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

Background

The 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.

Methods

In this double‐blind, randomized, phase II clinical trial, 45 patients (35 ± 15 years old, 66% female) with oral halitosis and tongue coating were allocated to three treatment groups (n = 15) using gums of oral dissolution (1 gum every 12 hours) for 10 days. Each gum contained LS (1 billion colony forming units – CFU) + inulin (1g), LS (1 billion CFU) or placebo. Primary outcomes were organoleptic test, Halimeter and tongue coating, whereas secondary outcomes were quality of life and treatment safety. Generalized linear models were employed, adjusting for age and gender. In vitro tests were performed to verify whether LS interacts with inulin and whether LS inhibits the growth of Porphyromonas gingivalis and Prevotella intermedia.

Results

Forty‐four patients (97%) completed the study. Patients treated with LS+inulin showed greater reduction in halitosis measured by Halimeter compared to placebo (adjusted post‐intervention average: 96.7 vs. 142.5 ppb; p = 0.003), whereas LS and placebo did not differ (115.7 vs. 142.5 ppb; p = 0.097). Organoleptic measurements and coating index showed a similar decrease for all groups. Quality of life improved in patients treated with LS+inulin compared to placebo (p = 0.029). Side effects were mild and transient in all groups. LS did not metabolize inulin but inhibited the growth of Porphyromonas gingivalis and Prevotella intermedia after 72 hours.

Conclusions

Treatment with Lactobacillus 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. ClinicalTrials.gov Identifier: NCT02794766.

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https://aap.onlinelibrary.wiley.com/doi/abs/10.1002/JPER.19-0089?af=R