{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:42:27Z","timestamp":1791196947560,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Periodontitis is a chronic inflammatory disease characterized by the destruction of periodontal tissues due to biofilm deposits and altered host immune response. Non-surgical periodontal therapy (NSPT) still represents the gold standard for treatment; however, its effectiveness in deep periodontal pockets is limited. Probiotics seem to modulate both oral microbiota and inflammatory response and have been proposed as an adjunctive therapy to NSPT. Methods: An electronic search was conducted on PubMed, Scopus, Medline, and Google Scholar to identify English randomized controlled trials (RCTs) evaluating probiotics as adjunctive treatments to NSPT. Studies were selected based on inclusion and exclusion criteria, and clinical outcomes such as probing depth (PD) and clinical attachment level (CAL) were extracted and analyzed. Results: Seven RCTs met the inclusion criteria. These studies showed significant improvements in PD and CAL when probiotics were used, specifically with Lactobacillus and Bifidobacterium species. However, outcomes ranged depending on the strain, dosage, and delivery method. Conclusions: Probiotics may be used as an adjunct treatment to NSPT; however, further studies are needed to define valid clinical guidelines.<\/jats:p>","DOI":"10.3390\/jcm14145114","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T12:09:53Z","timestamp":1752840593000},"page":"5114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of Probiotics as an Adjunct to Non-Surgical Periodontal Therapy (NSPT): A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4723-3360","authenticated-orcid":false,"given":"Leopoldo","family":"Mauriello","sequence":"first","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6278-5139","authenticated-orcid":false,"given":"Alessandro","family":"Cuozzo","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5116-3270","authenticated-orcid":false,"given":"Vitolante","family":"Pezzella","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Iorio-Siciliano","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4267-6992","authenticated-orcid":false,"given":"Gaetano","family":"Isola","sequence":"additional","affiliation":[{"name":"Unit of Periodontology, Department of General Surgery and Medical-Surgical Specialities, University of Catania, 95124 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3769-9786","authenticated-orcid":false,"given":"Gianrico","family":"Spagnuolo","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"},{"name":"Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1121-121X","authenticated-orcid":false,"given":"Luca","family":"Ramaglia","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4791-8794","authenticated-orcid":false,"given":"Andrea","family":"Blasi","sequence":"additional","affiliation":[{"name":"School of Dental Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/jcpe.13290","article-title":"Treatment of Stage I\u2013III Periodontitis\u2014The EFP S3 Level Clinical Practice Guideline","volume":"47","author":"Sanz","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Belibasakis, G.N., Belstr\u00f8m, D., Eick, S., Gursoy, U.K., Johansson, A., and K\u00f6n\u00f6nen, E. (2023). Periodontal Microbiology and Microbial Etiology of Periodontal Diseases: Historical Concepts and Contemporary Perspectives. Periodontology, early view.","DOI":"10.1111\/prd.12473"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Fernandes, G.V.O., Mosley, G.A., Ross, W., Dagher, A., Martins, B.G.d.S., and Fernandes, J.C.H. (2024). Revisiting Socransky\u2019s Complexes: A Review Suggesting Updated New Bacterial Clusters (GF-MoR Complexes) for Periodontal and Peri-Implant Diseases and Conditions. Microorganisms, 12.","DOI":"10.20944\/preprints202410.1812.v1"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/jcpe.13253","article-title":"Endpoints of Active Periodontal Therapy","volume":"47","author":"Loos","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/j.1600-051X.2008.01245.x","article-title":"Influence of Residual Pockets on Progression of Periodontitis and Tooth Loss: Results after 11 Years of Maintenance","volume":"35","author":"Matuliene","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"371","DOI":"10.17219\/dmp\/192121","article-title":"Revisiting and Rethinking on Staging (Severity and Complexity) Periodontitis from the New Classification System: A Critical Review with Suggestions for Adjustments and a Proposal of a New Flowchart","volume":"62","author":"Fernandes","year":"2025","journal-title":"Dent. Med. Probl."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tomasi, C., Abrahamsson, K.H., and Apatzidou, D. (2023). Subgingival Instrumentation. Periodontology, early view.","DOI":"10.1111\/prd.12485"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/jcpe.13245","article-title":"Subgingival Instrumentation for Treatment of Periodontitis. A Systematic Review","volume":"47","author":"Suvan","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/prd.12240","article-title":"Nonsurgical Therapy for Teeth and Implants\u2014When and Why?","volume":"79","author":"Lang","year":"2019","journal-title":"Periodontol. 