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06 July 2023

The best agents to prevent early childhood caries

Data sources

A comprehensive search strategy was planned and, accordingly, researchers analyzed three electronic databases including Medline, Embase, and Cochrane CENTRAL with no language and time restrictions to find the relevant literature. The team also conducted hand searches of the relevant articles to retrieve other possible studies.

Study selection

Both parallel and split-mouth RCTs with a minimum follow-up period of two years were included. Non-randomized studies were also selected.

Data extraction and synthesis

Data about study characteristics, demographic and clinical parameters, assessed outcome, outcome assessment methods etc. were retrieved by two independent authors. Network meta-analysis (NMA) was carried for two different outcomes viz caries increment and caries incidence. For the purpose of NMA, standardized mean difference (SMD) was calculated for analyzing the continuous outcome (caries increment) while Odds ratio was used for dichotomous outcome (caries incidence at individual level).


A total of 3,807 publication were retrieved and after sifting 33 RCTs and other quasi-randomized/ non-randomized studies were selected for this NMA. Network diagrams were created and two NMAs were carried; one for caries increment and another for caries incidence.

A total of 18 preventive agents were explored for caries increment and amongst these, only fluoride-foam and fluoride-salt exhibited significant better prevention than the control; with SMD and confidence interval values of 0.69 (0.32–1.06) and 0.66 (0.13–1.20) respectively.

While for caries incidence outcome 11 preventive agents could be included out of which, probiotic-milk + LowF toothpaste, fluoride-foam, fluoride-varnish, and FV + HFTP exhibited significant higher odds of caries prevention; and the odds ratio with 95% confidence intervals were 0.34 (CI = 0.15–0.77), 0.48 (CI = 0.37–0.63), 0.63 (CI = 0.48–0.81), and 0.73 (CI = 0.57–0.93) respectively. SUCRA rankings were also obtained for both the outcomes.


Fluoride preparations, namely fluoride-foam (FF), fluoride-salt (FS) and probiotic milk+ low-F toothpaste (PMLFTP), fluoride-varnish (FV) and fluoride-varnish+ high-F toothpaste (FVHFTP) were found to be effective in preventing early childhood caries.

Gugnani, N., Gugnani, S. "Which of the preventive agents perform best for prevention of early childhood caries?" Evid Based Dent 24, 61–63 (2023). https://doi.org/10.1038/s41432-023-00882-8

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