The antimicrobial effect of&nbsp;<i>Limosilactobacillus reuteri</i>&nbsp;as probiotic on oral bacteria: A scoping review

Nissia Ananda; Dewi Fatma Suniarti; Endang Winiati Bachtiar

doi:10.12688/f1000research.139697.2

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Systematic Review

Revised

The antimicrobial effect of Limosilactobacillus reuteri as probiotic on oral bacteria: A scoping review

[version 2; peer review: 3 approved]

Nissia Ananda¹, Dewi Fatma Suniarti², Endang Winiati Bachtiar²

PUBLISHED 04 Mar 2024

Author details Author details

¹ Dental Department, Universitas Indonesia Hospital, Universitas Indonesia, Depok, West Java, 16424, Indonesia
² Department of Oral Biology, Oral Science Research Center, Faculty of Dentistry, Universitas Indonesia, Jakarta, 10430, Indonesia

Nissia Ananda
Roles: Data Curation, Writing – Original Draft Preparation

Dewi Fatma Suniarti
Roles: Data Curation, Writing – Review & Editing

Endang Winiati Bachtiar
Roles: Data Curation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Dysbiosis among oral microbial community in the oral cavity can lead to several oral diseases. Probiotic therapy is known to correct these imbalances. Limosilactobacillus reuteri is one of the most studied strains of probiotics and can control oral microbiota through reuterin, a wide-spectrum antimicrobial agent. The objective of this review was to evaluate the effect of the antimicrobial activity of Limosilactobacillus reuteri on the oral bacteria of humans. This review used PubMed, Scopus, EMBASE, ScienceDirect, and Google Scholar databases as bibliographic resources. Studies with matching keywords were analyzed and screened with PRISMA-ScR recommendations. Sixteen articles were selected for this review, which included a total of 832 patients. Based on this review, Limosilactobacillus reuteri has a strong antibacterial effect against Streptococcus mutans in healthy individuals but is not effective against Lactobacillus. Additionally, it has a significant antibacterial effect against Porphiromonas gingivalis in patients with periodontitis, although its effectiveness is not stable in patients with peri-implant infections. Furthermore, Limosilactobacillus reuterihas varying results against other bacteria, indicating the need for further extensive research to ensure its efficacy.

Keywords

antimicrobial, dentistry, Limosilactobacillus reuteri, Lactobacillus reuteri, oral bacteria, oral microbiome, oral probiotic

Corresponding author: Nissia Ananda

Competing interests: No competing interests were disclosed.

Grant information: This work was supported by the Indonesian Endowment Fund for Education (LPDP), Ministry of Finance Republic of Indonesia.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2024 Ananda N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Ananda N, Suniarti DF and Bachtiar EW. The antimicrobial effect of Limosilactobacillus reuteri as probiotic on oral bacteria: A scoping review [version 2; peer review: 3 approved]. F1000Research 2024, 12:1495 (https://doi.org/10.12688/f1000research.139697.2) First published: 23 Nov 2023, 12:1495 (https://doi.org/10.12688/f1000research.139697.1) Latest published: 04 Mar 2024, 12:1495 (https://doi.org/10.12688/f1000research.139697.2)

Revised Amendments from Version 1

Authors are pleased to present the revised version of our manuscript, which incorporates several notable enhancements based on feedback and further research. Here are the key changes made:

1. A brief explanation regarding the utilization of L. reuteri in promoting general health has been included in the discussion section. This addition provides a broader context for understanding the potential applications of L. reuteri beyond the primary focus of the study.

2. We have introduced a paragraph discussing the relationship between L. reuteri and diabetes mellitus. This addition expands the scope of the manuscript and explores an important aspect of the topic.

3. To improve the organization and clarity of the discussion section, we have subdivided it into smaller subheadings. This structural adjustment aims to facilitate easier navigation and comprehension of the presented results.

4. Additional discussion has been incorporated regarding the mechanism of quorum quenching in probiotics, specifically its impact on pathogenic bacteria. Furthermore, we have provided further insights into the cytotoxic effects of Limosilactobacillus reuteri on human gingival fibroblasts.

5. Minor issues related to wording and writing have been addressed to ensure the clarity and coherence of the manuscript.

These changes collectively aim to enrich the content and readability of the manuscript, providing readers with a more comprehensive understanding of the topic.

See the authors' detailed response to the review by Firdaus Hariri
See the authors' detailed response to the review by Norifumi Nakamura
See the authors' detailed response to the review by Rizky Aditiya Irwandi

Introduction

Oral microbiome consists of a core microbiome and a variable microbiome. The core microbiome is community of predominant species that are present in various parts of the body under healthy condition. Meanwhile, a variable microbiome is a community of microorganisms species that varies and is exclusive between individuals because it has evolved in response to unique lifestyle and genotypic determinants.¹

Oral microbiomes usually reside in the oral cavity as biofilms and maintaining their homeostasis is important to protect the oral cavity.¹ The alteration of oral microbial balance may lead to diseases and antibiotics are a common antimicrobial approach to regain the oral microbiota equilibrium.²^–⁵ However, over-reliance on antibiotic administration increases the risk of developing antimicrobial resistance which WHO (World Health Organization) has declared as one the global health emergencies, also known as a silent pandemic. Therefore, an alternative intervention such as probiotics gains attention to maintain oral biofilm homeostasis.⁶^,⁷

Probiotics are living and viable microorganisms which in adequate quantities provide benefits to the host.⁸ Probiotics offer many health benefits by harnessing the strengthening effects of native beneficial microflora in the body. These exogenous microorganisms, considered Generally Safe (GRAS), exhibit various beneficial properties at various levels of human health. In particular, they play an important role in protecting the host from harmful microorganisms while strengthening the immune system. Known for their ability to improve gut health, probiotics contribute to maintaining a balanced gut microbiome, which is critical for digestive function and overall well-being.⁹ Probiotics also improve oral flora through a bacteriotherapy mechanism by increasing the composition of harmless microflora to maintain or restore beneficial oral flora and modulating the oral microbiota to prevent pathogenic colonization.¹⁰ In addition to bacteriotherapy mechanisms, probiotics also prevent or treat oral microbiota dysbiosis through stimulation of the host’s immune system and produce molecules or substances with antimicrobial effects.⁸^,¹¹^,¹² These concept provides an alternative therapy to fight infection with fewer side effects and is safer than antibiotics.¹⁰

Over the past few years, probiotic therapy has been used as an adjunct treatment in clinical dentistry.¹³ For oral or dental purposes, probiotics need to survive in the oral ecosystem.¹⁴ In terms of oral health, Limosilactobacillus reuteri has been extensively researched and is considered one of the most studied probiotics.¹⁵ Limosilactobacillus reuteri is known for its ability to control oral microbiota through reuterin, a wide-spectrum antimicrobial agent.¹⁶ However, some studies discovered that the Limosilactobacilluss reuteri probiotic should not be recommended as an adjunct treatment for oral infection as there were no microbiota alterations between the test and control groups.¹¹^,¹⁷^,¹⁸ The purpose of this study is to provide a comprehensive overview of the existing literature on the antimicrobial effect of Limosilactobacillus reuteri on oral bacteria. This review aims to synthesize and map out prior research in order to identify knowledge gaps and research needs related to this topic. By examining the breadth and depth of available literature, this review will evaluate the quality and quantity of existing research on the subject, and inform future research and practice. Ultimately, this scoping review aims to provide a foundation for future research and practice in this important area of alternative antimicrobial drug research.

Objective

This review evaluated the effect of the antimicrobial activity of Limosilactobacillus reuteri on the oral microbiota of humans.

Methods

Scoping review methods

To achieve this study’s objective, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) were applied.

Research questions

What is known from the literature about the antibacterial effect of Limosilactobacillus reuteri on oral bacteria in humans?

Search methods

We ran a search for full-text manuscripts written in English in several databases, such as PubMed, Scopus, EMBASE, ScienceDirect, and Google Scholar. There were no limitations regarding the articles’ publishing date at the search stage. The search was performed by identifying studies with the terms “(Lactobacillus reuteri OR Limosilactobacillus reuteri OR Probiotic) AND (Antimicrobial OR Antibacterial) AND (Oral OR Dental)”. Google Scholar was included in our search strategy to ensure a comprehensive search. However, due to the large number of results obtained from Google Scholar, we limited our screening to the first 10 pages of results, which were sorted by relevance.

Selection of studies

Rayyan, developed and manufactured by Qatar Computing Research Institute in Doha, Qatar, was used as a tool for the screening and selection of studies for inclusion in this study. We imported the search results into Rayyan, de-duplicated them, and then two reviewers (NA and DFS) screened the title and abstract of each study to determine its relevance to the research question. Studies that were deemed potentially relevant by either reviewer were included for full-text review. During the full-text review stage, each reviewer independently assessed the eligibility of each study based on predetermined inclusion and exclusion criteria. Any disagreements were resolved through discussion or by involving a third reviewer (EWB). Finally, the studies that met the inclusion criteria were selected for data extraction and analysis. Rayyan was used to record the results of the screening and selection process, including the number of studies included and excluded at each stage, and to facilitate the creation of a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Eligibility criteria

The inclusion criteria for the studies in this review were based on PICOS.

i. Population, or participants and conditions of interest: Oral or Dental bacteria in humans
ii. Interventions or exposures: Exposure to Limosilactobacilluss reuteri
iii. Comparisons or control groups: a control group of microbiomes that was not exposed to Limosilactobacillus Reuteri
iv. Outcomes of interest: Quantity of Oral Bacteria (Antimicrobial effect)
v. Study designs: Randomized controlled trials (RCTs) and non-RCTs, case-control studies, cross-sectional, as well as prospective and retrospective cohort studies were considered for inclusion. Systematic review studies were also included to explore the studies in the review that are relevant to this study.

