Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial. Oral probiotics reduce halitosis in patients wearing orthodontic braces: a randomized, triple-blind, placebo-controlled trial. Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It? Probiotics and prebiotics in gastrointestinal disorders Mixed treatment comparison analysis provides internally coherent treatment effect estimates based on overviews of reviews and can reveal inconsistency. The politics of probiotics: probiotics, necrotizing enterocolitis and the ethics of neonatal research Probiotics in Treatment of Allergic Rhinitis INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions
OBJECTIVE The objective of this study was to evaluate whether oral administration of lactobacilli alters the degree of halitosis and clinical conditions associated with halitosis . STUDY DESIGN Twenty patients with genuine halitosis were given 2.0 x 10(9)Lactobacillus salivarius WB21 and xylitol in tablet form daily .  Oral malodor and clinical parameters were evaluated at the same time of day for each patient after 2 and 4 weeks . RESULTS All 20 patients were positive for L. salivarius DNA in their saliva at 2 weeks , although 12 patients were negative for this organism at baseline . Oral malodor parameters significantly decreased at 2 weeks in the subjects with physiologic halitosis . The scores of an organoleptic test and bleeding on probing significantly decreased at 4 weeks in the subjects with oral pathologic halitosis . CONCLUSIONS Oral administration of probiotic lactobacilli primarily improved physiologic halitosis and also showed beneficial effects on bleeding on probing from the periodontal pocket PURPOSE The aim of this study was to examine the effect of chlorhexidine disinfection , as a chemical method of oral hygiene practice , and subsequent use of probiotics on  halitosis in children . The effects of mechanical and chemical oral hygiene practice methods on the severity of halitosis were also assessed . MATERIAL S AND METHODS 208 children with organoleptic test ( OLT ) scores of 2 or more were r and omly assigned to four groups : A : conventional oral hygiene practice s ( COH ) including toothbrushing and flossing ; B : COH + tongue scraping ( TS ) ; C : COH + TS + chlorhexidine ; D : COH + TS + chlorhexidine + probiotics . OLT was performed at 1-week and 3-month follow-ups . RESULTS A significant and stable number of participants showed major and moderate levels of improvement in OLT scores in group D ( p < 0.001 ) . The improvement of OLT scores in group C was also significant ( p < 0.001 ) , but not stable over the follow-ups ( p = 0.44 ) . Neither significant nor stable improvements in the OLT scores were detected in groups A and B through follow-ups ( p > 0.05 ) . CONCLUSION Probiotic therapy following oral disinfection with chlorhexidine may reduce the severity of halitosis over longer periods Orthodontic braces can impede oral hygiene and promote halitosis . The aim of the study was to investigate the effect of the oral probiotic Streptococcus salivarius M18 on oral hygiene indices and halitosis in patients wearing orthodontic braces . The study was a prospect i ve , r and omized , triple-blind , placebo-controlled trial . Patients undergoing fixed orthodontic treatment were r and omly allocated to a probiotic group  ( n = 32 ) and a placebo group ( n = 32 ) . Patients consumed 2 lozenges d-1 for one month . Assessment s were taken at baseline , at the end of the intervention , and at a 3 month follow-up . The outcome measures were plaque index ( PI ) , gingival index ( GI ) and halitosis-causing volatile sulfur compound ( VSC ) levels . The dental biofilms before and after the intervention were analyzed utilizing next-generation sequencing of bacterial 16S rRNA genes . PI and GI scores were not significantly influenced by the probiotic intervention ( intervention × time : p > 0.05 ) . The level of VSCs decreased significantly in both the probiotic group ( VSC reduction = -8.5 % , 95%CI = -7.4 % to -9.1 % , p = 0.015 ) and the placebo group ( -6.5 % , 95%CI = -6.0 % to -7.4 % , p = 0.039 ) after 1 month intervention . However , at the 3 month follow-up , the VSC levels in the placebo group returned to baseline levels whereas those in the probiotic group decreased further ( -10.8 % , 95%CI = -10.5 % to -12.9 % , p = 0.005 ) . Time , but not treatment , was associated with the decrease in microbial community alpha diversity and a modest effect on beta diversity . Oral probiotic S. salivarius M18 reduced the level of halitosis in patients with orthodontic braces , but had minimal effects on PI , GI and dental biofilm microflora Objective : Periodontitis is known to have multifactorial etiology , involving interplay between environmental , host and microbial factors . The current treatment approaches are aim ed at reducing the pathogenic microorganisms . Administration of beneficial bacteria ( probiotics ) has emerged as a promising concept in the prevention and treatment of periodontitis . Thus , the aim of the present study is to evaluate the efficacy of the local use of probiotics as an adjunct to scaling and root planing ( SRP ) in the treatment