{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:23:48Z","timestamp":1787747028037,"version":"build-2784847793"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Context:<\/jats:title>\n \n Early childhood caries (ECC) is a multifactorial biofilm-mediated disease strongly associated with cariogenic microorganisms such as\n Streptococcus mutans<\/jats:italic>\n and\n Lactobacillus acidophilus<\/jats:italic>\n . Salivary alpha-amylase has recently been proposed as a biochemical marker reflecting caries activity. With the availability of pediatric dentifrices of varying fluoride concentrations and herbal compositions, comparative clinical evidence of caries incidence in children with ECC remains limited.\n <\/jats:p>\n <\/jats:sec>\n \n Aim:<\/jats:title>\n \n To evaluate and compare the effects of high-fluoridated, low-fluoridated, nonfluoridated, and herbal pediatric dentifrices on salivary\n S. mutans<\/jats:italic>\n ,\n L. acidophilus,<\/jats:italic>\n and salivary alpha-amylase levels in children with ECC.\n <\/jats:p>\n <\/jats:sec>\n \n Settings and Design:<\/jats:title>\n Prospective, randomized, double-blind, parallel-group clinical\u2013microbiological trial.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n \n Fifty-six children with Severe ECC (decayed, missing, filled, treated (dmft) \u22654) were randomly allocated into four groups (\n n<\/jats:italic>\n = 14). Participants brushed twice daily with the assigned dentifrice for 15 days. Unstimulated saliva samples were collected at baseline and postintervention. Microbial counts were assessed using selective culture media, and alpha-amylase levels were analyzed by kinetic colorimetric assay. Brushing compliance was reinforced and monitored using a mobile health application. Statistical analysis was performed using one-way analysis of variance, Tukey\u2019s\n post hoc<\/jats:italic>\n test, paired\n t<\/jats:italic>\n -test, and nonparametric equivalents where applicable. The level of significance was set at\n P<\/jats:italic>\n < 0.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A significant reduction in\n S. mutans<\/jats:italic>\n and\n L. acidophilus<\/jats:italic>\n counts was observed in all groups postintervention (\n P<\/jats:italic>\n < 0.05). The high-fluoridated dentifrice group demonstrated the greatest percentage reduction in both microorganisms. Postintervention salivary alpha-amylase levels showed better modulation (\n P<\/jats:italic>\n = 0.030), with the lowest mean value in the high-fluoride group (109.43 \u00b1 11.62 milliunits per milliliter [mU\/mL]) and the highest in the nonfluoridated group (119.93 \u00b1 7.33 mU\/mL).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n High-fluoridated pediatric dentifrice demonstrated superior antimicrobial efficacy in children with ECC. Salivary alpha-amylase may serve as a useful adjunctive biomarker in caries assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jisppd.jisppd_155_26","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:00:17Z","timestamp":1787673617000},"page":"423-433","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparative evaluation of fluoridated, nonfluoridated, and herbal dentifrices with digital oral health intervention on salivary cariogenic microorganisms and alpha-amylase levels in children with severe early childhood caries"],"prefix":"10.4103","volume":"44","author":[{"given":"Arunima","family":"Sarkar","sequence":"first","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunjan","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumya","family":"Navit","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitusmita","family":"Kalita","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antra","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Paediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"issue":"Suppl 18","key":"R1-20260826","first-page":"S12","article-title":"Dental biofilm: Ecological interactions in health and disease","volume":"44","author":"Marsh","year":"2017","journal-title":"J Clin Periodontol"},{"key":"R2-20260826","doi-asserted-by":"crossref","first-page":"17030","DOI":"10.1038\/nrdp.2017.30","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"R3-20260826","first-page":"31","article-title":"Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies","volume":"46","year":"2024","journal-title":"Pediatr Dent"},{"key":"R4-20260826","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1067\/mpr.2001.113778","article-title":"A review of saliva: Normal composition, flow, and function","volume":"85","author":"Humphrey","year":"2001","journal-title":"J Prosthet Dent"},{"key":"R5-20260826","doi-asserted-by":"crossref","first-page":"357","DOI":"10.4103\/0970-9290.70800","article-title":"Evaluation of the antimicrobial activity of various concentrations of Tulsi (Ocimum sanctum) extract against Streptococcus mutans: An in vitro study","volume":"21","author":"Agarwal","year":"2010","journal-title":"Indian J Dent Res"},{"key":"R6-20260826","first-page":"262","article-title":"Fluoride therapy","volume":"46","year":"2024","journal-title":"Pediatr Dent"},{"key":"R7-20260826","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/s40368-019-00464-2","article-title":"Guidelines on the use of fluoride for caries prevention in children: An updated EAPD