Oral microbiota and its pharmacological modulation in periodontitis: a systematic review (PRISMA)

Periodontitis remains one of the most common causes of tooth loss, with disruption of oral microbial balance recognized as a key factor in its pathogenesis. Growing interest in the microbiota as a therapeutic target has made it important to study pharmacological approaches aimed at restoring balance and reducing inflammation. The purpose of this systematic review was to assess the effectiveness of probiotics, prebiotics, and other agents that influence the oral microbiota in periodontitis. Following PRISMA standards, studies published between 2020 and 2025 were analyzed, including clinical and review works. It was found that the use of probiotics (Lactobacillus reuteri,L. salivarius,Bifidobacterium spp.) and prebiotics (inulin) reduces periodontal pocket depth and gingival bleeding, normalizes microbial composition, and decreases inflammatory cytokine levels. The strongest effect was observed when these agents were combined with conventional mechanical debridement. The findings confirm that pharmacological modulation of the oral microbiota is a safe and effective adjunct to standard periodontal therapy. This review summarizes the latest evidence on the use of probiotics and prebiotics in dentistry and identifies the most promising microbial strains and future research directions for developing optimal treatment protocols.