{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:58:40Z","timestamp":1792303120468,"version":"4.4.0"},"reference-count":51,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Early childhood caries is closely associated with oral dysbiosis and the proliferation of Streptococcus mutans. Oral probiotics, particularly Lactobacillus reuteri and Lactobacillus rhamnosus, have been proposed as ecological modulators capable of reducing cariogenic microorganisms. Objective: To evaluate the efficacy of orally administered L. reuteri and L. rhamnosus in reducing salivary S. mutans levels in children aged 6 months to 12 years through a systematic review and meta-analysis. Methods: This review followed the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251086304). Searches were conducted in MEDLINE\/PubMed, CENTRAL, Embase, Scopus and LILACS without language or date restrictions. Randomized controlled trials administering the target probiotic strains for \u226530 days were included. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Random-effects meta-analyses were performed for continuous and dichotomous outcomes. Results: Six randomized controlled trials were included (N = 1362). Only two trials reported continuous outcomes in comparable log10 CFU\/mL format and could therefore be pooled for the continuous meta-analysis. This analysis showed a significant reduction in salivary S. mutans levels (MD = \u22120.65 log10 CFU\/mL; 95% CI: \u22120.97 to \u22120.34; p &lt; 0.0001; I2 = 19%), although the pooled estimate was largely driven by one study and should be interpreted cautiously. Four trials contributed to the dichotomous meta-analysis, which showed a non-significant trend toward risk reduction (OR = 0.73; 95% CI: 0.51\u20131.06; p = 0.10; I2 = 35%). Short-term interventions using high oral-retention formulations demonstrated the most consistent microbiological effects. Conclusions: Oral probiotics may significantly reduce salivary S. mutans in the short-term, especially when delivered through slow-dissolving formulations. However, their effects vary according to strain, vehicle, and intervention duration. Larger, standardized, and longer-term clinical trials are needed to determine the sustainability and clinical relevance of these effects.<\/jats:p>","DOI":"10.3390\/dj14020087","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T16:46:28Z","timestamp":1770137188000},"page":"87","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of Oral Probiotics on Streptococcus mutans in Children: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Andrea","family":"Caiza-Rennella","sequence":"first","affiliation":[{"name":"Carrera de Odontolog\u00eda, Universidad Bolivariana del Ecuador, Duran 092406, Ecuador"},{"name":"Facultad de Estomatolog\u00eda, Universidad de Ciencias M\u00e9dicas de la Habana, Habana 10100, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ordo\u00f1ez-Balladares","sequence":"additional","affiliation":[{"name":"Carrera de Odontolog\u00eda, Universidad Bolivariana del Ecuador, Duran 092406, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosangela","family":"Caicedo-Quiroz","sequence":"additional","affiliation":[{"name":"Carrera de Odontolog\u00eda, Universidad Bolivariana del Ecuador, Duran 092406, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8559-3364","authenticated-orcid":false,"given":"Indira","family":"G\u00f3mez-Capote","sequence":"additional","affiliation":[{"name":"Facultad de Estomatolog\u00eda, Universidad de Ciencias M\u00e9dicas de la Habana, Habana 10100, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7217-7548","authenticated-orcid":false,"given":"Zuilen","family":"Jim\u00e9nez-Quintana","sequence":"additional","affiliation":[{"name":"Facultad de Estomatolog\u00eda, Universidad de Ciencias M\u00e9dicas de la Habana, Habana 10100, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104599","DOI":"10.1016\/j.jdent.2023.104599","article-title":"The Effect of a Lozenge Combining Prebiotic Arginine and Probiotics on Caries Increment in Children during 10\u201312 Months, a Randomized Clinical Trial","volume":"135","author":"Porksen","year":"2023","journal-title":"J. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1415873","DOI":"10.1155\/2018\/1415873","article-title":"Early Childhood Caries: Epidemiology, Aetiology, and Prevention","volume":"2018","author":"Meyer","year":"2018","journal-title":"Int. J. Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s12602-022-09913-9","article-title":"Prevention of Recurrent Childhood Caries with Probiotic Supplements: A Randomized Controlled Trial with a 12-Month Follow-Up","volume":"14","author":"Granqvist","year":"2022","journal-title":"Probiotics Antimicro. Prot."