Chronic Tonsillitis Aggravates Chronic Periodontitis: Shared Pathogens and a Probiotic-Based Combined Sanation Protocol

Abstract

Chronic periodontitis (CP) is a dysbiosis-driven inflammatory disease, yet the influence of a persistent oropharyngeal focus such as chronic tonsillitis (CT) on its clinical, microbiological and immunological phenotype remains poorly defined. This prospective, controlled study (2019–2024) enrolled 156 adults (18–60 years) in three groups: CP with CT (Group 1, n = 64), CP without CT (Group 2, n = 62), and periodontally healthy controls (Group 3, n = 30). Periodontal indices, quantitative culture of paired periodontal-pocket and tonsillar-crypt samples with 16S-rRNA genotyping, and serum and oral-fluid cytokines were assessed. Within Group 1, patients received a staged combined-sanation algorithm adding tonsillar lavage and natural biotherapeutics—probiotics (Lactobacillus rhamnosus, Bifidobacterium longum), topical hyaluronate and antioxidants (Subgroup 3.1, n = 31)- or standard periodontal therapy (Subgroup 3.3, n = 33), with follow-up to 6 months. Despite equivalent oral hygiene, Group 1 was more severe than Group 2 (probing depth 4.9 ± 0.8 vs 4.1 ± 0.7 mm; p < 0.01), carried a heavier, more mixed pathogen load, and showed periodontal–tonsillar species concordance in 64.1% of patients with genotype-level identity in up to 35.9%. Cytokines were higher and graded with tonsillitis form and severity (r=0.42–0.68). At 6 months, Subgroup 3.1 outperformed 3.3 for probing depth (3.1±0.5 vs 3.7±0.6 mm) and commensal-flora restoration (78.5% vs 62.8%; both p<0.01), with complete remission in 82% versus 63%. Chronic tonsillitis acts as an active modifier of periodontitis through shared pathogens; a combined protocol using natural biotherapeutics produced superior, durable improvement, supporting interdisciplinary care.