Oral cavity niche-derived probiotics and dental caries in children and adolescents: a randomized clinical trial-based systematic review

Background: Bacteriotherapy using oral cavity-derived probiotics has emerged as a promising adjunctive strategy for caries prevention. This systematic review aimed to assess the impact of oral cavity niche-derived probiotics on the colony-forming units (CFU) of aciduric bacteria and the reduction in caries incidence in children 0–18 years. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a search was conducted across PubMed, Virtual Library on Dental Health, Springer, Wiley, Science Direct, and SciELO databases. Only randomized controlled clinical trials published in English language during the last twenty years, involving humans aged 0–18 years without pre-established medical conditions, were included. Studies required at least 15 participants and adequate control groups. Quality assessment was performed using the Cochrane Collaboration tool, and only low-risk bias studies were included. Results: Twelve randomized controlled trials met the inclusion criteria after screening 1114 initial references. Eight studies demonstrated significant reductions in Streptococcus mutans counts and caries incidence. The probiotic strains were Lactobacillus paracasei, L. reuteri, and Streptococcus species. Administration intervals ranged from 15 days to 14 months (mean: 7.25 months), with follow-up periods varying from 15 days to 6 months. Powdered milk and tablets were the delivery vehicles. Significant bacterial count reductions were observed as early as 15 days, with sustained effects during follow-up periods. Conclusions: When administered appropriately, oral cavity-derived probiotics have demonstrated safety and efficacy in reducing cariogenic bacteria counts and caries incidence in children and adolescents. These findings support probiotics as valuable adjuncts to preventive measures in pediatric dentistry, particularly among high-risk populations. However, prolonged or repeated exposure appears necessary for optimal colonization and sustained benefits. The PROSPERO Registration: The present systematic review protocol was registered at the Open Science Framework (OSF) platform (registration DOI: https://doi.org/10.17605/OSF.IO/V3FB9).

Oral probiotics; Dental caries prevention; Children

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