Do Probiotics Affect Oral Health in Patients Under Treatment with Fixed Orthodontic Appliances? A Systematic Review
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As the presence of fixed orthodontic appliances increases biofilm retention, a deterioration in periodontal clinical parameters can be observed and, under certain conditions, a cariogenic environment may develop, leading to enamel decalcification. The aim of the present review was to systematically investigate the available literature regarding the effects of probiotics on gingival inflammation and enamel decalcification development in patients under orthodontic treatment with fixed appliances. Searches without restrictions in eight databases and hand searching were carried out. Randomized controlled studies investigating the effect of probiotics on gingival health and enamel decalcification development in patients under orthodontic treatment with fixed appliances were reviewed. Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed according to the Cochrane Collaboration guidelines. Out of the initially identified unique records, four studies fulfilled the selection criteria for inclusion in the systematic review. Three studies evaluating gingival inflammation after probiotic use for up to one month did not show any statistically significant changes. The only study investigating enamel decalcification for a mean duration of 17 months of probiotic use did not demonstrate differences in the incidence of white spot lesions between the groups at debonding. No adverse effects were reported. Various problems were noted during risk of bias assessment. Overall, short-term probiotic administration does not seem to exert an effect in the development of gingival inflammation and enamel decalcification in patients under treatment with fixed orthodontic appliances. More high-quality studies involving different combinations of probiotic strains and of longer duration of intervention and follow-up are required.