Localized Necrotic Ulceration Gingivitis, in Orthodontic Patient, Treated with Non- Surgical Periodontal Therapy and with Probiotics (L. Reuteri)

Acute Necrotic Ulcerative Gingivitis constitute a group of aggressive semi-reversible periodontal disease usually linked to deep microbiome alterations (Treponema sp., B. melaninogenicus ssp. intermedius and the Fusobacterium sp) and difficult plaque removal. Patients undergoing in fixed orthodontic treatment could have higher risk in periodontal/gum disease development. Therapy for resilient and resistant ANUG is usually represented by pocket debridement and additional systemic therapies (often Metronidazole). In recent years patients resistance to antimicrobial therapies has strongly increased, so probiotic represent a new incoming approach in non surgical periodontal diseases treatment. The aim of this work is to report a case of orthodontic patient with refractory ANUG successfully treated with topical probiotic L. Reuteri. A 16-year-old female with a necrotic ulceration gingivitis reported to our private practice. The patient was submitted to local antiseptics and periodontal debridement for several months without improvement. We had decided to associate a treatment with topical probiotics Lactobacillus reuteri DSM 17938 and lactobacillus reuteri ATCC PTA 5289 to the non-surgical periodontal therapy. The solution of probiotic was injected into the pockets until the spill, for 3-5 minutes and at the end the patient did not rinse the mouth and was advised not to eat and drink for about an hour. The use of topical probiotics in the treatment of gingivitis and ANUG could be considered a valid alternative to conventional treatments for refractory cases in orthodontic patients. Further studies, especially randomized clinical trials, must be performed to confirm this starting result.