The exclusion criteria for this review were letters to editors, commentaries, case reports, articles with non-human samples, and non-oral/dental research articles.

Data extraction

Data were extracted from each study based on the author, year, country, study design, subject criteria, number of samples, groups in the research, strain of Limosilactobacillus reuteri used, delivery systems, other accompanying treatment, duration of intervention, bacteria affected, and the statistical analysis of oral bacteria count.

Methodological quality assesment

We used version 2 of the Cochrane Risk-Of-Bias (RoB 2) Tool, developed and manufactured by Cochrane Collaboration, a non-profit organization based in London, United Kingdom, to assess the methodological quality of the studies. The risk of bias in each individual study was assessed by two reviewers, independently. The criteria of this assessment consisted of the following five domains: the randomisation process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result.

Results

Search results

The electronic literature research process was conducted in April 2023, and 14352 studies were identified. The studies were obtained from the following four databases: PubMed, Scopus, EMBASE, ScienceDirect, and Google Scholar. A total of 1962 studies were eliminated due to duplication, 12355 studies were excluded by title and abstract screening. From the remaining thirty-five studies, nineteen studies were also excluded due to the following reasons: their subject was not human, there was no microbiome outcome in the study, the studies in the systematic review did not met the criteria, the study was only study protocol with no result, and the probiotic used was not Limosilactobacillus reuteri or Limosilactobacillus reuteri mixed with other bacteria. Therefore, sixteen studies were selected in this review for analysis (Table 1). The PRISMA flowchart of this systematic review is presented in Figure 1.

Table 1. Included studies.

Author (Year)	Country	Design of study	Subject	Patients, n	Groups, n	Strain of L. Reuteri	Delivery systems	Accompanied with other treatment	Duration of intervention	Observation Period	Bacteria affected	Main finding
Nikawa et al. (2004)	Japan	RCT	Healthy female subjects who were 20 years old	40	G1: given placebo yoghurt daily for 2 weeks, and then given reuteri yoghurt daily for another 2 weeks n = 20 G2: given reuteri yoghurt daily for the first 2 weeks, then given placebo yoghurt daily for the next 2 weeks. n = 20	L. reuteri SD2112 (ATCC55730)	Yoghurt	-	2 weeks of intervention	4 weeks	Oral mutans streptococci	L. reuteri significantly reduced the oral mutans streptococci in each group (P<0.05)
Caglar et al. (2006)	Turkey	RCT	Healthy young adults, 21-24 years of age	120 (71 male, 49 female)	G1: drank 200 ml water through a prepared straw containing probiotic bacteria once daily G2: drank 200 ml water through a placebo straw without bacteria once daily G3: ingested one sucking tablet with probiotic bacteria once daily G4: ingested one sucking tablet without bacteria once daily	Probiotic straw consisted of a telescopic polypropene membrane with an oil droplet containing L. reuteri ATCC 55730 (minimum 10⁸ CFU/straw) attached to its inner part Tablet consisted of L. reuteri ATCC 55730 (10⁸ CFU/tablet)	Straw Tablet	-	3 weeks	3 weeks	Salivary mutans streptococci Salivary lactobacilli	G1 and G3 showed significantly reduced number of mutans streptococci between baseline and end of intervention G2 and G4 showed no statistically differences of mutans streptococci score on baseline and on the 3rd week G1, G2, G3, and G4 showed no statistically differences of Lactobacilli score on baseline and on the 3rd week
Caglar et al. (2007)	Turkey	RCT	Healthy young adults, 21-24 years of age	80 (44 women, 36 men)	G1: consumed one chewing gum with probiotic bacteria three times daily (n=20) G2: consumed two chewing gums with xylitol three times daily (n=20) G3: consumed two chewing gums with probiotic bacteria and four with xylitol daily (n=20) G4: chewed placebo gums without active ingredients three times a day (n=20)	L. reuteri (ATCC 55730 at a dose of 1×108 CFU/gum and ATCC PTA 5289 at a dose of 1× 108 CFU/gum)	Lozenge	Brush the teeth twice a day with fluoride-containing toothpaste	3 weeks	3 weeks	Salivary mutans streptococci Salivary lactobacilli	G1 and G2 exhibit significantly reduced number of Salivary mutans streptococci on week 3 compared to baseline (P < 0.05) G3 and G4 showed no statistically significant difference Salivary mutans streptococci count between baseline and week 3 G1, G2, G3, G4 showed no significant difference S alivary lactobacilli scores between baseline and week 3
Caglar et al. (2008)	Turkey	RCT	Healthy young women aged 20 years old	20	G1: exposed to L. reuteri (n=10) G2: control group (n=10)	L. reuteri ATCC 55730/L. reuteri ATCC PTA 5289 (1.1 x 10⁸ CFU)	Medical device contains a pouch in which the probiotic or placebo lozenge can be inserted in	No	10 days, with 15 minutes of intervention/day	10 days	Salivary mutans streptococci Salivary lactobacilli	G1 exhibit significantly reduced number of Salivary mutans streptococci on day 10 P = 0.016 No statistically significant difference between G1 and G2 on Salivary lactobacilli count on day 10
Vivekananda et al. (2010)	India	RCT with split mouth design	Chronic periodontitis patients	30	G1: SRP (Scaling root planing) treated quadrants + probiotic lozenge G2: SRP treated quadrants + placebo lozenge G3: Non-SRP quadrants + probiotic lozenge G4: Non-SRP quadrants + placebo lozenge	L. reuteri DSM 17938 (1 x 10⁸ CFU) and L. reuteri ATCC PTA 5289 (1 x 10⁸ CFU)	Lozenge	Scaling root planing (G1 and G2)	Day 21 to day 42 (21 days)	Baseline Day – 21 Day – 42	Aggregatibacter actinomycetemcomitans Porphyromonas gingivalis Prevotella intermedia	G1 and G3 were able to significantly reduce the CFU counts of the Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia
Iniesta et al. (2012)	Spain	RCT	Patients with gingivitis	40	G1: exposed to L. reuteri (n=20) G2: control group (n=20)	Two strains of L. reuteri (DSM-17938 and ATCC PTA 5289) at a dose of 2 x 10⁸ CFU/tablet	Tablet	After screening, participants received tooth-polishing (rubber cup and abrasive paste) and provided with a new toothbrush, fluoride toothpaste and dental floss	28 days (baseline to week 4)	Baseline Week 4 Week 8	Lactobacillus spp. Porphyromonas gingivalis Prevotella intermedia Fusobacterium nucleatum Parvimonas micra Campylobacter rectus Capnocytophaga Eikenella corrodens Tannerella forsythia Aggregatibacter actinomycetemcomitans	In saliva: G1 showed significant reductions in total anaerobic counts after 4 weeks (p = 0.021) and counts of Prevotella intermedia after 8 weeks (p = 0.030) In subgingival: G1 showed significant reductions in the changes baseline to 4 weeks for Porphyromonas gingivalis counts (p = 0.008)
Hallstrom et al. (2016)	Sweden	RCT	Patients with peri-implant mucositis	46	G1: test group (the in-office treatment included topical application of oil containing L. reuteri around selected implant and patient given probiotic tablet twice daily for 3 months) n = 22 G2: control group (got the same in-office mechanical treatment with topical application of placebo oil and given placebo tablet) n = 24	L. reuteri strains DSM 17938 and ATCC PTA 5289	Topical oil and tablet	titanium curretes, polishing using a rubber cup and polishing paste	3 months	week 0 week 4 week 12 week 26	Porphyromonas gingivalis (FDC381) Prevotella intermedia (ATCC26511) Prevotella nigrescens (ATCC 33563) Tannerella forsythia (ATCC43037) Aggregatibacter actinomycetemcomitans (FDC Y4) Fusobacterium nucleatum (ATCC10953) Treponema Denticola (OMGS3271) Parvimonas micra (OMGS2852) Campylobacter rectus (ATCC33238) Porphymonas endodontis (OMGS1205) Filifactor alocis (ATCC35896) Prevotella tannerae (ATCC51259)	No major alterations over time or differences between G1 and G2 were recorded
Tada et al. (2017)	Japan	RCT	Patients with peri-implantitis	30	G1: exposed to L. reuteri (n=15) G2: control group (n=15)	One probiotics tablet contained 1x108 CFU L. reuteri strains DSM 17938 and ATCC PTA 5289	Tablet	supragingival scaling, prescribtion of azythromycin 500 mg/day for 3 days	24 weeks	24 weeks	Fusobacterium nucleatum Porphyromonas gingivalis Prevotella intermedia Aggregatibacter actinomycetemcomitans Treponema denticola Tannerella forsythia	No statistically significant difference between G1 and G2 in other peri-implant microbiota
Alamoudi et al. (2018)	Kingdom of Saudia Arabia	RCT	Healthy children aged 3-6 years	178	G1: received L. reuteri probiotic lozenges (n = 90) G2: received placebo lozenges (n = 88)	L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289	Lozenge	Regular dental hygiene for the children using a “pea-size” amount of provided toothpaste with 500 ppm fluoride twice daily.	28 days	28 days	Mutans streptococci Lactobacillus	G1 showed significantly lower microbial counts compared to G2 for both salivary Mutans streptococci (P=0.000) and Lactobacilli (P=0.020)
Galofre et al. (2018)	Spain	RCT	Patients that partially edentulous and had implants with mucositis or peri-implantitis	44	G1: mucositis patients (n=22) G1.1: mucositis patients who received probiotic lozenge (n=11) G1.2: mucositis patients who received placebo lozenge (n=11) G2: peri-implantitis patients (n=22) G2.1: peri-implantitis patients who received probiotic lozenge (n=11) G2.2: peri-implantitis patients who received placebo lozenge (n=11)	L. reuteri (1 × 10⁸ living cells of DSM 17938 and 1 × 10⁸ living cells of ATCC PTA 5289)	Lozenge	Supragingival prophylaxis in the mucositis implants Subgingival non-surgical mechanical therapy in peri-implantitis implants and titanium curettes	every day for 30 days	30 days 60 days 90 days	Aggregatibacter actinomycetemcomitans Tannerella forsythia Porphyromonas gingivalis Treponema denticola Prevotella intermedia Peptostreptococcus micros Fusobacterium nucleatum Campylobacter rectus Eikenella corrodens	Significantly reduced Porphyromonas gingivalis between G1.1 and G1.2 (bacterial count on day 90 minus bacterial count on baseline) P = 0.031 However no statistically significant difference between G1.1 and G1.2, also G.21 and G2.2 in other peri-implant microbiota
Lauritano et al. (2019)	Italy	RCT	Patients with peri-implant mucositis	10	G1: consumed one chewing gum with probiotic bacteria one per day (n=5) G2: chewed placebo tablet one per day (n=5)	L.reuteri DSM 17938 and ATCC PTA 5289	Chewing tablet	non-surgical mechanical therapy	28 days	28 days	Porphyromonas gingivalis Tannerella forsythia Treponema denticola	No statistically significant difference between G1 and G2 in other peri-implant microbiota
Pena et al. (2019)	Spain	RCT	Mucositis patients with dental implants	50	G1: Probiotic group (given probiotic tablet on day 15-45) n = 25 G2: Placebo group (given placebo tablet on day 15-45) n = 25	L. reuteri (DSM 17938 and ATCC PTA 5289)	Tablet	Mechanical debridement of dental implant with adjunctive administration of a 0.12% chlorhexidine mouthrinse (day 0-15)	intervention on day 15-45	day - 15 day - 45 day - 135	Aggregatibacter actinomycetemcomitans (Aa) Tannerella forsythia (Tf) Porphyromonas gingivalis (Pg) Treponema denticola (Td) Prevotella intermedia (Pi) Peptostreptococcus micros (Pm) Fusobacterium nucleatum (Fn) Campylobacter rectus (Cr) Eikenella corrodens (Ec)	Significantly reduced Peptostreptococcus micros in G1 compared to G2 (bacterial count on day 45 minus bacterial count on day 15) P = 0.001 Significantly reduced Peptostreptococcus micros and Fusobacterium nucleatum in G1 compared to G2 (bacterial count on day 135 minus bacterial count on baseline) P (Pm) = 0.045 P (Fn) = 0.034 However no statistically significant difference between G1 and G2 in other peri-implant microbiota
Elsadek et al. (2020)	Saudi Arabia	Non-RCT experimental	Periodontitis patients with Diabetes Mellitus	60	G1: administered probiotic and root surface debridement G2: rendered with root surface debridement alone	L. reuteri (DSM 17938 and ATCC PTA 5289) at 2 x 10⁸ CFU	Tablet	Root surface debridement	Two tablets/day for 3 weeks	Basline 3 months	Porphyromonas gingivalis Tannerella forsythia Treponema denticola	G1 exhibit significantly reduced number of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola compared to G2 on 3 months evaluation
Laleman et al. (2020)	Belgium	RCT	Patients with peri-implantitis	19	G1: topical application of the probiotic drops after the treatment and consume probiotic lozenges G2: topical application of the placebo drops after the treatment and consume placebo lozenges	L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289	Drop	Full mouth prophylaxis Mechanical debridement of the peri-implant sites Peri-implant pockets were subgingivally air polished	12 weeks	baseline week 6 week 12 week 24	Porphyromonas gingivalis Prevotella intermedia Fusobacterium nucleatum Aggregatibacter actinomycetemcomitans	Significantly reduced Porphyromonas gingivalis in G1 compared to G2 on week 6 observation in the saliva sample P = 0.006 Significantly reduced Aggregatibacter actinomycetemcomitans in G1 compared to G2 on week 12 and week 24 observations in the saliva sample, and similar result on the week 24 observation in the tongue sample P (week12-saliva) = 0.034 P (week 24-saliva) = 0.040 P (week 24-tongue) < 0.001 Significantly reduced Prevotella intermedia in G1 compared to G2 on week 6, week 12 and week 24 observations in the tongue sample, and similar result on the week 24 observation in the subgingival sample p < 0.001
Badri et al. (2021)	Makkah, Saudi Arabia	RCT	Healthy children aged 8-12 years	53	G1: One lozenge of L. reuteri every day (n=18) G2: Chlorhexidine mouthwash everyday (n=17) G3: Control group (n=18)	L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289	Lozenge	Brushing teeth	1 month	Day – 15 Day – 30	S. mutans	Significantly difference S. mutans count on day 15 and day 30: G3 > G1 > G2
El-bagoory et al. (2021)	USA	RCT	Chronic periodontitis patients	12	G1: exposed to L. reuteri (n=6) G2: control group (n=6)	L. reuteri DSM 17938 (1X10⁸ CFU)	Suspension through blunt syringe delivered to subgingival sites	Scaling root planing	Four times of application: • Baseline • 1 week • 2 week • 4 week	Baseline 3 months 6 months	Porphyromonas gingivalis	G1 showed significantly reduced number of Porphyromonas gingivalis on the 3 months and 6 months evaluation

