Effect of Probiotic Toothpaste on Enamel Mineralization and Streptococcus mutans Levels in Cleft Orthodontic Patients-A Randomized Clinical Trial

Cleft Palate Craniofac J. 2025 Jan 8:10556656241309444. doi: 10.1177/10556656241309444. Online ahead of print.

Abstract

Objective: To assess the effectiveness of probiotic and fluoride toothpaste on enamel mineralization and Streptococcus mutans levels in cleft lip and/or palate patients undergoing fixed orthodontic appliance therapy.

Design: A randomized comparative trial with a 1:1 allocation ratio.

Participants: Thirty-two patients with cleft lip and/or palate undergoing fixed orthodontic appliances were recruited.

Interventions: Cleft lip and/or palate patients undergoing fixed orthodontic appliances were randomized into Group 1 (probiotic toothpaste) or Group 2 (fluoride toothpaste). The toothpaste was given to the patient after oral prophylaxis. The patients were advised to use the toothpaste two times a day (morning and night) for a period of 4 weeks.

Main outcomes: Enamel mineral content was assessed before intervention (T0) and after 4 weeks of intervention (T1) using DIAGNOdent. Streptococcus mutans levels were assessed after 4 weeks of intervention (T1) for both the groups using real time-polymerization chain reaction (RT-PCR). Paired t-tests and t-tests were used for intragroup and intergroup comparisons, respectively. A P-value < .05 was considered statistically significant.

Results: Both the groups showed improvement in enamel mineral content after 4 weeks of intervention. Streptococcus mutans levels in the probiotic-containing toothpaste were lesser when compared to the fluoridated toothpaste group. No statistically significant difference was found between probiotic toothpaste and fluoridated toothpaste in both the assessed parameters.

Conclusions: Probiotic toothpaste is as effective as fluoride toothpaste in enamel remineralization. Probiotic toothpaste showed greater inhibitory effect on Streptococcus mutans than the fluoridated toothpaste.

Keywords: Streptococcus mutans; cleft lip; cleft palate; fluoride; probiotic.