Journal of Indian Society of Periodontology
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SHORT COMMUNICATION
Year : 2017  |  Volume : 21  |  Issue : 4  |  Page : 341-343  

Long-term effect of Lactobacillus brevis CD2 (Inersan®) and/or doxycycline in aggressive periodontitis


1 Department of Periodontology, Narsinhbhai Patel Dental College, Visnagar, Gujarat, India
2 JSS Dental College, Mysore, Karnataka, India

Date of Submission12-Sep-2017
Date of Acceptance01-Nov-2017
Date of Web Publication29-Jan-2018

Correspondence Address:
Dr. Mishal Piyush Shah
B/29, Utsav Bungalows, Mehsana, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisp.jisp_215_17

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   Abstract 

Context: The over usage and broad use of antibiotics resulted in the emergence of resistant microorganisms to the drugs which also disturb the indigenous microflora, which include the Lactobacillus in the oral cavity. Hence, it is preferred to avoid the use of antibiotics. Aims: The hypothesis tested in this study was that 14 days of treatment with Lactobacillus brevis CD2 lozenges, L. brevis CD2 with oral doxycycline, or doxycycline alone would have a beneficial effect on periodontal health after 5 months. Settings and Design: It was a randomized clinical trial. Materials and Methods: Eighteen nonsmoking patients aged 14–35 years, with aggressive periodontitis, were randomized to receive 14 days of treatment with L. brevis CD2 lozenges (two lozenges daily), L. brevis CD2 lozenges with oral doxycycline (100 mg tablet once daily), or doxycycline alone. Saliva samples were taken on day 0, 2 weeks, 2 months, and 5 months. Clinical parameters (plaque index, gingival index, probing pocket depth, and clinical attachment level) and microbiological parameters (lactobacilli and Aggregatibacter actinomycetemcomitans) were evaluated. Statistical Analysis Used: Changes between groups were evaluated using repeated measure analysis of variance. Results: All clinical parameters shown to be numerically improved at 5 months when compared with baseline in all the three groups. The improvement (P < 0.01) in gingival index was statistically significant, and the intergroup results were also statistically significant (P < 0.01). Conclusions: Fourteen days of treatment with lozenges having L. brevis CD2 have a lasting effect on clinical measures of aggressive periodontitis, particularly gingival index. This effect appears to be equivalent to that produced by doxycycline.

Keywords: Aggregatibacter actinomycetemcomitans, aggressive periodontitis, doxycycline, lactobacilli, probiotic


How to cite this article:
Shah MP, Gujjari SK, Chandrasekhar VS. Long-term effect of Lactobacillus brevis CD2 (Inersan®) and/or doxycycline in aggressive periodontitis. J Indian Soc Periodontol 2017;21:341-3

How to cite this URL:
Shah MP, Gujjari SK, Chandrasekhar VS. Long-term effect of Lactobacillus brevis CD2 (Inersan®) and/or doxycycline in aggressive periodontitis. J Indian Soc Periodontol [serial online] 2017 [cited 2019 Oct 14];21:341-3. Available from: http://www.jisponline.com/text.asp?2017/21/4/341/223048


   Introduction Top


Lactobacillus brevis CD2 has shown to be effective in the prevention and treatment of carious lesions and gingival–periodontal lesions.[1],[2],[3],[4]

Shah [4] demonstrated that 14 days of treatment with L. brevis CD2 lozenges, L. brevis CD2 with oral doxycycline, or doxycycline alone were all associated with statistically significant improvements in clinical measures at 2 months. Concentrations of Aggregatibacter actinomycetemcomitans fell sharply in all groups [4] and remained very low after 2 weeks, and the probiotic groups also showed persistently increased lactobacilli concentration. L. brevis CD2 is thought to suppress the inflammatory process through the expression of arginine deiminase.[3]

The hypothesis tested in this study was that 14 days of treatment with L. brevis CD2 lozenges, L. brevis CD2 with oral doxycycline, or doxycycline alone would have a beneficial effect on periodontal health after 5 months.


   Materials and Methods Top


The study design was a randomized clinical trial, approved by the Ethical Committee of Institutional Review Board. Informed written consent was obtained from all patients. Methods are described in full by Shah.[4]

The study comprised 18 nonsmoking patients under the age group of 14–35 years, with sites having probing depth and clinical attachment loss ≥5 mm and bone loss to be seen radiographically. Patients were randomized to receive 14 days of treatment with L. brevis CD2 lozenges, L. brevis CD2 lozenges with oral doxycycline (100 mg tablet once daily), or doxycycline alone.[4] The L. brevis CD2 lozenges (Inersan ®, VSL Pharmaceuticals, Inc., Towson, MD, USA) contain 109 colony-forming units per lozenge, sweetening agents such as mannitol, aspartame, and fructose, anticaking agents including talc, silicon dioxide, and magnesium stearate, and having banana flavoring.