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Uerlich, M.F., Baker, S.R., Day, P.F., Brown, L., and Vettore, M.V. (2021). Common Determinants of Dental Caries and Obesity in Children: A Multi-Ethnic Nested Birth Cohort Study in the United Kingdom. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182312561"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Giacaman, R.A., Fern\u00e1ndez, C.E., Mu\u00f1oz-Sandoval, C., Le\u00f3n, S., Garc\u00eda-Manr\u00edquez, N., Echeverr\u00eda, C., Vald\u00e9s, S., Castro, R.J., and Gambetta-Tessini, K. (2022). Understanding Dental Caries as a Non-Communicable and Behavioral Disease: Management Implications. Front. Oral. Health, 3.","DOI":"10.3389\/froh.2022.764479"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e7974","DOI":"10.5867\/medwave.2020.06.7974","article-title":"Prevalence and incidence of dental caries associated with the effect of tooth brushing and fluoride varnishing in schoolchildren at Galapagos Islands, Ecuador: Protocol of the EESO-Gal study","volume":"20","year":"2020","journal-title":"Medwave"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1177\/00220345231160756","article-title":"Microbial Indicators of Dental Health, Dysbiosis, and Early Childhood Caries","volume":"102","author":"Kahharova","year":"2023","journal-title":"J. Dent. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/s41415-021-3775-4","article-title":"Understanding Dental Caries as a Non-Communicable Disease","volume":"231","author":"Pitts","year":"2021","journal-title":"Br. Dent. J."},{"key":"ref_9","first-page":"525","article-title":"Ecological Events in Oral Health and Disease: New Opportunities for Prevention and Disease Control?","volume":"45","author":"Marsh","year":"2017","journal-title":"J. Calif. Dent. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1159\/000499037","article-title":"Critical Appraisal of Oral Pre- and Probiotics for Caries Prevention and Care","volume":"53","author":"Zaura","year":"2019","journal-title":"Caries Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1038\/s41579-018-0089-x","article-title":"The Oral Microbiota: Dynamic Communities and Host Interactions","volume":"16","author":"Lamont","year":"2018","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zheng, H. (2021). Analysis of Oral Microbial Dysbiosis Associated with Early Childhood Caries. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01543-x"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Liu, R., Liu, Y., Yi, J., Fang, Y., Guo, Q., Cheng, L., He, J., and Li, M. (2025). Imbalance of Oral Microbiome Homeostasis: The Relationship between Microbiota and the Occurrence of Dental Caries. BMC Microbiol., 25.","DOI":"10.1186\/s12866-025-03762-6"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00253-024-13362-5","article-title":"Oral Microbiota in Preschoolers with Rampant Caries: A Matched Case\u2013Control Study","volume":"108","author":"Wu","year":"2024","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1111\/jcmm.13496","article-title":"Probiotic Lactobacillus Sp. Inhibit Growth, Biofilm Formation and Gene Expression of Caries-inducing Streptococcus mutans","volume":"22","author":"Wasfi","year":"2018","journal-title":"J. Cell. Mol. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/eos.12528","article-title":"Prevention of Dental Caries as a Non-communicable Disease","volume":"126","author":"Twetman","year":"2018","journal-title":"Eur. J. Oral. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20587384211031107","DOI":"10.1177\/20587384211031107","article-title":"The Use of Lactobacillus reuteri DSM 17938 and ATCC PTA 5289 on Oral Health Indexes in a School Population: A Pilot Randomized Clinical Trial","volume":"35","year":"2021","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/ijos.2014.52","article-title":"Probiotics to Counteract Biofilm-Associated Infections: Promising and Conflicting Data","volume":"6","author":"Vuotto","year":"2014","journal-title":"Int. J. Oral. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1038\/s41598-020-80921-x","article-title":"Lactobacillus reuteri AN417 Cell-Free Culture Supernatant as a Novel Antibacterial Agent Targeting Oral Pathogenic Bacteria","volume":"11","author":"Yang","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.ijfoodmicro.2004.03.006","article-title":"Lactobacillus reuteri in Bovine Milk Fermented Decreases the Oral Carriage of Mutans Streptococci","volume":"95","author":"Nikawa","year":"2004","journal-title":"Int. J. Food Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3920\/BM2013.0089","article-title":"Effect of Tablets Containing Probiotic Bacteria (Lactobacillus reuteri) on Early Caries Lesions in Adolescents: A Pilot Study","volume":"5","author":"Keller","year":"2014","journal-title":"Benef. Microbes"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jung, H.