Figure 1. Flowchart of the scoping review.

General characteristics of included studies

Fifteen of the selected studies were randomized controlled trials (RCTs), and one study was a non-RCT experimental study. These studies were published between 2004 and 2021. Of the sixteen studies, six articles utilized healthy human subjects (four articles used healthy young adult humans, and two articles used healthy children). Three studies included in this study were conducted with peri-implant mucositis patients, two studies used peri-implantitis patients, and one study used both peri-implantitis and peri-implant mucositis patients. Additionally, one study was conducted with gingivitis patients, two studies used periodontitis patients, and one study used periodontitis patients with Diabetes Mellitus condition. A total of 832 patients were included in these studies. The duration of intervention in the included studies ranged from 10 days to 24 weeks. On the other hand, the observation periods in these studies also ranged from baseline to 26 weeks.

Strains of Limosilactobacillus reuteri Used in Studies

In two studies originating from Turkey, a combination of Limosilactobacillus reuteri ATCC 55730 and ATCC PTA 5289 strains were used, while another two studies used only the Limosilactobacillus reuteri ATCC 55730 strain. Meanwhile, one study used only the Limosilactobacillus reuteri DSM 17938 strain, and eleven other studies used a combination of Limosilactobacillus reuteri DSM 17938 and ATCC PTA 5289 strains.

Results of the quality assessment

During the quality assessment, it was found that the “low” percentage dominated the included articles, although there were still a few articles with the conclusion of “some concerns”. Additionally, only one article had a “high” result, and this article was a non-RCT experimental study. Therefore, it was reasonable to have a high bias value during this assessment (as shown in Figure 2 and Table 2). As a result, we concluded that all the studies included in this review are of good quality based on the Cochrane Risk-Of-Bias (RoB 2) Tool.

Figure 2. The distribution of risk-of-bias judgments within each bias domain.

Table 2. Quality assesment of each studies.

Author	Risk of bias domain
Author	Randomization process	Deviations from the intended interventions	Missing outcome data	Measurement of the outcome	Selection of the reported result	Overall Bias
Caglar et al. (2008)	Low	Some concerns	Low	Low	Some concerns	Some concerns
Galofre et al. (2018)	Low	Low	Low	Low	Low	Low
Caglar et al. (2007)	Low	Low	Low	Low	Low	Low
Pena et al. (2019)	Low	Low	Low	Low	Some concerns	Some concerns
Nikawa et al. (2004)	Low	Low	Low	Low	Some concerns	Some concerns
Hallstrom et al. (2016)	Low	Low	Low	Low	Some concerns	Low
Lauritano et al. (2019)	Low	Low	Low	Low	Low	Low
Caglar et al. (2006)	Low	Low	Low	Low	Some concerns	Some concerns
Tada et al. (2017)	Low	Low	Low	Low	Low	Low
Laleman et al. (2020)	Low	Low	Low	Low	Some concerns	Some concerns
Alamoudi et al. (2018)	Low	Low	Low	Low	Low	Low
Elsadek et al. (2020)	High	Low	Low	Low	Low	High
Vivekananda et al. (2010)	Low	Low	Low	Low	Some concerns	Some concerns
Badri et al. (2021)	Low	Low	Low	Low	Low	Low
Iniesta et al. (2012)	Low	Low	Low	Low	Low	Low
El-bagoory et al. (2021)	Low	Low	Low	Low	Low	Low

