Can probiotic supplements prevent early childhood caries? A systematic review and meta-analysis

Abstract

The aim of this study was to explore the preventive effect of probiotic supplements on the development of early childhood caries (ECC). We searched the PubMed, Google Scholar and Cochrane databases up to January 15, 2021. The authors screened the hits independently for relevance, extracted outcome data and assessed the risk of bias. We performed a random effects meta-analysis to pool and compare the incidence of ECC in children assigned to test or placebo groups, respectively. The authors included nine randomised controlled trials published between 2001 and 2021, involving 2,363 preschool children. We assessed two publications with a moderate risk of bias and seven with high risk of bias. The median caries incidence in the probiotic test groups was 8.5% compared with 17.5% in the placebo groups and this difference was statistically significant (P<0.001). A pooled random effects meta-analysis on caries incidence on subject level showed a small but statistically significant risk difference in favour of the probiotic intervention (-0.05, 95% confidence interval (CI) -0.10, -0.00; P<0.05). The mean difference in caries increment on tooth/surface level was -0.57, (95% CI -0.91, -0.23; P<0.01). In conclusion, we demonstrated a small but statistically significant preventive effect of probiotic supplements on ECC. However, the certainty of this finding was low due to the risk of bias, heterogeneity and inconsistencies across the studies. Further long-term randomised controlled trials with low risk of bias are required in order to answer the research question with a higher certainty.

Probiotics‐containing beverages and dental caries: A systematic review and meta‐analysis

“…These findings are consistent with the quantitatively summarized evidence concerning the effect of probiotics on dental caries in children [13][14][15]. However, these previously published systematic reviews included data from the sample analyzed in the study of Rodriguez et al [26] and from a subsample analysis considering the effects of probiotics on caries occurrence and immunological modulation [31].…”

“…In the meta-analysis of Twetman and Jørgensen [13], the observed effect on early childhood caries increment (pooled mean difference) on tooth or surface level favored the intervention with probiotics (−0.57 (95 % CI −0.91 to −0.23); p < 0.01) over the control groups. In the meta-analysis of Meng et al [15], a lower RR for caries incidence (RR 0.70 [95 % CI 0.54 to 0.91]) and a lower caries progression (SMD −0.24 [95 % CI −0.34 to −0.10]) were reported.…”

“…Previously published systematic reviews with metaanalyses demonstrated that frequent consumption of probiotics-containing products (e.g., lozenges, yogurt) promotes a reduction in the counts of Streptococcus mutans in dental plaque and in saliva [10][11][12], a result that has been claimed as a health-related benefit in terms of potentially reducing the risk of dental caries development. More recently, small clinical effects of probiotics on reducing the development of early childhood caries were revealed by summarized quantitative data [13][14][15]. Data from randomized clinical trials also suggest that probiotics influence caries development, especially with supplemented milk or reconstituted milk powder.…”

Effects of probiotics on preventing caries in preschool children: a systematic review and meta-analysis

“…A previous meta-analysis by Hao et al [41] (2021) on the efficacy and safety of bifidobacterium in preventing caries concluded that bifidobacterium could not reduce the incidence of caries and the counts of Streptococcus mutans and Lactobacillus in primary teeth. Twetman et al [42] (2021) included 9 articles in their meta-analysis which investigated whether probiotics could effectively prevent caries in young children and concluded that probiotics had a small but statistically significant preventive effect on caries in the young children. However, different probiotic strains may have different effects on caries prevention.…”

Prevention of Recurrent Childhood Caries with Probiotic Supplements: A Randomized Controlled Trial with a 12-Month Follow-Up

“…In this context, the microbial colonization and maturation of the oral cavity early in life is of particular interest since the first 1000 days of life provide a window of opportunity for modulating the microbiota through interventions with pre- and probiotics to promote a healthy growth and development [ 10 ]. Several previous studies have indicated that infants, toddlers, and preschool children that are exposed to probiotic supplements can display significant reductions in caries incidence in the primary dentition [ 11 , 12 ]. We therefore thought it was of interest to evaluate if the use of probiotic supplements as adjunct to standard care after restorative treatment could reduce the risk of recurrent decay.…”