-Y., Cai, J.-N., Yoo, S.C., Kim, S.-H., Jeon, J.-G., and Kim, D. (2022). Collagen Peptide in a Combinatorial Treatment with Lactobacillus rhamnosus Inhibits the Cariogenic Properties of Streptococcus mutans: An In Vitro Study. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23031860"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/omi.12242","article-title":"Lactobacillus rhamnosus LRB Mediated Inhibition of Oral Streptococci","volume":"33","author":"Biswas","year":"2018","journal-title":"Mol. Oral. Microbiol."},{"key":"ref_24","first-page":"583","article-title":"Effect of the Probiotic Lactobacillus rhamnosus LB21 on the Cariogenicity of Streptococcus mutans UA159 in a Dual-Species Biofilm Model","volume":"49","author":"Giacaman","year":"2016","journal-title":"Caries Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"10","DOI":"10.2298\/SARH201129001N","article-title":"The Role of Yogurt Enriched with LGG Culture (Lactobacillus rhamnosus GG) in Dental Caries Prevention","volume":"150","author":"Neskovic","year":"2022","journal-title":"Srp. Arh. ZA Celok. Lek."},{"key":"ref_26","first-page":"1","article-title":"Clinical Outcomes of Probiotic Lactobacillus rhamnosus SD11 Supplementation for Dental Caries Prevention in Young Children: A Randomized Controlled Trial","volume":"28","author":"Janwong","year":"2025","journal-title":"Khon Kaen Univ. Dent. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.sdentj.2020.05.006","article-title":"Effectiveness of Probiotic Lozenges and Chlorhexidine Mouthwash on Plaque Index, Salivary pH, and Streptococcus mutans Count among School Children in Makkah, Saudi Arabia","volume":"33","author":"Felemban","year":"2021","journal-title":"Saudi Dent. J."},{"key":"ref_28","first-page":"259","article-title":"Evaluation of Lactobacillus reuteri Probiotic Lozenge Intake on Salivary Cariogenic Bacterial Counts in Preschool Children: A Randomized Clinical Trial","volume":"24","author":"Almabadi","year":"2020","journal-title":"Med. Sci."},{"key":"ref_29","first-page":"221","article-title":"Effect of Consumption of Lactobacillus rhamnosus GG and Calcium, in Carrot-Pineapple Juice on Dental Caries Risk in Children","volume":"5","author":"Pohjavuori","year":"2010","journal-title":"Int. J. Probiotics Prebiotics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1159\/000235581","article-title":"Effect of Long-Term Consumption of Milk Supplemented with Probiotic Lactobacilli and Fluoride on Dental Caries and General Health in Preschool Children: A Cluster-Randomized Study","volume":"43","author":"Twetman","year":"2009","journal-title":"Caries Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1159\/000047484","article-title":"Effect of Long-Term Consumption of a Probiotic Bacterium, Lactobacillus rhamnosus GG, in Milk on Dental Caries and Caries Risk in Children","volume":"35","author":"Nase","year":"2001","journal-title":"Caries Res."},{"key":"ref_32","first-page":"85","article-title":"Effects of Probiotics on Preventing Caries in Preschool Children: A Systematic Review and Meta-Analysis","volume":"47","author":"Meng","year":"2023","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"9977","DOI":"10.1080\/10408398.2022.2077693","article-title":"Efficacy of Probiotics against Dental Caries in Children: A Systematic Review and Meta-Analysis","volume":"63","author":"Shi","year":"2023","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/ccd.ccd_40_23","article-title":"Efficacy and Safety of Probiotics for Dental Caries in Preschool Children: A Systematic Review and Meta-Analysis","volume":"15","author":"Panchbhai","year":"2024","journal-title":"Contemp. Clin. Dent."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Talib, E.Q., Talib, A.Q., Najm, A.Z., and Alzwghaibi, A.F. (Microbes Infect. Dis., 2025). The Effectiveness of Probiotics in Preventing and Managing Dental Caries and Gingival Health in Children Aged 1\u201318 Years: A Systematic Review and Meta-Analysis, Microbes Infect. Dis., online ahead of print.","DOI":"10.21608\/mid.2025.348985.2421"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Zhang, J., Wang, Q., and Duan, Z. (2024). Preventive Effects of Probiotics on Dental Caries in Vitro and in Vivo. BMC Oral. Health, 24.","DOI":"10.1186\/s12903-024-04703-x"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Healthcare Interventions: Explanation and Elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2891","DOI":"10.1007\/s00784-020-03606-9","article-title":"Significant Elevation of Salivary Human Neutrophil Peptides 1-3 Levels by Probiotic Milk in Preschool Children with Severe Early Childhood Caries: A Randomized Controlled Trial","volume":"25","author":"Wattanarat","year":"2021","journal-title":"Clin. Oral. Investig."