DESIGN:
An
investigator and participant masked, parallel-group randomised control trial examining the
tooth surfaces of 288
children aged 5-9 years (n = 141 in the intervention group, n = 147 in the
control group).
Children in the intervention group were provided a daily lozenge containing 2%
arginine (
prebiotic),
Lacticaseibacillus rhamnosus and
Lactobacillus paracasei subsp. paracasei (
probiotics).
Children in the
control group were provided with a placebo lozenge.
Parents of participants were also provided with 1450 ppm
fluoride toothpaste and advised to brush their
children's
teeth twice daily. Clinical and radiographic examinations were undertaken at baseline and 10-12 months assessing caries activity, progression and regression at a
tooth surface level. A modified ICDAS and radiographic scoring system were used to
record presence and extent of
carious lesions. CASE SELECTION Of 343
children who met the inclusion criteria, 21,888
tooth surfaces were examined in 288 low caries
risk children aged between 5-9 years. Fifty-four participants withdrew consent (n = 31 for intervention group, n = 24 for
control group) and 1
child was excluded as they were pre-cooperative for their dental examination. Participants were recruited from four municipalities in
Denmark. To be eligible to participate,
children had to be medically healthy, cooperative for clinical and radiographic examination, and able to ingest a daily lozenge. DATA
ANALYSIS:
The primary outcome for this study was
relative risk reduction (RRR) of caries activity, progression and regression. Although not present in this study, the main study broadly showed equality between the two groups in terms of their social demographic, dietary, oral
health-related factors. The authors used modified Poisson regression to determine any surface level differences between the intervention and placebo groups. The threshold for statistical significance was set as follows p < 0.05 was considered statistically significant. The authors describe that a
power calculation was undertaken for the main study. However, none of the outcomes in this study were powered for.
RESULTS:
19,950
tooth surfaces were included in the final
analysis. There was no significant difference in change in caries activity between the two groups. There was a trend towards reduction in
relative risk in the intervention group, with fewer active lesions (RRR 15.3%; -6.0%, -32.4%), more caries regression (RRR 0.3%; -0.4%, -1.0%) and reduced caries progression (RRR 13.6%; -8.0%, -30.9%) observed than in the
control group.
CONCLUSIONS:
The use of a
probiotic and
prebiotic daily lozenges as an adjunct to 1450 ppm
fluoride toothpaste and
oral hygiene instruction did not result in a significantly reduced
relative risk of change in caries status compared to placebo. Further
research over an increased intervention
time with a higher caries
risk population may identify potential advantages of adjunctive pre- and
probiotics fluoride toothpaste in the prevention, arrest and regression of
dental caries.