Nonfluoride remineralizing agent for caries prevention in children: A systematic review and meta-analysis

Background: The recent outburst of nonfluoride remineralizing agents suggests that it may serve as alternative and as an adjunct for fluoride in preventing, arresting, or even reversing dental caries. Aim: This study aims to assess the caries prevention potential of a variety of nonfluoride agents in children, with an efficient and extended literature database search. Materials and Methods: Electronic (MEDLINE, PubMed, and The Cochrane Library) and manual searches were conducted for relevant studies published till March 2020. Randomized control trials (RCTs) that investigated the effect of nonfluoride remineralizing agents such as casein phosphopeptide-amorphous calcium phosphate (ACP), ACP, arginine, probiotic, xylitol, chlorhexidine, and nanoparticles in remineralization and prevention of dental caries were assessed. Results: Twelve studies met the criteria. There were 2653 patients in the test group and 2596 in the control group. Participants using nonfluoride agents were more likely to experience a reduction in dental caries compared to control ([standardized mean difference {SMD}] −0.55 [−1.06, 0.04], 95% confidence interval [CI], I2 = 98%), but there was substantial heterogeneity (98%) across studies. Moreover, an overall statistically insignificant benefit of Non-fluoride agent was detected (SMD −0.55 [−1.06, 0.04], 95% CI, I2 = 98% P < 0.00001). Conclusion: High-quality RCTs on the preventive effect of nonfluoride agents in children are still important to make a conclusive recommendation.