of patients with chronic periodontitis and halitosis . Methods : This is a r and omized , placebo-controlled , double-blinded trial involving 32 systemically healthy chronic periodontitis patients . After SRP , the subjects were r and omly assigned into the test and control groups . Test group ( SRP + probiotics ) received subgingival delivery of probiotics and probiotic mouthwash , and control group ( SRP + placebo ) received subgingival delivery of placebo and placebo mouthwash for 15 days . Plaque index ( PI ) , modified gingival index ( MGI ) , and bleeding index ( BI ) were assessed at baseline , 1 and 3 months thereafter , whereas probing depth ( PD ) and clinical attachment level were assessed at baseline and after 3 months . Microbial assessment using N-benzoyl-DL-arginine-naphthylamide ( BANA ) and halitosis assessment using organoleptic scores ( ORG ) was done at baseline , 1 and 3 months . Findings : All the clinical and microbiological parameters were significantly reduced in both groups at the end of the study . Inter-group comparison of PD reduction ( PDR ) and clinical attachment gain ( CAG ) revealed no statistical significance except for PDR in moderate pockets for the test group . Test group has shown statistically significant improvement in PI , MGI , and BI at 3 months compared to control group . Inter-group comparison revealed a significant reduction in BANA in test group at 1 month . ORG were significantly reduced in test group when compared to control group . Conclusion : Within the limitations of the study , the present investigation showed that the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction in moderate pockets and reduced oral malodor parameters Background / Aims Despite numerous r and omized clinical trials and meta-analyses , there is no increased evidence for the efficacy of  probiotics  in the treatment of irritable bowel syndrome ( IBS ) . We review this evidence , identify and analyse the reasons for this lack of evidence and propose method ological improvements for future studies . Methods Based on a literature search , we identified 56 papers that matched the purpose of our analyses . Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics . They were analysed regarding  patients included , treatment duration , probiotic dosage , and outcome measures . Results Trials in both groups suffered from heterogeneity with respect to probiotic concentration , duration of treatment , and other method ological issues ( crossover design and underpowered studies ) . This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead . Multi-strain preparations combined 2 to 8 different bacterial subspecies , mostly lactobacilli or bifidobacteria , and used variable lengths of treatments . Overall , more than 50 % of trials presented negative outcomes . The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative , whereas trials employing bifidobacteria showed positive results . Conclusions The heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses . The use of different bacterial strains and different mixtures of these strains , as well as different dosages , are the main contributors to this heterogeneity . Current data provides limited evidence for the efficacy of a small number of  single-strain probiotics  in IBS ( mostly bifidobacteria ) and sound studies following strict trial guidelines ( Food and Drug Administration and European Medicines Agency guidelines for clinical trials ) are needed . We summarised and proposed some method ological issues for future studies in the field Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium OBJECTIVES To propose methods for mixed treatment comparisons ( MTC ) based on pooled summaries of the type produced in overviews of review s. STUDY DESIGN AND SETTING Overviews of review s ( umbrella review s ) summarize the results of multiple systematic review s into a single document . They report the summary estimates from the original pairwise meta-analyses and discuss them in narrative form , with the intention of identifying the most effective treatment . We present methods for MTC synthesis , tailored for use with overviews of review s. These generate a single internally consistent summary of all the relative treatment effects and assessment s of whether the summary is consistent with the data . These methods are applied to a published overview of treatments for childhood nocturnal enuresis . We apply the methods to both fixed-effect ( FE ) and r and om-effects ( RE ) meta-analyses of the original trials . RESULTS The summary relative risks based on FE meta-analyses , as originally published , were highly inconsistent . Those based on RE meta-analyses were consistent and could , given st and ard assumptions on comparability of treatment effects in meta- analysis , form a basis for coherent decision making . CONCLUSION Along with the summaries from systematic review s , MTC methods should be used in overviews to provide a single coherent analysis of all treatment comparisons and to check for evidence consistency There have been over twenty prospect i ve , r and omized trials of the use of probiotics to prevent  necrotizing