{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:12:32Z","timestamp":1789035152637,"version":"build-2803163510"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Special Care in Dentistry"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Children with Down Syndrome (DS) are at heightened risk for oral diseases due to their distinct physiological and immune characteristics. Matrix metalloproteinases (MMPs), particularly MMP\u20108 and MMP\u20109, are key mediators of periodontal tissue breakdown. Probiotics may provide a novel, well\u2010tolerated alternative to conventional antiseptics by modulating these biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center, parallel\u2010arm, randomized, single\u2010blind pilot trial compared a sugar\u2010free microencapsulated probiotic oral rinse against a 0.2% chlorhexidine digluconate rinse in children with DS. A total of 118 participants aged 6\u201314 years were enrolled; following attrition after oral rehabilitation, 40 children (20 per group) were allocated to intervention, and 15 participants per group completed all assessments. After individualized oral rehabilitation and oral health education, participants were randomized (1:1). Group 1 received probiotic rinse and Group 2 chlorhexidine rinse, both administered twice daily for two weeks. Primary outcomes were salivary MMP\u20108 and MMP\u20109 levels (enzyme\u2010linked immunosorbent assay). Secondary outcomes were plaque index (PI), gingival index (GI), oral hygiene index\u2013simplified (OHI\u2010S), and bleeding on probing (BOP). Outcomes were assessed at baseline prior to oral rehabilitation (T0), two weeks after completion of oral rehabilitation (T1), two weeks following completion of the rinse protocol (T2), and six months post\u2010rinse (washout period, T3) by blinded examiners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 30 randomized participants completed the trial (15 per group). Both groups showed significant within\u2010group reductions in MMP\u20108, MMP\u20109, PI, GI, OHI\u2010S, and BOP at follow\u2010up (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Between\u2010group comparisons showed no significant differences in MMP levels, PI, GI or OHI\u2010S at any interval. At six months, the probiotic group demonstrated a greater reduction in BOP compared with chlorhexidine (median difference \u20136.0; 95% CI [\u20139.0, \u20133.0];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001). Given the two\u2010week duration of rinsing, this isolated 6\u2010month difference should be interpreted cautiously.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Harms<\/jats:title>\n                    <jats:p>No systemic side effects or gastrointestinal symptoms were reported. Mild tooth staining occurred in two participants in the chlorhexidine group; no adverse effects were reported in the probiotic group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both rinses demonstrated within\u2010group improvements, although no significant between\u2010group differences were observed in the primary biochemical outcomes. The probiotic rinse showed comparable short\u2010term efficacy and better tolerability, but due to underpowering and design limitations, findings remain exploratory. Larger, adequately powered studies are required to determine true clinical effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This study was a registered clinical trial with the Clinical Trials Registry of India (CTRI\/2023\/04\/051447). The trial was prospectively registered, adhering to the WHO standards for clinical trial registration to ensure transparency and integrity in reporting health\u2010related outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/scd.70213","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:36:38Z","timestamp":1784014598000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of a Microencapsulated Sugar\u2010Free Probiotic Oral Rinse on Gingival Health and Salivary Matrix Metalloproteinases 8 and 9 in Children With Down Syndrome: A Pilot Randomized Clinical Trial"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2343-5977","authenticated-orcid":false,"given":"Swagata","family":"Saha","sequence":"first","affiliation":[{"name":"Department of Pedodontics and Preventive Dentistry, Dr. D. Y. Patil Dental College &amp; Hospital Dr. D. Y. Patil Vidyapeeth (Deemed to be University)  Pune Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-6223","authenticated-orcid":false,"given":"Manju Raman","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9677-4144","authenticated-orcid":false,"given":"Kavita","family":"Rai","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8872-860X","authenticated-orcid":false,"given":"Prajna P.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4113-5572","authenticated-orcid":false,"given":"Suchetha Kumari","family":"N.","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, K S Hegde Medical Academy (KSHEMA) NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3268-6743","authenticated-orcid":false,"given":"Prajna","family":"Bhandary","sequence":"additional","affiliation":[{"name":"Central Research Laboratory KSHEMA NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1604-2120","authenticated-orcid":false,"given":"Sharmila","family":"K. P.","sequence":"additional","affiliation":[{"name":"Central Research Laboratory KSHEMA NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4043-9638","authenticated-orcid":false,"given":"Neevan","family":"D'souza","sequence":"additional","affiliation":[{"name":"K S Hegde Medical Academy (KSHEMA) NITTE (Deemed to be University)  Mangaluru Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_2_15_2_1","volume-title":"Oral Health in Down Syndrome. 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