Saliva samples were taken on day 0, after which patients underwent scaling and root planing. After 2 weeks, further saliva samples were taken, and study treatment was initiated. The third visit was at 2 months and data were reported previously.[4] We now report the data for a follow-up visit at 5 months.

Clinical parameters (various parameters such as plaque index, gingival index, probing pocket depth, and clinical attachment level) were evaluated at all visits. The samples of saliva were cultured to determine the counts of lactobacilli and A. actinomycetemcomitans. Clinical variables were recorded as mean ± standard deviation. For both bacterial and clinical outcome measures, one-way analysis of variance (ANOVA) was used to compare data from the different groups at each time interval. Changes between groups were evaluated using repeated measure ANOVA.


   Results Top


Clinical parameters at 5 months are shown in [Table 1].
Table 1: Clinical parameters at baseline and 5 months

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All clinical parameters are shown to be numerically improved at 5 months when compared with baseline in all three groups. The improvement (P< 0.01) in gingival index was statistically significant, and the intergroup results were also statistically significant (P< 0.01). The improvements in plaque amount, probing depth, and clinical attachment level did not reach statistical significance and found no significant difference between groups.

There found to be statistically significant difference between mean lactobacilli counts for the three groups at 5 months (P = 0.04). Counts peaked at 2 months in the probiotic groups. The L. brevis CD2 alone group showed the highest peak counts, and counts in this group remained above baseline at 5 months [Figure 1]. Lactobacilli counts in the L. brevis CD2 plus doxycycline group peaked at just under 60% of the levels seen with L. brevis CD2 alone and had returned to baseline at 5 months. Lactobacilli counts were close to 0 at 5 months in the doxycycline alone group. Counts of A. actinomycetemcomitans were minimal from 2 weeks in all groups and were unchanged between the 2- and 5-month visits (data not shown).
Figure 1: Lactobacilli concentration (colony-forming unit/ml). One-way ANOVA was used to compare data in the different groups at each time interval. Changes between groups were evaluated using repeated measure ANOVA

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   Discussion Top


These data confirm that 14 days of treatment with L. brevis CD2 lozenges have a lasting effect on clinical measures of periodontitis, particularly gingival index. This effect appears to be equivalent to that produced by doxycycline. No synergy was observed when the two agents were administered concomitantly. Concentrations of lactobacilli remained elevated 5 months after treatment with L. brevis CD2 alone, but not when L. brevis CD2 was administered with doxycycline. Comparing probiotics with antibiotics, probiotics could be used as an alternative to antibiotics in the treatment of patients with aggressive periodontitis, without the risks of promoting antibiotic resistance and/or disturbing the body microflora.

Acknowledgement

We express our sincere thanks to Mr. Kanwaldeep Chadda, Country Manager, CD Pharma Pvt., Ltd., for providing the Inersan ® lozenges which were needed for the study. We also express our sincere thanks to Dr. Murli and Mr. Sivaram, Defense Food Research Laboratory, for their help during the microbiological analysis. We sincerely thank Dr. Lancy D'Souza for his help with the statistical analysis of the data.

Financial support and sponsorship

This study was funded by CD Pharma Pvt., Ltd.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Vuotto C, Barbanti F, Mastrantonio P, Donelli G. Lactobacillus brevis CD2 inhibits prevotella melaninogenica biofilm. Oral Dis 2014;20:668-74.  Back to cited text no. 1
[PUBMED]    
2.
Campus G, Cocco F, Carta G, Cagetti MG, Simark-Mattson C, Strohmenger L, et al. Effect of a daily dose of Lactobacillus brevis CD2 lozenges in high caries risk schoolchildren. Clin Oral Investig 2014;18:555-61.  Back to cited text no. 2
[PUBMED]    
3.
Ierardo G, Bossù M, Tarantino D, Trinchieri V, Sfasciotti GL, Polimeni A, et al. The arginine-deiminase enzymatic system on gingivitis: Preliminary pediatric study. Ann Stomatol (Roma) 2010;1:8-13.  Back to cited text no. 3
    
4.
Shah MP, Gujjari SK, Chandrasekhar VS. Evaluation of the effect of probiotic (inersan®) alone, combination of probiotic with doxycycline and doxycycline alone on aggressive periodontitis-A clinical and microbiological study. J Clin Diagn Res 2013;7:595-600.  Back to cited text no. 4
[PUBMED]    


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