The treatment and prevention of periodontitis is focused on the reduction and the elimination of pathogenic bacteria, especially A. actinomycetemcomitans and black pigmented bacteria such as P. gingivalis . To prevent recurrent disease, the recolonization of these bacteria should be inhibited in the periodontal pocket. Since the replacement therapy was introduced in periodontics by Hillman et al, Jeong et al reported that hydrogen peroxide-producing Lactobacillus acidophilus V-20 completely inhibited P. gingivalis and A. actinomycetemcomitans in vitro and mouth gargling with Lactobacillus acidophilus V-20 in periodontitis patients during the maintenance phase improved clinical condition and reduced the No. of P. gingivalis and A. actinomycetemcomitans at 4 weeks of treatment. Prior to replacement therapy with bacteria, dynamics of microbial colonization should be considered.

This study was performed to evaluate the change in the viable cell number of Lactobacilli and P. gingivalis after oral administration of L. acidophilus V-20. In periodontal health, gargling increased the No. of Lactobacilli in saliva, buccal mucosa, supragingival plaque from the first week, which maintained for 2-3 weeks after gargling stop, and then returned to the undetectable baseline level at the ninth week. In the periodontal pocket of moderate periodontitis patients, daily irrigation for 1 week and weekly irrigation for subsequent 3 weeks decreased the viable cell number of P. gingivalis during the period of irrigation and increased the number of Lactobacilli , which was maintained from the second to the seventh week. L. acidophilus V-20 was isolated for the first 2 weeks of oral administration, and the 3 different strains of Lactobacilli were isolated continuously for remaining period and identified as L. alimentarius , L. casei subspecies casei and L. fructosus . The first two Lactobacilli strains completely inhibited P. gingivalis in vitro and all the isolated Lactobacilli strains reduced the artificial plaque formation by 55-63%.

These results showed that mouth gargling or pocket irrigation with L. acidophilus V-20 increased the No. of intraoral Lactobacilli and caused to decrease in the No. of P. gingivalis . This suggests that the replacement therapy by these Lactobacilli might be useful in the maintenance care of periodontal patients.