enterocolitis ( NEC ) in premature babies . A Cochrane meta- analysis of 16 of the studies ( 1 ) including 2842 preterm infants , reported that ‘ enteral probiotics supplementation significantly reduced the incidence of severe NEC ( stage II or more ) ( typical RR , 0.35 ; 95 % CI , 0.24–0.52 ) and mortality ( typical RR , 0.40 ; 95 % CI , 0.27–0.60 ) with no evidence of harm . They concluded , ‘ Enteral supplementation of probiotics prevents severe NEC and all-cause mortality in preterm infants ’ . In a sensitivity analysis , including only the 4 highest quality studies , the results and conclusions were unchanged . For neonates born at < 32 weeks of gestation , the number needed to treat in order to prevent one NEC or one death is twenty . The risks of probiotics are minimal . A more recently published systematic review included several additional r and omized controlled trials , mostly published in the Chinese literature , and analysed a total of 20 publications and over 3800 preterm infants ; it came to similar conclusions as the Cochrane meta- analysis ( 2 ) . Probiotics are used in many European units but only rarely in North-America . In spite of the evidence , this safe and effective treatment for one of the most serious complications of prematurity has never been studied in the United States and perhaps never will . Probiotics will probably never be approved by the U.S. Food and Drug Administration ( FDA ) . Instead , they will remain in regulatory purgatory , neither approved nor unapproved , an evidence -based treatment that can not become the st and ard of care , a safe and effective treatment that is not on hospital formularies in the United States . Probiotics fall into a peculiar lacuna of the regulatory system . Most innovative treatments are either drugs or devices , and the regulatory pathways for evaluating and approving them are fairly well defined by federal law . The FDA has jurisdiction over both drugs and devices . Probiotics are neither drugs nor devices , and they are made by companies that generally market health products to the general public . In contrast , in Canada , probiotics are under the jurisdiction of the Natural Health Products Directorate ( NHPD ) which has rigorous requirements for quality control and detailed labelling . But the NHPD does not evaluate overtly medical cl aims made about a product . It has little experience dealing with either a product that could actually decrease major complications or save lives in a particularly fragile population where mortality is rather common . Probiotics are quite inexpensive to manufacture . People can even make them at home . They are in most yogurts . For pennies , some parents buy them for their preterm infants in health food stores . Some mothers have started adding probiotics to their breast milk . In these cases , the medical team can either be unaware a preterm infant is in fact receiving probiotics or tacitly not interfere with these parental initiatives . Given the low cost of probiotics and Articles in the series A Different View are edited by William Meadow ( wlm1@uchicago.edu ) . We encourage you to offer your own different view either in response to A Different View you do not fully agree with , or on an unrelated topic . Send your article to Dr. Meadow ( wlm1@uchicago.edu ) Many r and omized controlled trials ( RCTs ) have been done on role of probiotics as a treatment modality in allergic rhinitis . We conducted a review on the same . A systematic search of published literature was done . RCTs comparing effect of probiotics with placebo were included . A predefined set of outcome measures were assessed . Continuous data were expressed as pooled st and ardized mean difference ( SMD ) with 95 % confidence interval ( CI ) . Dichotomous data were expressed as odds ratio with 95 % CI . P value < 0.05 was considered significant . RevMan version 5 was used for all the analyses . Seven RCTs were eligible for inclusion .  Probiotic intake  improved quality of life score in patients with allergic rhinitis [ SMD -1.17 ( 95 % CI -1.47 , -0.86 ; P < 0.00001 ) ] . Other parameter that improved with probiotic intake was decrease in the number of episodes of rhinitis per year . There was no significant change in blood or immunologic parameters in the probiotic group , SMD -0.10 ( 95 % CI -0.26 , 0.06 ; P = 0.22 ) . Adverse events were not significant . Probiotic therapy might be useful in rhinitis , but the present data do not allow any treatment recommendations & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy
Current evidence is supportive of recommending probiotics for the management of halitosis .
Based on this review , transient ( average of 2 weeks ) dosing with probiotics ( mainly Lactobacillus strains ) has a moderate effect on halitosis regarding OLT scores , but we could not confirm the effects of probiotics on the VSC reduction .
Although several studies have evaluated the inhibitory effect of  probiotics  on  halitosis  , findings are inconsistent .
This systematic review and meta- analysis of r and omized clinical trials ( RCT ) was conducted to summarize the evidence on the effect of  probiotics on halitosis .