The efficacy of lactic acid bacteria-based toothpaste on oral health: a systematic review and meta-analysis.

2025-10-20
Frontiers in oral health 6
- Eun-Mi Choi
- Su-Kyung Park

PubMed: 41190323
DOI: 10.3389/froh.2025.1668943

Study Design

Type: Systematic Review
Population: Twelve RCTs
Methods: Following PRISMA guidelines, five databases (MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL) were searched through February 2025. Randomized controlled trials (RCTs) evaluating toothpastes containing probiotic, prebiotic, synbiotic, or postbiotic agents were included. Risk of bias was evaluated using the RoB 2 tool.

Introduction

Lactic acid bacteria (LAB) have emerged as promising adjunctive agents for oral health management due to their antimicrobial and immunomodulatory properties. With the increasing incorporation of probiotics into oral care products, it is critical to evaluate their clinical efficacy. This systematic review and meta-analysis aimed to assess the effectiveness of LAB-based toothpaste in improving oral health outcomes.

Methods

Following PRISMA guidelines, five databases (MEDLINE, EMBASE, Scopus, Web of Science, and CENTRAL) were searched through February 2025. Randomized controlled trials (RCTs) evaluating toothpastes containing probiotic, prebiotic, synbiotic, or postbiotic agents were included. Primary outcomes included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Secondary outcomes assessed oral microbiota changes. Risk of bias was evaluated using the RoB 2 tool.

Results

Twelve RCTs were included, with four studies suitable for meta-analysis. Meta-analysis demonstrated significant plaque reduction at 3 months [Mean Difference (MD) = -0.64; 95% confidence interval (CI): -1.14 to -0.15; p = 0.01] and BOP improvement (MD = -1.49; 95% CI: -2.42 to -0.56; p = 0.002). Longer interventions (≥6 months) in periodontitis patients revealed significant PPD reduction (MD = -1.32; 95% CI: -1.81 to -0.84; p < 0.00001) and CAL improvement (MD = -0.79; 95% CI: -1.25 to -0.33; p = 0.0007). Streptococcus mutans levels were significantly reduced across multiple studies.

Conclusions

LAB-based toothpaste demonstrates beneficial effects on plaque control and gingival inflammation. However, substantial heterogeneity (I² > 75% for most outcomes) limits effect estimate precision. Lactobacillus paracasei strains showed consistent benefits, while sustained use (≥6 months) appears necessary for periodontal improvements.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420250650340, PROSPERO CRD420250650340.

Research Insights

Supplement	Dose	Health Outcome	Effect Type	Effect Size	Source
Bifidobacterium animalis BS-01	—	Improved Clinical Attachment	Beneficial	Small	View source and CAL improvement (MD = -0.79; 95% CI: -1.25 to -0.33; p = 0.0007).
Bifidobacterium animalis BS-01	—	Improved Plaque Index	Beneficial	Moderate	View source Meta-analysis demonstrated significant plaque reduction at 3 months [Mean Difference (MD) = -0.64; 95% confidence interval (CI): -1.14 to -0.15; p = 0.01]
Bifidobacterium animalis BS-01	—	Reduced Gingival Bleeding	Beneficial	Moderate	View source Meta-analysis demonstrated ... BOP improvement (MD = -1.49; 95% CI: -2.42 to -0.56; p = 0.002).
Bifidobacterium animalis BS-01	—	Reduced Probing Pocket Depth	Beneficial	Moderate	View source Longer interventions (≥6 months) in periodontitis patients revealed significant PPD reduction (MD = -1.32; 95% CI: -1.81 to -0.84; p < 0.00001)
Bifidobacterium animalis BS-01	—	Reduced Streptococcus Mutans Levels	Beneficial	Small	View source Streptococcus mutans levels were significantly reduced across multiple studies.