Discussions

Antibiotic resistance is progressively increasing, emphasizing the urgency of finding alternative antibacterial substances.¹⁹ Many studies have tried to find alternative methods, other than antibiotics, to treat oral cavity diseases, one of which involves biofilm inhibitors, such as quorum quenching (QQ) or the inhibition of quorum sensing (QS).²⁰ QS is a chemical signaling process of microorganisms that aims to monitor and regulate their population density. This chemical signaling system allows bacteria to coordinate their behavior and enhance their survival skills to respond to environmental changes through the growth and synthesis of biofilm matrix, enabling them to increase their resistance to conventional therapies such as antibiotics and antiseptics. Researchers and clinicians are increasingly compelled to seek novel strategies for combating biofilm-related illnesses. Among these approaches, QQ has emerged as a promising avenue. QQ targets bacterial communication networks crucial for virulence, presenting various potential applications in dentistry. Studies indicate that probiotics have the capability to inhibit QS in cariogenic and periodontopathic bacteria within the oral cavity. Through QQ, probiotics disrupt the communication pathways of these bacteria, hindering biofilm formation and virulence factor coordination.²⁰^,²¹

Generally, oral biofilms consist primarily of commensal species that are in equilibrium and harmless to the host. However, both local and systemic-derived insults are capable of inducing alteration towards microbial dysbiosis leading to increased number of pathogenic microbial species. The involvement of quorum sensing mechanisms in facilitating biofilm formation helps bacteria perpetuate this dysbiotic state.²⁰ Moreover, interest in probiotics has tremendously risen over the last 10 years, and several health claims have been made regarding probiotics’ antibacterial activity.¹⁹^,²¹ In digestive studies, probiotics have a good adhesion to the gut, effectively enhancing intestinal epithelial homeostasis and interfering with the quorum sensing that favors a dysbiotic state.²²

Limosilactobacillus reuteri, a gut symbiont naturally found in the human intestines, has garnered significant attention for its potential health benefits. Since its isolation in 1962, numerous studies have delved into its functions and mechanisms, particularly in addressing various diseases. These include gastrointestinal disorders, hypercholesterolemia, skin infections, allergic asthma, and hand, foot, and mouth disease (HFMD), among others. Notably, research on Limosilactobacillus reuteri has increasingly focused on its role in intestinal health, with a particular emphasis on conditions like inflammatory bowel disease (IBD), colorectal cancer (CRC), and functional bowel diseases in children. The findings suggest that Limosilactobacillus reuteri offer promising prospects for enhancing overall health and well-being, particularly in the realm of digestive health and immune function.²³ Furthermore, Limosilactobacillus reuteri is now widely studied for its potential benefits in oral health.¹⁵

A previous study demonstrated that the combination of two strains of Limosilactobacillus reuteri, ATCC PTA 5289 and DSM 17938, did not exhibit detrimental effects on the viability of gingival fibroblasts. Employing the MTT assay, this study analyzed the viability of human gingival fibroblasts when exposed to Limosilactobacillus reuteri. These findings suggest a potential compatibility of Limosilactobacillus reuteri with gingival fibroblasts, indicating a favorable safety profile for its use in oral health applications. This current review is important as a preliminary knowledge to identify the effect of Limosilactobacillus reuteri on pathogenic bacteria in the oral cavity.²⁴

The impact of Limosilactobacillus reuteri on microbiomes associated with dental caries (Mutans streptococci and salivary lactobacilli)

Six studies in this review analyzed the antibacterial properties of Limosilactobacillus reuteri against Mutans streptococci in healthy humans. Despite variations in probiotic delivery mechanisms, intervention duration, and observation periods, these studies found an overall positive antibacterial effect. Additionally, among the six studies, four used Limosilactobacillus reuteri ATCC 55730, and two studies combined this strain with Limosilactobacillus reuteri ATCC PTA 5289.²⁵^–²⁹ Two study performed by Alamoudi et al. (2018) and Badri et al. (2021) also used Limosilactobacillus reuteri DSM 17938 and ATCC PTA 5289.²⁹^,³⁰ Nikawa et al. (2004) conducted a study with a 2-week intervention period where Limosilactobacillus reuteri was administered via yoghurt, and the count of Mutans streptococci was observed for 4 weeks.²⁸ Five other studies observed the count of Mutans streptococci immediately after the intervention duration.²⁵^–²⁷^,³⁰ The results of these studies showed that Limosilactobacillus reuteri has an immediate and long-term effect of up to two weeks against Mutans streptococci. Related to this result, Caglar et al. (2009) conducted a study to investigate whether Limosilactobacillus reuteri ATCC 55730 survived in the oral cavity after the discontinuation of intervention. They found that Limosilactobacillus reuteri decreased gradually, where after 1 week, only 8% of bacteria were detected, and after 5 weeks, the bacteria were completely undetected.³¹

One limitation of the findings on Mutans streptococci presented in this scoping review is that the subjects included in the literature are all healthy individuals. While these studies provide valuable insights into the prevalence and distribution of Streptococcus mutans in healthy populations, they may not necessarily reflect the same patterns observed in individuals with other oral health disorders. In fact, other studies have shown that there are significant differences in the levels of Mutans streptococci in individuals with severe periodontitis compared to healthy individuals.³² Therefore, future research should aim to explore the distribution of Mutans streptococci in a more diverse range of populations, including those with varying levels of oral health disorders. This will help to better understand the role of Mutans streptococci in the development and progression of oral diseases and inform more targeted prevention and treatment strategies.

Four of the six previously mentioned studies also analyzed salivary lactobacilli count as a dependent variable. All of the studies performed with healthy adults had the result that Limosilactobacillus reuteri has no significant antibacterial effect on salivary lactobacilli.²⁵^–²⁸ However, a study by Alamoudi et al. (2018) with healthy children as participants, discovered a positive antibacterial effect of Limosilactobacillus reuteri on salivary lactobacilli.²⁹ This result may be influenced by the dental hygiene performed by the children using the provided fluoride toothpaste. It may also be due to the absence of salivary lactobacilli in newborns, and 40% of the 3-year-old population have it to varying degrees. Whereas salivary lactobacilli in adults depend on ecological conditions, such as pits and fissures or partially erupted wisdom teeth which provide an environment that supports its growth.³³

The studies performed on healthy subjects concerning Mutans streptococci and salivary lactobacilli count were based on the prior knowledge that both microbiomes are related to dental caries. One of the salivary lactobacilli species, Lactobacillus acidophilus, has characteristics that will increase significantly 2-3 months before dental caries appear. This phenomenon is called the “explosion of Lactobacillus”. However, the main oral acid production was not from lactobacilli, thereby making it only a secondary microbiome in dental caries. Lactobacillus cannot adhere to tooth surfaces on their own, as they need retention niches. On the other hand, Streptococcus mutans could produce extracellular polysaccharides to help them adhere to the tooth structure. Streptococcus mutans’ main feature is its acidophilic nature. This allows it to become the dominant bacteria in the oral cavity during acidic conditions. Moreover, the intracellular polysaccharides in Streptococcus mutans create energy reserves, so the level of acid produced, especially lactic acid, remains constant even when external sugar intake is low. Hence, Mutans streptococci and salivary lactobacilli are strongly associated with dental caries.³⁴

The impact of Limosilactobacillus reuteri on microbiomes associated with peri-implant infection

Laleman et al. (2020), Tada et al. (2017), and Galofre et al. (2018) used peri-implantitis patients as their research subjects. These three studies analyzed the antibacterial effect of Limosilactobacillus reuteri DSM 17938 and ATCC PTA 5289 on Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans. Furthermore, Tada et al. (2019) and Galofre et al. (2018) also analyzed Treponema denticola and Tannerella forsythia, whereas only Galofre et al. (2018) analyzed Peptostreptococcus micros, Campylobacter rectus, and Eikenella corrodens. All of the patients received non-surgical mechanical debridement of the peri-implant sites.¹⁸^,³⁵^,³⁶ Two of these studies found that there were no significant differences between the treated and control groups in microbiome counts after 24 weeks and 30 days of intervention with Limosilactobacillus reuteri lozenges.¹⁸^,³⁶ However, the study conducted by Laleman et al. (2020) that used probiotic drops as the drug delivery mechanism found different results compared to the other two studies. The intervention period was 12 weeks and the observation time was the baseline, week 6, week 12, and week 24. This study also evaluated the microbiome counts in the following three sites: saliva, tongue, and subgingival. The count of Porphyromonas gingivalis was only reduced in the saliva of the treated group at the week 6 observation. The count of Aggregatibacter actinomycetemcomitans significantly decreased in the saliva and tongue at week 12. On week 24, the count of Aggregatibacter actinomycetemcomitans also decreased in the saliva. Next, the count of Prevotella intermedia in the tongue of the treated group showed a significant decrease in all of the observation periods, and a decrease was also found in the subgingival area on week 24.³⁵ These varying results may be influenced by the drug delivery mechanisms and the sites evaluated. Nevertheless, we can conclude that the number of peri-implant microbiota evaluated at the subgingival site was generally not affected by Limosilactobacillus reuteri, whether administered by lozenge or drops. Thus, similar studies need to be conducted for the tongue area and saliva evaluation, and a larger number of samples needs to be used to obtain conclusive results.

