Are Lactobacillus salivarius G60 and inulin more efficacious to treat patients with oral halitosis and tongue coating than the probiotic alone and placebo? A randomized clinical trial

Abstract

BackgroundThe combination of probiotics and prebiotics might be useful to treat oral halitosis. The aim of this study was to assess the effect of Lactobacillus salivarius G60 (LS) and inulin on oral halitosis and tongue coating.MethodsIn this double‐masked, randomized, phase II clinical trial, 45 patients (aged 35 ± 15 years, 66% female) with oral halitosis and tongue coating were allocated to three treatment groups (n = 15) using gums of oral dissolution (one gum every 12 hours) for 10 days. Each gum contained LS (1 billion colony forming units [CFUs]) + inulin (1 g), LS (1 billion CFU) or placebo. Primary outcomes were organoleptic test, Halimeter, and tongue coating, whereas secondary outcomes were quality of life (QOL) and treatment safety. Generalized linear models were used, adjusting for age and sex. In vitro tests were performed to verify whether LS interacts with inulin and whether LS inhibits the growth of Porphyromonas gingivalis and Prevotella intermedia.ResultsForty‐four patients (97%) completed the study. Patients treated with LS + inulin showed greater reduction in halitosis measured by Halimeter compared with placebo (adjusted post‐intervention average: 96.7 versus 142.5 ppb; P = 0.003), whereas LS and placebo did not differ (115.7 versus 142.5 ppb; P = 0.097). Organoleptic measurements and coating index showed a similar decrease for all groups. QOL improved in patients treated with LS + inulin compared with placebo (P = 0.029). Side effects were mild and transient in all groups. LS did not metabolize inulin but inhibited the growth of P. gingivalis and P. intermedia after 72 hours.ConclusionsTreatment with L. salivarius G60 combined or not with inulin showed significant decrease in the outcomes organoleptic test, Halimeter, and coating index, improving oral halitosis. However, no significant difference was obtained between the groups.

Influence of Lactobacillus reuteri, Bifidobacterium animalis subsp. lactis, and prebiotic inulin on dysbiotic dental biofilm composition ex vivo

“…In a randomized controlled trial, Mousquer et al. used a combination of inulin and Lactobaciullus salivarius for the treatment of halitosis 50 . This combination resulted in a significant decrease in oral malodor compared with placebo suggesting a modification of the microbiome, although microbiological analysis was limited in this study 50 .…”

“…used a combination of inulin and Lactobaciullus salivarius for the treatment of halitosis 50 . This combination resulted in a significant decrease in oral malodor compared with placebo suggesting a modification of the microbiome, although microbiological analysis was limited in this study 50 . No prior study has evaluated the effect of inulin in combination with a probiotic strain in the treatment of periodontitis or maintenance of periodontal health.…”

Efficacy of probiotics in the management of halitosis: a systematic review and meta-analysis

“… 42 65 However, in an original article the TCS and PI showed a pronounced decline after using probiotics compared with the baseline, with no decrease in the placebo group. 61 This phenomenon might be related to the type of probiotics, some of which were reported to boost salivary flow by interacting with the oral microbiota. 66 …”

“…42 65 However, in an original article the TCS and PI showed a pronounced decline after using probiotics compared with the baseline, with no decrease in the placebo group. 61 This phenomenon might be related to the type of probiotics, some of which were reported to boost salivary flow by interacting with the oral microbiota. 66 From the current studies, there are two main types of studies on the effect of probiotics on halitosis: one is to observe the effect during continuous use of probiotics and the other is to observe the effect at follow-up after stopping the use of probiotics.…”

Pathophysiology and Management of Tongue Involvement in COVID-19 Patients

“…Moreover, the yellow discoloration of the tongue can be attributed to fever and infection, which is correlated with lung damage severity [ 38 ]. Furthermore, the tongue’s greasy coatings may indicate either damage to the free oxygen radicals scavenger system or dysbiosis, which latter is a decrease in the levels of Lactobacillus and Bifidobacterium [ 39 ]. Besides, the tongue’s tenderness reflects organ failure within the context of a systemic disease, such as COVID-19 [ 40 ].…”