2011 Volume 54 Issue 6 Pages 466-475
Objectives: The purpose of the present study was to evaluate the effect of sugar-free chewing gums containing Enterococcus faecium (E. faecium) on periodontal health and oral microbial flora. Material and methods: Thirty generalized chronic periodontitis patients (57.3 y ± 8.4) who signed an informed consent were recruited in this study. The subjects were grouped double-blindly into two groups: 1) fifteen subjects chewing E. faecium gum or 2) fifteen subjects chewing placebo gum. Before and after the four-week experiment period, saliva was collected after 5 minutes of stimulation and then used for biochemical measurements (lactate dehydrogenase (LDH), alkaline phosphatase (ALP) activities, free hemoglobin (F-Hb), pH) and microbiological measurements for periodontopathic bacteria: Porphyromonas gingivalis gingivalis), Treponema denticola (T denticola), Tannerella forsythia (T forsythia), Prevotella intermedia (P intermedia), Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) and total bacterial counts by using the real-time polymerase chain reaction (PCR) method. The microbiological quantitative measurements were also taken from the deepest periodontal pocket of each patient. To evaluate whether E. faecium was fixed in the oral cavity or not, saliva and periodontal pocket samples were also analyzed by conventional bacterial culture of E. faecium. Clinical periodontal measurements were done for Ramfjord's six representative teeth including plaque index (PlI), probing pocket depth (PPD), gingival index (GI), and bleeding on probing (BOP). Statistical analyses were performed with Student's t-test for subjects' distribution and Wilcoxon's signed-ranks test for microbial, biochemical and clinical data. A P value of below 5 % was considered significant. Results: The E. faecium gum group showed a significant decrease in red complex periodontal pathogens including 7: forsythia, 7: denticola and P.gingivalis compared to the base-line, especially in saliva samples (p<0.05). However, this tendency was not seen in subgingival plaque samples from each deepest periodontal pocket. Both groups had significantly improved clinical status in PH, GI, PPD, BOP and biochemical markers for ALP and F-Hb in saliva at four weeks after the experiments compared to the base-line. None of the patients showed E. faecium fixation or acidific change of pH. Conclusion: The present study suggests that sugar-free chewing gums containing the lactic acid-producing bacteria, E. faecium, could have beneficial effects on periodontal health by inhibiting periodontal red complex pathogens including P. gingivalis, T. denticola and T. forsythia.