Regarding peri-implant mucositis patients, four of the selected studies analyzed the antibacterial effect of Limosilactobacillus reuteri DSM 17938 and ATCC PTA 5289 on Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola.¹¹^,³⁶^–³⁸ Three of the previous four studies also analyzed Prevotella intermedia, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Campylobacter rectus. Two of these three studies analyzed Peptostreptococcus micros and Eikenella corrodens, whereas the other study analyzed Fillifactor alocis, Porphyromonas endodontis, and Parvimonas micra.³⁶^–³⁸ Overall, it can be concluded that Limosilactobacillus reuteri had no antibacterial effect on Tannerella forsythia and Treponema denticola in peri-implant mucositis patients as there was no positive result from the four studies despite differences in the intervention period, observation time, and drug delivery mechanisms.¹¹^,³⁶^–³⁸ Similar negative results from the three studies were also noted in Prevotella intermedia, Aggregatibacter actinomycetemcomitans, and Campylobacter rectus. Additionally, Eikenella corrodens was found to be not affected by Lactobacillus reuteri in two studies.³⁶^–³⁸

Porphyromonas gingivalis in peri-implant mucositis patients was found to be significantly affected by Limosilactobacillus reuteri application via probiotic lozenge for thirty days. However, this result was only positive on day-90 observation time while the study also performed observation on days 30 and 60. Nevertheless, as previously described, Porphyromonas gingivalis in the saliva of peri-implantitis patients was significantly affected by Limosilactobacillus reuteri in the week-6 of observation and there was no significant difference in the week 12 and week 24 samples. However, these results were considered inconclusive due to the small number of samples and require further research.³⁶

Pena et al. (2019) conducted a study with no statistically significant different results between the treated and control group in all peri-implant microbiota after administering Limosilactobacillus reuteri tablets from day 15 until day 45 of the study. However, he also analyzed the difference between the bacteria count on the day of observation and at the beginning of the study in each group, then he compared those numbers between both groups. This method resulted in significantly reduced Peptostreptococcus micros in the treated group compared to the control group, as indicated by the difference in bacterial counts between day 15 and day 45, and between day 135 and baseline. Another positive result was also found in Fusobacterium nucleatum in bacterial count on day 135 minus the bacterial count on the baseline.³⁸

The impact of Limosilactobacillus reuteri on microbiomes associated with periodontal infection

One study conducted by Iniesta et al. (2012) provided evidence that the administration of Lactobacillus reuteri DSM 17938 and PTA 5289 probiotic tablets for 28 days effectively reduced the total anaerobic bacteria counts in saliva samples after 4 weeks and Prevotella intermedia counts after 8 weeks in gingivitis patients. This probiotic combination exhibited inhibitory effects against various periodontopathogens, such as Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Campylobacter rectus, Capno, Eikenella corrodens, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans in saliva samples. However, despite the significant total microbiological changes observed, these reductions in the target species did not translate into any clinically significant outcomes, as the inter-group differences in the clinical variables were not significant. This lack of clinical efficacy could be attributed to either the sample population or the short evaluation period. On the other hand, a significant reduction was observed only in Porphyromonas gingivalis counts in the subgingival sample from baseline to 4 weeks. These findings suggest that using Lactobacillus reuteri DSM 17938 and PTA 5289 probiotic tablets as an adjunct therapy could be promising for managing gingivitis and its associated periodontal pathogens, particularly Porphyromonas gingivalis.³⁹

Three articles in this scoping review examined the use of Limosilactobacillus reuteri DSM 17938 as a probiotic intervention in periodontitis patients. Of these three studies, one included diabetic patients with periodontitis, while the other two used healthy individuals with no systemic disease. The probiotic was administered in two studies as a tablet containing a combination of Limosilactobacillus reuteri DSM 17938 and ATCC PTA 5289, while the third study used only Limosilactobacillus reuteri DSM 17938 in the form of a suspension delivered through a blunt syringe to subgingival sites.⁴⁰^–⁴² Interestingly, the study with diabetic patients showed a significant reduction in the number of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola after three weeks of probiotic tablet use, which was sustained after a three-month evaluation.⁴⁰ On the other hand, in line with the previous result, the study conducted by Vivekananda with a split-mouth study design in India found that only the treatment modalities that included the Limosilactobacillus reuteri tablet, either alone or in combination with scaling root planing, were able to significantly reduce the counts of pathogens tested (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia).⁴¹ Lastly, the study conducted by El-bagoory et al. (2021) showed a significant reduction in the number of Porphyromonas gingivalis on the three-month and six-month evaluations after only four applications of the probiotic suspension delivered to subgingival sites, even though it was administered only at baseline, week 1, week 2, and week 4.⁴²

Acknowledging the potential influence of Limosilactobacillus reuteri on the results in previously mentioned diabetic samples, several studies have indicated its relationship with diabetes mellitus. While one study observed a decrease in HbA1c levels after twice-daily treatment with Limosilactobacillus reuteri DSM-17938 and ATCC PTA5289 probiotics for 3 weeks, though not statistically significant, indicating a potential trend toward improved glycemic control.⁴³ Additionally, Limosilactobacillus reuteri strains ADR-1 and ADR-3 have shown beneficial effects on Type 2 Diabetes Mellitus, possibly mediated by changes in intestinal flora.⁴⁴ Furthermore, daily treatment with Limosilactobacillus reuteri SD5865 has been associated with increased GLP-1 and GLP-2 secretion, improved insulin sensitivity, and reduced HbA1c levels, indicative of enhanced glucose metabolism.⁴⁵

The effectiveness of Limosilactobacillus reuteri in treating specific periodontal pathogens in peri-implant mucositis and periodontitis patients can vary depending on the distinct microbial network shape present in these niches. Peri-implant biofilm is more homogeneous and similar to supragingival biofilm than subgingival biofilm, while subgingival biofilm in periodontitis patients contains a higher number of microorganisms. In addition to this, the host response and habitat structure surrounding implants and teeth can also affect the microbial community structure and the effectiveness of probiotics.⁴⁶ Furthermore, the rough surface of dental implants increases the rate of biofilm formation around the implant, and surface roughness contributes to increased plaque buildup.⁴⁷

Based on our review, it was found that Limosilactobacillus reuteri is a probiotic bacterium that exhibits varying levels of antimicrobial activity against different pathogens. However, its effectiveness can be further enhanced by combining it with other clinical care and active ingredients such as natural compounds or prebiotics. For instance, Holm et al. (2022) showed that the antimicrobial effectiveness of Limosilactobacillus reuteri (ATCC PTA 5289) can be improved by combining it with glycerol against periodontal pathobionts and anaerobic commensals. This may be attributed to the increased production of reuterin by Limosilactobacillus reuteri from glycerol.⁴⁸ Hence, combining Limosilactobacillus reuteri with other active ingredients such as natural compounds or prebiotics may be a useful strategy for improving its antimicrobial efficacy. However, further details on this strategy need to be explored, including relevant references and future research perspectives. It is worth mentioning that some newly introduced compounds have a significant influence on the oral environment. The use of paraprobiotics, lysates, and postbiotics can modify clinical and microbiological parameters in periodontal patients.⁴⁹^–⁵¹ Therefore, these products should be considered in combination with Limosilactobacillus reuteri in future clinical trials.

Limitation of the study

In conducting a scoping review, it is important to consider the limitations of the study design in order to interpret the findings in a meaningful way. One limitation of the current scoping review is the potential for bias in quality assessment due to the inclusion of a non-randomized study with a high risk of bias. However, the review also included 15 other studies, all of which were randomized control trials. Of these, 9 studies were found to have a low risk of bias, while 6 studies had “some concerns” regarding risk of bias based on the Cochrane Risk-Of-Bias (RoB 2) Tool. Although the non-randomized study may have impacted the overall quality of the evidence included in the review, the findings of the randomized control trials provide important insights into the effectiveness of the interventions studied. Moreover, the inclusion of grey literature in the search strategy can help to enhance the comprehensiveness of the review. Overall, while limitations should be acknowledged and considered in the interpretation of the findings, the scoping review still provides valuable insights and can serve as a foundation for future research in the field.

Furthermore, in this scoping review, it was found that several studies included in the analysis received materials and funding from a sponsor. Additionally, one author from a study received a PhD grant from the sponsor, while another author received a lecturing fee. Nonetheless, the authors of these studies stated that the involvement of the sponsor did not have any impact on the results of their research. It is essential to acknowledge the presence of external funding sources and their potential influence on study outcomes, as transparency in reporting is crucial in scientific research. Despite the presence of sponsorship, the authors of the reviewed studies made it clear that the research conducted was not compromised, and their findings were not influenced by the sponsors. However, it is necessary to approach the results with caution, as the presence of external funding sources can still potentially affect the outcome of research studies.

Conclusions

Limosilactobacillus reuteri exhibits a strong antibacterial effect on Streptococcus mutans and has a less significant impact on Lactobacilli in healthy individuals. Additionally, Limosilactobacillus reuteri has antibacterial properties against Porphyromonas gingivalis in periodontitis and gingivitis patient although its effectiveness is not stable in patients with peri-implant infections. The study suggests that Lactobacillus reuteri does not have a noteworthy impact on Campylobacter rectus and Eikenella corrodens. However, the effectiveness of Limosilactobacillus reuteri varies concerning other bacteria such as Prevotella intermedia, Peptostreptococcus micros, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum. Further research is essential to examine the antibacterial properties of Limosilactobacillus reuteri on the oral/dental microbiomes, taking into account variations in the strains used, intervention periods, subjects, and observation times. This research is crucial in advancing our understanding of Limosilactobacillus reuteri’s potential as a probiotic for maintaining oral/dental health.

Data availability

Underlying data

No data are associated with this article.

