{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:25:12Z","timestamp":1790922312591,"version":"4.1.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Evid Based Dent"],"published-print":{"date-parts":[[2024,3]]},"abstract":"Abstract<\/jats:title>\n Design<\/jats:title>\n An investigator and participant masked, parallel-group randomised control trial examining the tooth surfaces of 288 children aged 5\u20139\u00a0years (n<\/jats:italic>\u2009=\u2009141 in the intervention group, n<\/jats:italic>\u2009=\u2009147 in the control group). Children in the intervention group were provided a daily lozenge containing 2% arginine (prebiotic), Lacticaseibacillus rhamnosus<\/jats:italic> and Lactobacillus paracasei<\/jats:italic> subsp. paracasei<\/jats:italic> (probiotics).<\/jats:p>\n Children in the control group were provided with a placebo lozenge. Parents of participants were also provided with 1450\u2009ppm fluoride toothpaste and advised to brush their children\u2019s teeth twice daily. Clinical and radiographic examinations were undertaken at baseline and 10\u201312 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.<\/jats:p>\n <\/jats:sec>\n Case selection<\/jats:title>\n Of 343 children who met the inclusion criteria, 21,888 tooth surfaces were examined in 288 low caries risk children aged between 5\u20139 years. Fifty-four participants withdrew consent (n<\/jats:italic>\u2009=\u200931 for intervention group, n<\/jats:italic>\u2009=\u200924 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.<\/jats:p>\n <\/jats:sec>\n Data analysis<\/jats:title>\n 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\u00a0health-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<\/jats:italic>\u2009<\u20090.05 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.<\/jats:p>\n <\/jats:sec>\n Results<\/jats:title>\n 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%; \u22126.0%, \u221232.4%), more caries regression (RRR: 0.3%; \u22120.4%, \u22121.0%) and reduced caries progression (RRR: 13.6%; \u22128.0%, \u221230.9%) observed than in the control group.<\/jats:p>\n <\/jats:sec>\n Conclusions<\/jats:title>\n The use of a probiotic and prebiotic daily lozenges as an adjunct to 1450\u2009ppm 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1038\/s41432-024-00976-x","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T14:03:19Z","timestamp":1706709799000},"page":"39-40","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["PRO\u2014biotics? Are pre- and probiotics a valuable adjunct to fluoridated toothpaste in the battle against dental decay?"],"prefix":"10.1038","volume":"25","author":[{"given":"Rhyanna","family":"Mughal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"976_CR1","unstructured":"Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO."},{"key":"976_CR2","unstructured":"Public Health England, Department of Health and Social Care, NHSE&I. (2021): Delivering Better Oral Health \u2013 an evidence-based toolkit for prevention. https:\/\/www.gov.uk\/government\/publications\/delivering-better-oral-health-anevidence-based-toolkit-for-prevention."},{"key":"976_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/nrdp.2017.30","volume":"3","author":"NB Pitts","year":"2017","unstructured":"Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, et al. Dental caries. Nat Rev Dis Primers. 2017;3:1\u20136.","journal-title":"Nat Rev Dis Primers"},{"key":"976_CR4","unstructured":"Rodriguez A, Biazus-Dalcin C, Marshall J, Gorman R. Smile4life: a co-designed educational and training resource guide. University of Dundee: NHS Education for Scotland. 2022."},{"key":"976_CR5","doi-asserted-by":"publisher","first-page":"104599","DOI":"10.1016\/j.jdent.2023.104599","volume":"135","author":"CJ P\u00f8rksen","year":"2023","unstructured":"P\u00f8rksen CJ, Keller MK, Damholt A, Frederiksen AK, Ekstrand KR, Markvart M, et al. The effect of a lozenge combining prebiotic arginine and probiotics on caries increment in children during 10\u201312 months, a randomized clinical trial. J Dent. 2023;135:104599.","journal-title":"J Dent"},{"key":"976_CR6","first-page":"539","volume":"45","author":"S Twetman","year":"2017","unstructured":"Twetman S, J\u00f8rgensen MR, Keller MK. Fifteen years of probiotic therapy in the dental context: what has been achieved? J Calif Dent Assoc. 2017;45:539\u201345.","journal-title":"J Calif Dent Assoc"},{"key":"976_CR7","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1159\/000486429","volume":"52","author":"KR Ekstrand","year":"2018","unstructured":"Ekstrand KR, Gimenez T, Ferreira FR, Mendes FM, Braga MM. The international caries detection and assessment system\u2013ICDAS: a systematic review. Caries Res. 2018;52:406\u201319.","journal-title":"Caries Res"},{"key":"976_CR8","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1159\/000324439","volume":"45","author":"KR Ekstrand","year":"2011","unstructured":"Ekstrand KR, Luna LE, Promisiero L, Cortes A, Cuevas S, Reyes JF, et al. The reliability and accuracy of two methods for proximal caries detection and depth on directly visible proximal surfaces: an in vitro study. Caries Res. 2011;45:93\u20139.","journal-title":"Caries Res"}],"container-title":["Evidence-Based Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41432-024-00976-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41432-024-00976-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41432-024-00976-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T10:05:15Z","timestamp":1711101915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41432-024-00976-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,31]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["976"],"URL":"https:\/\/doi.org\/10.1038\/s41432-024-00976-x","relation":{},"ISSN":["1462-0049","1476-5446"],"issn-type":[{"value":"1462-0049","type":"print"},{"value":"1476-5446","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,31]]},"assertion":[{"value":"3 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The author declares no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}