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e20170318","DOI":"10.1590\/1678-7757-2017-0318","article-title":"Effects of a Food Enriched with Probiotics on Streptococcus mutans and Lactobacillus Spp. Salivary Counts in Preschool Children: A Cluster Randomized Trial","volume":"26","author":"Villavicencio","year":"2018","journal-title":"J. Appl. Oral. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"279","DOI":"10.4103\/jisppd.jisppd_519_20","article-title":"A Clinical Trial on Topical Effect of Probiotics on Oral Streptococcus mutans Counts in Children","volume":"39","author":"Patil","year":"2021","journal-title":"J. Indian Soc. Pedod. Prev. Dent."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S207","DOI":"10.5005\/jp-journals-10005-2149","article-title":"Effectiveness of Oral Probiotics in Reducing S. mutans Count in Caries-Active Children: A Comparison with Chlorhexidine and Herbal Mouthrinse (Hiora\u00ae)","volume":"15","author":"Kamble","year":"2022","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Ebrahim, F., Malek, S., James, K., MacDonald, K., Cadieux, P., Burton, J., Cioffi, I., Levesque, C., and Gong, S. (2022). Effectiveness of the Lorodent Probiotic Lozenge in Reducing Plaque and Streptococcus mutans Levels in Orthodontic Patients: A Double-Blind Randomized Control Trial. Front. Oral Health, 3.","DOI":"10.3389\/froh.2022.884683"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Starck, E., Machado, V., Botelho, J., Proen\u00e7a, L., Barroso, H., Ascenso, C., and Rozan, C. (2025). Effects of Probiotic Short-Term Regiment on Oral Health Parameters in Children: A Pilot Randomized Controlled Trial. Nutrients, 17.","DOI":"10.3390\/nu17223604"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5005\/jp-journals-10005-2527","article-title":"Randomized Clinical Trial of Oral Probiotic Streptococcus Salivarius M18 on Salivary Streptococcus mutans in Preprimary Children","volume":"16","author":"Salim","year":"2023","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1177\/0022034515623935","article-title":"Probiotic Compared with Standard Milk for High-Caries Children: A Cluster Randomized Trial","volume":"95","author":"Ruiz","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3823","DOI":"10.1007\/s00784-020-03712-8","article-title":"The Consumption of Milk Supplemented with Probiotics Decreases the Occurrence of Caries and the Salivary Concentration of h\u03b2D-3 in Children","volume":"25","author":"Sandoval","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_47","first-page":"6","article-title":"Probiotic Supplementation in Dental Caries: Is It Possible to Replace Conventional Treatment?","volume":"43","author":"Coqueiro","year":"2018","journal-title":"Nutr. Rev. Soc. Bras. Aliment. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sakaryali Uyar, D., \u00dcsk\u00fcdar G\u00fc\u00e7l\u00fc, A., \u00c7elik, E., Memis \u00d6zg\u00fcl, B., Altay Ko\u00e7ak, A., and Basustaoglu, A. (2024). Evaluation of Probiotics\u2019 Efficiency on Cariogenic Bacteria: Randomized Controlled Clinical Study. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04659-y"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s00784-010-0423-9","article-title":"Probiotic Lactobacillus Paracasei Effect on Cariogenic Bacterial Flora","volume":"15","author":"Chuang","year":"2011","journal-title":"Clin. Oral. Investig."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3109\/00016357.2011.572289","article-title":"Salivary Mutans Streptococci and Lactobacilli Modulations in Young Children on Consumption of Probiotic Ice-Cream Containing Bifidobacterium Lactis Bb12 and Lactobacillus Acidophilus La5","volume":"69","author":"Singh","year":"2011","journal-title":"Acta Odontol. Scand."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000335567","article-title":"Bifidobacterium Animalis Subsp. Lactis BB-12 Administration in Early Childhood: A Randomized Clinical Trial of Effects on Oral Colonization by Mutans Streptococci and the Probiotic","volume":"46","author":"Taipale","year":"2012","journal-title":"Caries Res."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/2\/87\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T09:20:51Z","timestamp":1770196851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/2\/87"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["dj14020087"],"URL":"https:\/\/doi.org\/10.3390\/dj14020087","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]}}}