Extended data

Harvard Dataverse: Search Strategy for the Article “The Antimicrobial Effect of Limosilactobacillus reuteri as Probiotic on Oral Bacteria: A scoping review”, https://doi.org/10.7910/DVN/IPHU9X.⁵²

Reporting guidelines

Harvard Dataverse: PRISMA-ScR Checklist for the Article “The Antimicrobial Effect of Limosilactobacillus reuteri as Probiotic on Oral Bacteria: A scoping review”, https://doi.org/10.7910/DVN/EIGWI1.⁵³

Harvard Dataverse: PRISMA Flow Diagram for the Article “The Antimicrobial Effect of Limosilactobacillus reuteri as Probiotic on Oral Bacteria: A scoping review”, https://doi.org/10.7910/DVN/VJLVI9.⁵⁴

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

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43. Elsadek MF, Ahmed BM, Alkhawtani DM, et al.: A comparative clinical, microbiological and glycemic analysis of photodynamic therapy and Lactobacillus reuteri in the treatment of chronic periodontitis in type-2 diabetes mellitus patients. Photodiagnosis Photodyn. Ther. 2020; 29: 101629. PubMed Abstract | Publisher Full Text
44. Hsieh MC, Tsai WH, Jheng YP, et al.: The beneficial effects of Lactobacillus reuteri ADR-1 or ADR-3 consumption on type 2 diabetes mellitus: a randomized, double-blinded, placebo-controlled trial. Sci. Rep. 2018; 8: 1–11.
45. Abuqwider J, Altamimi M, Mauriello G: Limosilactobacillus reuteri in Health and Disease. Microorganisms. 2022; 10: 1–17.
46. Sousa V, Nibali L, Spratt D, et al.: Peri-implant and periodontal microbiome diversity in aggressive periodontitis patients: a pilot study. Clin. Oral Implants Res. 2017; 28(5): 558–570. PubMed Abstract | Publisher Full Text
47. Dhir S: Biofilm and dental implant: The microbial link. J. Indian Soc. Periodontol. 2013 Jan; 17(1): 5–11. PubMed Abstract | Publisher Full Text | Free Full Text
48. Van Holm W, Verspecht T, Carvalho R, et al.: Glycerol strengthens probiotic effect of Limosilactobacillus reuteri in oral biofilms: A synergistic synbiotic approach. Mol. Oral Microbiol. 2022 Dec 1; 37(6): 266–275. PubMed Abstract | Publisher Full Text
49. Butera A, Gallo S, Maiorani C, et al.: Management of gingival bleeding in periodontal patients with domiciliary use of toothpastes containing hyaluronic acid, lactoferrin, or paraprobiotics: A randomized controlled clinical trial. Appl. Sci. 2021; 11(18). Publisher Full Text
50. Butera A, Gallo S, Pascadopoli M, et al.: Home Oral Care of Periodontal Patients Using Antimicrobial Gel with Postbiotics, Lactoferrin, and Aloe Barbadensis Leaf Juice Powder vs. Conventional Chlorhexidine Gel: A Split-Mouth Randomized Clinical Trial. Antibiotics. 2022; 11(1). PubMed Abstract | Publisher Full Text | Free Full Text
51. Vale GC, Mayer MPA: Effect of probiotic Lactobacillus rhamnosus by-products on gingival epithelial cells challenged with Porphyromonas gingivalis. Arch. Oral Biol. 2021; 128(March): 105174. PubMed Abstract | Publisher Full Text
52. Ananda N, Bachtiar EW, Suniarti DF: Search Strategy for the Article “The Antimicrobial Effect of Limosilactobacillus reuteri as Probiotic on Oral Bacteria: A scoping review”. Harvard Dataverse. 2023; V1. Publisher Full Text
53. Ananda N, Bachtiar EW, Suniarti DF: PRISMA-ScR Checklist for the Article “The Antimicrobial Effect of Limosilactobacillus reuteri as Probiotic on Oral Bacteria: A scoping review”. Harvard Dataverse. 2023; V1. Publisher Full Text
54. Ananda N, Bachtiar EW, Suniarti DF: PRISMA Flow Diagram for the Article “The Antimicrobial Effect of Limosilactobacillus reuteri as Probiotic on Oral Bacteria: A scoping review”. Harvard Dataverse. 2023; V1. Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 23 Nov 2023

Author details Author details

Nissia Ananda
Roles: Data Curation, Writing – Original Draft Preparation

Dewi Fatma Suniarti
Roles: Data Curation, Writing – Review & Editing

Endang Winiati Bachtiar
Roles: Data Curation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This work was supported by the Indonesian Endowment Fund for Education (LPDP), Ministry of Finance Republic of Indonesia.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (2)

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Published: 04 Mar 2024, 12:1495

https://doi.org/10.12688/f1000research.139697.2

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https://doi.org/10.12688/f1000research.139697.1

© 2024 Ananda N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ananda N, Suniarti DF and Bachtiar EW. The antimicrobial effect of Limosilactobacillus reuteri as probiotic on oral bacteria: A scoping review [version 2; peer review: 3 approved]. F1000Research 2024, 12:1495 (https://doi.org/10.12688/f1000research.139697.2)

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Reviewer Report 27 Mar 2024

Norifumi Nakamura, Kagoshima University, Korimoto, Kagoshima, Japan

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https://doi.org/10.5256/f1000research.163098.r252502

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Reviewer Report 14 Mar 2024

Rizky Aditiya Irwandi, University College London, London, UK

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https://doi.org/10.5256/f1000research.163098.r252504

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Reviewer Report 09 Feb 2024

Rizky Aditiya Irwandi, University College London, London, UK

Approved with Reservations

https://doi.org/10.5256/f1000research.152995.r237795

The authors provide a rather extensive review of the per-oral probiotics research, specifically its influence on oral microbiome not limited to oral-derived pathogens. Overall, the scoping review has adhered to the standardized criteria and all relevant information relevant to the review has been well delivered in detail. To achieve this, I would strongly recommend the authors to revise some aspects detailed below:
Introduction
Paragraph 1: It would be concise to exclude the first paragraph.
Paragraph 2: As the second paragraph becomes the first one, consider removing the word “Generally” would be appropriate.
Paragraph 3: It would be concise to exclude the third paragraph.
Paragraph 4: Consider removing “usually” from the first sentence and combining the first two sentences with conjunction words such as “and” would be more concise. For instance:
“Oral microbiomes reside in the oral cavity as biofilms and maintaining their homeostasis is important to protect the oral cavity as the main gateway to the body. The shifted oral microbial balance may lead to diseases and antibiotics are a common antimicrobial approach to regain the oral microbiota equilibrium. Over-reliant antibiotic administration, however, increases the risk of developing antimicrobial resistance which WHO declared as one of the global health emergencies and is also known as a silent pandemic. Therefore, an alternative intervention such as probiotics gains attention to maintain oral biofilm homeostasis”
Paragraph 5: removing “will” in the first sentence and “can” in the second and third as well as replacing “which is” with “by” in the second sentence and correcting the typo “pathogen” to “pathogenic” would help readers to better understand the ideas delivered by the authors.
Results
The authors included RCT studies. I would recommend the authors include the RCT registration ID by clinicaltrial.gov or any other relevant RCT databases and present them in Table 1. This is particularly important to objectively assess each study confirming that indeed the RCTs designed by certain studies have fulfilled the criteria of the commonly used RCT databases.
The authors mentioned that the review adheres to the PRISMA-ScR and that it would be easier for the reader to have a completed fillable checklist. This can be provided as supplemental information to the article. The authors may refer to this webpage for the checklist: http://www.prisma-statement.org/documents/PRISMA-ScR-Fillable-Checklist_11Sept2019.pdf
Discussion
Paragraph one: the authors delivered ideas about the need for alternatives to antimicrobial approaches (in this case antibiotics) by harnessing bacterial quorum sensing. At the same time, however, the authors mentioned that quorum sensing leads to antibiotic resistance. I found this conflicting and this likely confuses the reader. I would recommend the authors revisit by restructuring this part.
The use of active voices is, I would suggest, preferable to strengthen the clarity of ideas delivered. For example, the first sentences could be:
“Oral biofilms consist primarily of commensal species that are in equilibrium and harmless to the host. However, both oral and systemic-derived insults are capable of inducing the alteration towards microbial dysbiosis leading to an increased number of pathogenic microbial species.”
Minor errors:
Paragraph 2: Replace “on the other side” with “moreover”
Paragraph 3: Replace “conditions” with “disorders”
The authors comprehensively discussed the studies included in the review. The detailed mechanisms of probiotic actions (for example, how probiotics are likely to influence bacterial quorum sensing) would provide a strong rationale for continuing the use of probiotics to regain the balance of oral microbiota. The ideas would be even more robust if the authors could expand more on the aspect such as to what extent the use of the probiotics is strongly recommended and perhaps any potential side effects should be highlighted (if no side effects are available, considering the explanation of the possible mechanism of this would be recommended).

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: oral microbiology and immunology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

13 Apr 2024

Author Response
Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:
... Continue reading
Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:

Introduction

I deleted the first and third paragraph

I removed the “Generally” word on the second paragraph (the new first paragraph)

I have incorporated your suggestion regarding the writing and wording of the 4th and 5th paragraphs.