2000"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/jcpe.12443","article-title":"Minimally Invasive Non-Surgical Approach for the Treatment of Periodontal Intrabony Defects: A Retrospective Analysis","volume":"42","author":"Nibali","year":"2015","journal-title":"J. Clin. Periodontol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/jcpe.13237","article-title":"Regenerative Surgery versus Access Flap for the Treatment of Intra-Bony Periodontal Defects: A Systematic Review and Meta-Analysis","volume":"47","author":"Nibali","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1111\/jcpe.13984","article-title":"Minimally Invasive Non-Surgical Periodontal Therapy of Intrabony Defects: A Prospective Multi-Centre Cohort Study","volume":"51","author":"Mehta","year":"2024","journal-title":"J. Clin. Periodontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/jre.12221","article-title":"Non-Surgical Periodontal Therapy with Systemic Antibiotics in Patients with Untreated Chronic Periodontitis: A Systematic Review and Meta-Analysis","volume":"50","author":"Keestra","year":"2015","journal-title":"J. Periodontal Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/jcpe.13264","article-title":"Adjunctive Effect of Systemic Antimicrobials in Periodontitis Therapy: A Systematic Review and Meta-Analysis","volume":"47","author":"Teughels","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_15","first-page":"310","article-title":"Non-Surgical Treatment of Moderate Periodontal Intrabony Defects With Adjunctive Cross-Linked Hyaluronic Acid: A Single-Blinded Randomized Controlled Clinical Trial","volume":"52","author":"Blasi","year":"2024","journal-title":"J. Clin. Periodontol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/s00784-020-03397-z","article-title":"Effectiveness of a Nutraceutical Agent in the Non-Surgical Periodontal Therapy: A Randomized, Controlled Clinical Trial","volume":"25","author":"Isola","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2146\/ajhp090168","article-title":"Probiotics","volume":"67","author":"Williams","year":"2010","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_18","first-page":"e161","article-title":"Effect of Probiotics as a Complement to Non-Surgical Periodontal Therapy in Chronic Periodontitis: A Systematic Review","volume":"25","year":"2020","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Och\u00f4a, C., Castro, F., Bulhosa, J.F., Manso, C., Fernandes, J.C.H., and Fernandes, G.V.O. (2023). Influence of the Probiotic L. Reuteri on Periodontal Clinical Parameters after Nonsurgical Treatment: A Systematic Review. Microorganisms, 11.","DOI":"10.3390\/microorganisms11061449"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/jcpe.12545","article-title":"Clinical Efficacy of Probiotics as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Chronic Periodontitis: A Systematic Review and Meta-Analysis","volume":"43","author":"Davideau","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.idairyj.2008.03.004","article-title":"Probiotics-From Metchnikoff to Bioactives","volume":"18","author":"Vasiljevic","year":"2008","journal-title":"Int. Dairy J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"R453","DOI":"10.1016\/j.cub.2014.03.034","article-title":"ROS Function in Redox Signaling and Oxidative Stress","volume":"24","author":"Schieber","year":"2014","journal-title":"Curr. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wang, Y., Wu, Y., Wang, Y., Xu, H., Mei, X., Yu, D., Wang, Y., and Li, W. (2017). Antioxidant Properties of Probiotic Bacteria. Nutrients, 9.","DOI":"10.3390\/nu9050521"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mazziotta, C., Tognon, M., Martini, F., Torreggiani, E., and Rotondo, J.C. (2023). Probiotics Mechanism of Action on Immune Cells and Beneficial Effects on Human Health. Cells, 12.","DOI":"10.3390\/cells12010184"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.fsi.2015.12.047","article-title":"Effects of Dietary Supplementation of Lactobacillus rhamnosus or\/and Lactococcus lactis on the Growth, Gut Microbiota and Immune Responses of Red Sea Bream, Pagrus Major","volume":"49","author":"Dawood","year":"2016","journal-title":"Fish Shellfish Immunol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1126\/science.aac4255","article-title":"Commensal Bifidobacterium Promotes Antitumor Immunity and Facilitates Anti-PD-L1 Efficacy","volume":"350","author":"Sivan","year":"2015","journal-title":"Science"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S0168-1605(01)00674-2","article-title":"Two Antioxidative Lactobacilli Strains as Promising Probiotics","volume":"72","author":"Kullisaar","year":"2002","journal-title":"Int. J. Food Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Homayouni Rad, A., Pourjafar, H., and Mirzakhani, E. (2023). A Comprehensive Review of the Application of Probiotics and Postbiotics in Oral Health. