptic and VSC score were higher in the treatment group A - professional oral hygiene plus probiotic lozenges. Conclusion. The administration of the probiotic Lactobacillus reuteri as a mouth dissolving lozenge showed to be useful to decrease the subjective and objective levels of oral malodor. Further studies are needed to provide definitive data supporting the effectiveness of probiotics in the treatment of halitosis.