Results

Thank you for your suggestion to include RCT registration IDs for the articles selected in our scoping review. However, after careful consideration, we have decided not to pursue this request for several reasons. Firstly, it's important to note that not all selected articles may have RCT registration IDs available, particularly if they were published before mandatory registration policies were implemented or if they encompass a range of study designs beyond RCTs. Additionally, obtaining RCT registration IDs for older studies may not be feasible due to logistical constraints. Moreover, the primary focus of our scoping review is not on assessing the registration status of RCTs but rather on mapping existing literature on the topic at hand. Therefore, including RCT registration IDs for each article may not align with the scope and objectives of our review. Furthermore, while RCT registration is an important aspect of research transparency, the absence of registration IDs does not necessarily imply lower quality or validity of the included studies. We have ensured the trustworthiness of the literature reviewed through other rigorous inclusion criteria. Lastly, considering the space constraints and journal requirements, including RCT registration IDs for each article may unnecessarily lengthen the manuscript and detract from the main findings and discussion. We appreciate your input and understanding regarding our decision not to include RCT registration IDs in our scoping review

The PRISMA-ScR checklist has been provided in the datasets, with the link to access it written in the data availability section.

Discussion

I added a brief explanation of quorum quenching, which inhibits quorum sensing.

I have implemented your suggestion regarding the writing and wording of the 2nd and 3rd paragraphs. I also have applied your suggestion concerning the use of active voice.

I have included additional discussion on the mechanism of quorum quenching, which inhibits quorum sensing in probiotics, affecting pathogenic bacteria. Furthermore, I have elaborated on the cytotoxicity of Limosilactobacillus reuteri on human gingival fibroblasts.
Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:

Introduction

I deleted the first and third paragraph

I removed the “Generally” word on the second paragraph (the new first paragraph)

I have incorporated your suggestion regarding the writing and wording of the 4th and 5th paragraphs.

Results

Thank you for your suggestion to include RCT registration IDs for the articles selected in our scoping review. However, after careful consideration, we have decided not to pursue this request for several reasons. Firstly, it's important to note that not all selected articles may have RCT registration IDs available, particularly if they were published before mandatory registration policies were implemented or if they encompass a range of study designs beyond RCTs. Additionally, obtaining RCT registration IDs for older studies may not be feasible due to logistical constraints. Moreover, the primary focus of our scoping review is not on assessing the registration status of RCTs but rather on mapping existing literature on the topic at hand. Therefore, including RCT registration IDs for each article may not align with the scope and objectives of our review. Furthermore, while RCT registration is an important aspect of research transparency, the absence of registration IDs does not necessarily imply lower quality or validity of the included studies. We have ensured the trustworthiness of the literature reviewed through other rigorous inclusion criteria. Lastly, considering the space constraints and journal requirements, including RCT registration IDs for each article may unnecessarily lengthen the manuscript and detract from the main findings and discussion. We appreciate your input and understanding regarding our decision not to include RCT registration IDs in our scoping review

The PRISMA-ScR checklist has been provided in the datasets, with the link to access it written in the data availability section.

Discussion

I added a brief explanation of quorum quenching, which inhibits quorum sensing.

I have implemented your suggestion regarding the writing and wording of the 2nd and 3rd paragraphs. I also have applied your suggestion concerning the use of active voice.

I have included additional discussion on the mechanism of quorum quenching, which inhibits quorum sensing in probiotics, affecting pathogenic bacteria. Furthermore, I have elaborated on the cytotoxicity of Limosilactobacillus reuteri on human gingival fibroblasts.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

13 Apr 2024

Author Response
Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:
... Continue reading
Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:

Introduction

I deleted the first and third paragraph

I removed the “Generally” word on the second paragraph (the new first paragraph)

I have incorporated your suggestion regarding the writing and wording of the 4th and 5th paragraphs.

Results

Thank you for your suggestion to include RCT registration IDs for the articles selected in our scoping review. However, after careful consideration, we have decided not to pursue this request for several reasons. Firstly, it's important to note that not all selected articles may have RCT registration IDs available, particularly if they were published before mandatory registration policies were implemented or if they encompass a range of study designs beyond RCTs. Additionally, obtaining RCT registration IDs for older studies may not be feasible due to logistical constraints. Moreover, the primary focus of our scoping review is not on assessing the registration status of RCTs but rather on mapping existing literature on the topic at hand. Therefore, including RCT registration IDs for each article may not align with the scope and objectives of our review. Furthermore, while RCT registration is an important aspect of research transparency, the absence of registration IDs does not necessarily imply lower quality or validity of the included studies. We have ensured the trustworthiness of the literature reviewed through other rigorous inclusion criteria. Lastly, considering the space constraints and journal requirements, including RCT registration IDs for each article may unnecessarily lengthen the manuscript and detract from the main findings and discussion. We appreciate your input and understanding regarding our decision not to include RCT registration IDs in our scoping review

The PRISMA-ScR checklist has been provided in the datasets, with the link to access it written in the data availability section.

Discussion

I added a brief explanation of quorum quenching, which inhibits quorum sensing.

I have implemented your suggestion regarding the writing and wording of the 2nd and 3rd paragraphs. I also have applied your suggestion concerning the use of active voice.

I have included additional discussion on the mechanism of quorum quenching, which inhibits quorum sensing in probiotics, affecting pathogenic bacteria. Furthermore, I have elaborated on the cytotoxicity of Limosilactobacillus reuteri on human gingival fibroblasts.
Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:

Introduction

I deleted the first and third paragraph

I removed the “Generally” word on the second paragraph (the new first paragraph)

I have incorporated your suggestion regarding the writing and wording of the 4th and 5th paragraphs.

Results

Thank you for your suggestion to include RCT registration IDs for the articles selected in our scoping review. However, after careful consideration, we have decided not to pursue this request for several reasons. Firstly, it's important to note that not all selected articles may have RCT registration IDs available, particularly if they were published before mandatory registration policies were implemented or if they encompass a range of study designs beyond RCTs. Additionally, obtaining RCT registration IDs for older studies may not be feasible due to logistical constraints. Moreover, the primary focus of our scoping review is not on assessing the registration status of RCTs but rather on mapping existing literature on the topic at hand. Therefore, including RCT registration IDs for each article may not align with the scope and objectives of our review. Furthermore, while RCT registration is an important aspect of research transparency, the absence of registration IDs does not necessarily imply lower quality or validity of the included studies. We have ensured the trustworthiness of the literature reviewed through other rigorous inclusion criteria. Lastly, considering the space constraints and journal requirements, including RCT registration IDs for each article may unnecessarily lengthen the manuscript and detract from the main findings and discussion. We appreciate your input and understanding regarding our decision not to include RCT registration IDs in our scoping review

The PRISMA-ScR checklist has been provided in the datasets, with the link to access it written in the data availability section.

Discussion

I added a brief explanation of quorum quenching, which inhibits quorum sensing.

I have implemented your suggestion regarding the writing and wording of the 2nd and 3rd paragraphs. I also have applied your suggestion concerning the use of active voice.

I have included additional discussion on the mechanism of quorum quenching, which inhibits quorum sensing in probiotics, affecting pathogenic bacteria. Furthermore, I have elaborated on the cytotoxicity of Limosilactobacillus reuteri on human gingival fibroblasts.
Competing Interests: No competing interests were disclosed. Close
Report a concern

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Reviewer Report 07 Feb 2024

Norifumi Nakamura, Kagoshima University, Korimoto, Kagoshima, Japan

Approved

https://doi.org/10.5256/f1000research.152995.r226208

The antimicrobial activity of Limosilactobacillus reuteri, one of the probiotic strains, is of great interest and brings useful information to the field of dentistry
However, the following major and minor problems are observed and should be corrected before acceptance.

Major problems.
1. It would be required to describe the results of the evaluation of the effect of the antibacterial activity of Limosylactobacillus reuteri on human oral bacteria based on the 16 papers that were finally selected.
2. The discussion contains too many results and seems redundant. The discussion should be organized into important items with small headings.
3. What are the criteria for arranging the 16 papers summarized in Table 1? Wouldn't it be easier for readers to read them if they were sorted by year of publication or evidence level of study design?

Minor problems
4. The article by Badari (2020), which was selected for Systematic review, is not in the list of references.
5. The year in the text is different from the year in the list of references
5. The text is well written, but is divided into too many small paragraphs.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Oral and Maxillofacial Surgery, Reconstructive Surgery, Odontogenic Tumors

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response 13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

13 Apr 2024

Author Response

Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems
... Continue reading Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems

1. I have summarized the findings from the selected articles in the discussion section. However, it cannot be generalized as a whole because the target bacteria of each article are not the same. Therefore, by adding subheadings in the discussion section, the results presented can be clarified.

2. I subdivided the discussion section into smaller subheadings.

3. I have reordered the articles in the table to be sorted by year of publication.

Minor problems

4. The article by Badari was previously miswritten as Matuq in reference number 28

5. The years of the references have already been synchronized between the manuscript and the references.

6. I believe that the division of my article into numerous smaller paragraphs is not an issue. It follows the standard convention that a paragraph typically consists of at least three sentences.
Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems

1. I have summarized the findings from the selected articles in the discussion section. However, it cannot be generalized as a whole because the target bacteria of each article are not the same. Therefore, by adding subheadings in the discussion section, the results presented can be clarified.

2. I subdivided the discussion section into smaller subheadings.

3. I have reordered the articles in the table to be sorted by year of publication.

Minor problems

4. The article by Badari was previously miswritten as Matuq in reference number 28

5. The years of the references have already been synchronized between the manuscript and the references.

6. I believe that the division of my article into numerous smaller paragraphs is not an issue. It follows the standard convention that a paragraph typically consists of at least three sentences.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

13 Apr 2024

Author Response

Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems
... Continue reading Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems

1. I have summarized the findings from the selected articles in the discussion section. However, it cannot be generalized as a whole because the target bacteria of each article are not the same. Therefore, by adding subheadings in the discussion section, the results presented can be clarified.