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1120995"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1902\/jop.1992.63.4s.322","article-title":"The Bacterial Etiology of Destructive Periodontal Disease: Current Concepts","volume":"63","author":"Socransky","year":"1992","journal-title":"J. Periodontol."},{"key":"ref_30","first-page":"e282","article-title":"Probiotics and Oral Health: A Systematic Review","volume":"22","year":"2017","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1111\/jcpe.13329","article-title":"Effects of Adjunctive Probiotic L. Reuteri Lozenges on S\/RSD Outcomes at Molar Sites with Deep Pockets","volume":"47","author":"Pelekos","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1902\/jop.2015.140612","article-title":"Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis","volume":"86","author":"Cakar","year":"2015","journal-title":"J. Periodontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/idh.12509","article-title":"Effect of the Local Probiotics in the Therapy of Periodontitis A Randomized Prospective Study","volume":"20","year":"2022","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Sachelarie, L., Scrobota, I., Romanul, I., Iurcov, R., Potra Cicalau, G.I., and Todor, L. (2025). Probiotic Therapy as an Adjuvant in the Treatment of Periodontal Disease: An Innovative Approach. Medicina, 61.","DOI":"10.3390\/medicina61010126"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1902\/jop.2016.150665","article-title":"Clinical Effects of Lactobacillus rhamnosus in Non-Surgical Treatment of Chronic Periodontitis: A Randomized Placebo-Controlled Trial With 1-Year Follow-Up","volume":"87","author":"Morales","year":"2016","journal-title":"J. Periodontol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s00784-023-04870-1","article-title":"Bifidobacterium Animalis Subsp. Lactis as Adjunct to Non-Surgical Periodontal Treatment in Periodontitis: A Randomized Controlled Clinical Trial","volume":"27","author":"Kuru","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00784-020-03449-4","article-title":"Probiotic Strains of Lactobacillus brevis and Lactobacillus plantarum as Adjunct to Non-Surgical Periodontal Therapy: 3-Month Results of a Randomized Controlled Clinical Trial","volume":"25","author":"Pudgar","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"De Mendon\u00e7a, C.D., da Mata, A.D.S.P., Azevedo, L.F.R., Marques, J.F., Silveira, J.M.L., and Marques, D.N.d.S. (2024). Probiotics in the Non-Surgical Treatment of Periodontitis: A Systematic Review and Network Meta-Analysis. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-05027-6"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jdsr.2023.02.001","article-title":"Clinical, Microbiological and Immunological Short, Medium and Long-Term Effects of Different Strains of Probiotics as an Adjunct to Non-Surgical Periodontal Therapy in Patients with Periodontitis. Systematic Review with Meta-Analysis","volume":"59","author":"Ausenda","year":"2023","journal-title":"Jpn. Dent. Sci. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/cap.10253","article-title":"A Placebo-Controlled Randomized Clinical Trial of Antibiotics versus Probiotics as an Adjuvant to Nonsurgical Periodontal Treatment among Smokers with Stage III, Grade C Generalized Periodontitis","volume":"13","author":"Ghazal","year":"2023","journal-title":"Clin. Adv. Periodontics"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Huo, P., Deng, L., Lu, J., Kan, P., Jing, R., and Luo, L.J. (2025). The Impact of Limosilactobacillus reuteri in Combination with Non-Surgical Periodontal Therapy on Periodontal Clinical Parameters and Salivary and Subgingival Microbiota Composition in Individuals with Stage III\u2013IV Periodontitis: A Randomized Controlled Trial. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-06084-1"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Benavides-Reyes, C., Cabello, I., Mag\u00e1n-Fern\u00e1ndez, A., Rodr\u00edguez-Barranco, M., Usta, S.N., and Mesa, F. (2025). Clinical Effects of Probiotics on the Treatment of Gingivitis and Periodontitis: A Systematic Review and Meta-Analysis. BMC Oral Health, 25.","DOI":"10.1186\/s12903-025-05888-5"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/jcpe.13232","article-title":"The Adjunctive Use of Host Modulators in Non-Surgical Periodontal Therapy. A Systematic Review of Randomized, Placebo-Controlled Clinical Studies","volume":"47","author":"Donos","year":"2020","journal-title":"J. Clin. Periodontol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5114\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:12:08Z","timestamp":1760033528000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,18]]},"references-count":43,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14145114"],"URL":"https:\/\/doi.org\/10.3390\/jcm14145114","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,18]]}}}