2. I subdivided the discussion section into smaller subheadings.

3. I have reordered the articles in the table to be sorted by year of publication.

Minor problems

4. The article by Badari was previously miswritten as Matuq in reference number 28

5. The years of the references have already been synchronized between the manuscript and the references.

6. I believe that the division of my article into numerous smaller paragraphs is not an issue. It follows the standard convention that a paragraph typically consists of at least three sentences.
Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems

1. I have summarized the findings from the selected articles in the discussion section. However, it cannot be generalized as a whole because the target bacteria of each article are not the same. Therefore, by adding subheadings in the discussion section, the results presented can be clarified.

2. I subdivided the discussion section into smaller subheadings.

3. I have reordered the articles in the table to be sorted by year of publication.

Minor problems

4. The article by Badari was previously miswritten as Matuq in reference number 28

5. The years of the references have already been synchronized between the manuscript and the references.

6. I believe that the division of my article into numerous smaller paragraphs is not an issue. It follows the standard convention that a paragraph typically consists of at least three sentences.
Competing Interests: No competing interests were disclosed. Close
Report a concern

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Reviewer Report 19 Dec 2023

Firdaus Hariri, University of Malaya,, Kuala Lumpur,, Malaysia

Approved

https://doi.org/10.5256/f1000research.152995.r226213

Well done to the team of researchers for this valuable review.

1) In general, the paper is well written and very structured.
2) The objective and research question are clear and the methodology used to achieve the objective is comprehensively described supplemented with the application of appropriate review protocol.
3) Results are well structured, supplemented with excellent summary tables.
4) Discussion:
- as Limosilactobacillus reuteri has been widely used as valuable probiotic in human, may I recommend a brief paragraph, either in 'Introduction' or at beginning of 'Discussion' on its usage in general health (authors only described its potential role in oral health).
- to supplement the discussion on paragraph 12 (on diabetic patients) with studies about the role of Limosilactobacillus reuteri in diabetes mellitus (e.g metabolic or beneficial effect).

Thank you.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Metagenomic, oral health, oral and maxillofacial surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

13 Apr 2024

Author Response

Thank you for your insightful comments as a reviewer of my article. I have taken your suggestions into consideration. I added a brief explanation about the usage of Limosilactobacillus reuteri ... Continue reading Thank you for your insightful comments as a reviewer of my article. I have taken your suggestions into consideration. I added a brief explanation about the usage of Limosilactobacillus reuteri in general health in the discussion section, and I also included a paragraph discussing the relationship between Limosilactobacillus reuteri and diabetes mellitus.
Thank you for your insightful comments as a reviewer of my article. I have taken your suggestions into consideration. I added a brief explanation about the usage of Limosilactobacillus reuteri in general health in the discussion section, and I also included a paragraph discussing the relationship between Limosilactobacillus reuteri and diabetes mellitus.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

13 Apr 2024

Author Response

Thank you for your insightful comments as a reviewer of my article. I have taken your suggestions into consideration. I added a brief explanation about the usage of Limosilactobacillus reuteri ... Continue reading Thank you for your insightful comments as a reviewer of my article. I have taken your suggestions into consideration. I added a brief explanation about the usage of Limosilactobacillus reuteri in general health in the discussion section, and I also included a paragraph discussing the relationship between Limosilactobacillus reuteri and diabetes mellitus.
Thank you for your insightful comments as a reviewer of my article. I have taken your suggestions into consideration. I added a brief explanation about the usage of Limosilactobacillus reuteri in general health in the discussion section, and I also included a paragraph discussing the relationship between Limosilactobacillus reuteri and diabetes mellitus.
Competing Interests: No competing interests were disclosed. Close
Report a concern

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Firdaus Hariri, University of Malaya,, Kuala Lumpur,, Malaysia
Norifumi Nakamura, Kagoshima University, Korimoto, Kagoshima, Japan
Rizky Aditiya Irwandi, University College London, London, UK

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27 Mar 2024 | for Version 2

Norifumi Nakamura, Kagoshima University, Korimoto, Kagoshima, Japan

4 Views Cite this report Responses(0)

Approved

The revised version of this article has been improved following the reviewer's indications and suggestions.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Oral and Maxillofacial Surgery, Reconstructive Surgery, Odontogenic Tumors

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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14 Mar 2024 | for Version 2

Rizky Aditiya Irwandi, University College London, London, UK

2 Views Cite this report Responses(0)

Approved

The authors have revised the manuscript accordingly and I am pleased to inform you that it is approved.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

oral microbiology and immunology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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09 Feb 2024 | for Version 1

Rizky Aditiya Irwandi, University College London, London, UK

10 Views Cite this report Responses(1)

Approved With Reservations

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

oral microbiology and immunology

Respond to this report

Responses (1)

Author Response

13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

Thank you for your perceptive feedback as a reviewer of my article. I have carefully considered your suggestions, and I will address each of your comments point by point below:

Introduction

I deleted the first and third paragraph
I removed the “Generally” word on the second paragraph (the new first paragraph)
I have incorporated your suggestion regarding the writing and wording of the 4th and 5th paragraphs.

Results

Thank you for your suggestion to include RCT registration IDs for the articles selected in our scoping review. However, after careful consideration, we have decided not to pursue this request for several reasons. Firstly, it's important to note that not all selected articles may have RCT registration IDs available, particularly if they were published before mandatory registration policies were implemented or if they encompass a range of study designs beyond RCTs. Additionally, obtaining RCT registration IDs for older studies may not be feasible due to logistical constraints. Moreover, the primary focus of our scoping review is not on assessing the registration status of RCTs but rather on mapping existing literature on the topic at hand. Therefore, including RCT registration IDs for each article may not align with the scope and objectives of our review. Furthermore, while RCT registration is an important aspect of research transparency, the absence of registration IDs does not necessarily imply lower quality or validity of the included studies. We have ensured the trustworthiness of the literature reviewed through other rigorous inclusion criteria. Lastly, considering the space constraints and journal requirements, including RCT registration IDs for each article may unnecessarily lengthen the manuscript and detract from the main findings and discussion. We appreciate your input and understanding regarding our decision not to include RCT registration IDs in our scoping review
The PRISMA-ScR checklist has been provided in the datasets, with the link to access it written in the data availability section.

Discussion

I added a brief explanation of quorum quenching, which inhibits quorum sensing.
I have implemented your suggestion regarding the writing and wording of the 2nd and 3rd paragraphs. I also have applied your suggestion concerning the use of active voice.
I have included additional discussion on the mechanism of quorum quenching, which inhibits quorum sensing in probiotics, affecting pathogenic bacteria. Furthermore, I have elaborated on the cytotoxicity of Limosilactobacillus reuteri on human gingival fibroblasts.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

6 Views

07 Feb 2024 | for Version 1

Norifumi Nakamura, Kagoshima University, Korimoto, Kagoshima, Japan

6 Views Cite this report Responses(1)

Approved

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Oral and Maxillofacial Surgery, Reconstructive Surgery, Odontogenic Tumors

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Author Response

13 Apr 2024

Nissia Ananda, Dentistry, Universitas Indonesia, Depok, Indonesia

Thank you for your valuable feedback as a reviewer of my article. I have carefully considered your suggestions. Below, I will address each of your comments individually:

Major problems

1. I have summarized the findings from the selected articles in the discussion section. However, it cannot be generalized as a whole because the target bacteria of each article are not the same. Therefore, by adding subheadings in the discussion section, the results presented can be clarified.

2. I subdivided the discussion section into smaller subheadings.

3. I have reordered the articles in the table to be sorted by year of publication.

Minor problems

4. The article by Badari was previously miswritten as Matuq in reference number 28

5. The years of the references have already been synchronized between the manuscript and the references.

6. I believe that the division of my article into numerous smaller paragraphs is not an issue. It follows the standard convention that a paragraph typically consists of at least three sentences.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

13 Views

19 Dec 2023 | for Version 1

Firdaus Hariri, University of Malaya,, Kuala Lumpur,, Malaysia

13 Views Cite this report Responses(1)

Approved

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Metagenomic, oral health, oral and maxillofacial surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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The antimicrobial effect of Limosilactobacillus reuteri as probiotic on oral bacteria: A scoping review

Abstract

Keywords

Revised Amendments from Version 1

Introduction

Objective

Methods

Scoping review methods

Research questions

Search methods

Selection of studies

Eligibility criteria

Data extraction

Methodological quality assesment

Results

Search results

Table 1. Included studies.

Figure 1. Flowchart of the scoping review.

General characteristics of included studies

Strains of Limosilactobacillus reuteri Used in Studies

Results of the quality assessment

Figure 2. The distribution of risk-of-bias judgments within each bias domain.

Table 2. Quality assesment of each studies.

Discussions

The impact of Limosilactobacillus reuteri on microbiomes associated with dental caries (Mutans streptococci and salivary lactobacilli)

The impact of Limosilactobacillus reuteri on microbiomes associated with peri-implant infection

The impact of Limosilactobacillus reuteri on microbiomes associated with periodontal infection

Limitation of the study

Conclusions

Data availability

Underlying data

Extended data

Reporting guidelines

References

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