policy document","volume":"20","author":"Toumba","year":"2019","journal-title":"Eur Arch Paediatr Dent"},{"key":"R9-20260826","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4103\/0970-4388.37010","article-title":"Effect of fluoride varnish on Streptococcus mutans counts in plaque of caries-free children using Dentocult SM strip mutans test: A randomized controlled triple blind study","volume":"25","author":"Jeevarathan","year":"2007","journal-title":"J Indian Soc Pedod Prev Dent"},{"key":"R10-20260826","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1159\/000317490","article-title":"Preventive effect of high-fluoride dentifrice (5,000 ppm) in caries-active adolescents: A 2-year clinical trial","volume":"44","author":"Nordstr\u00f6m","year":"2010","journal-title":"Caries Res"},{"key":"R11-20260826","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s00784-013-1119-8","article-title":"Effects of high-fluoride dentifrice (5,000-ppm) on caries-related plaque and salivary variables","volume":"18","author":"Mannaa","year":"2014","journal-title":"Clin Oral Investig"},{"key":"R12-20260826","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1111\/adj.12247","article-title":"Antibacterial activity of fluoride compounds and herbal toothpastes on Streptococcus mutans: An in vitro study","volume":"60","author":"Randall","year":"2015","journal-title":"Aust Dent J"},{"key":"R13-20260826","first-page":"1","article-title":"A comparison of the efficacy of a probiotic toothpaste, a fluoridated toothpaste in management of Streptococci mutans in plaque around orthodontic brackets-an in vivo study","volume":"8","author":"Mutha","year":"2024","journal-title":"J Contemp Orthod"},{"key":"R14-20260826","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1128\/mr.50.4.353-380.1986","article-title":"Role of Streptococcus mutans in human dental decay","volume":"50","author":"Loesche","year":"1986","journal-title":"Microbiol Rev"},{"key":"R15-20260826","first-page":"589 94","article-title":"Are dental diseases examples of ecological catastrophes?","volume":"11","author":"Twetman","year":"2003","journal-title":"Trends Microbiol"},{"key":"R16-20260826","first-page":"246","article-title":"Evaluation of some properties of fluoride dentifrices marketed to children","volume":"20","author":"Lodi","year":"2006","journal-title":"Braz Oral Res"},{"key":"R17-20260826","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1159\/000320364","article-title":"Low-fluoride acidic dentifrice: A randomized clinical trial in a fluoridated area","volume":"44","author":"Vilhena","year":"2010","journal-title":"Caries Res"},{"issue":"Suppl 1","key":"R18-20260826","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/adj.12045","article-title":"Minimum intervention dentistry principles and objectives","volume":"58","author":"Walsh","year":"2013","journal-title":"Aust Dent J"},{"key":"R19-20260826","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/S1806-83242014.50000001","article-title":"Evidence-based recommendation on toothpaste use","volume":"28","author":"Cury","year":"2014","journal-title":"Braz Oral Res"},{"key":"R20-20260826","doi-asserted-by":"crossref","first-page":"183","DOI":"10.5005\/jp-journals-10005-1915","article-title":"Antimicrobial efficacy of commercially available low-fluoride and fluoride-free dentifrices for children","volume":"14","author":"Reddy","year":"2021","journal-title":"Int J Clin Pediatr Dent"},{"key":"R21-20260826","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12903-017-0432-z","article-title":"Prevalence of severe early childhood caries and associated socioeconomic and behavioral factors in Xinjiang, China: A cross-sectional study","volume":"17","author":"Li","year":"2017","journal-title":"BMC Oral Health"},{"key":"R22-20260826","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1055\/s-0039-1698943","article-title":"Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study","volume":"6","author":"Prakash","year":"2012","journal-title":"Eur J Dent"},{"key":"R23-20260826","first-page":"3","article-title":"The in vitro antimicrobial activity of natural infant fluoride-free toothpastes on oral micro-organisms","volume":"78","author":"Carvalho","year":"2011","journal-title":"J Dent Child (Chic)"},{"key":"R24-20260826","first-page":"4921614","article-title":"Antibacterial effects of natural herbal extracts on Streptococcus mutans: Can they be potential additives in dentifrices?","author":"Ravi","year":"2017","journal-title":"Int J Dent 2017"},{"key":"R25-20260826","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12903-019-0741-5","article-title":"The antiplaque\/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: A systematic review and meta-analysis","volume":"19","author":"Jassoma","year":"2019","journal-title":"BMC Oral Health"},{"key":"R26-20260826","doi-asserted-by":"crossref","first-page":"26","DOI":"10.4103\/0970-9290.38928","article-title":"In vitro evaluation of antibacterial activity of an herbal dentifrice against Streptococcus mutans and Lactobacillus acidophilus","volume":"19","author":"Vyas","year":"2008","journal-title":"Indian J Dent Res"},{"key":"R27-20260826","first-page":"DC05","article-title":"Comparison of antimicrobial efficacy of triclosan-containing, herbal and homeopathy toothpastes\u2014An in vitro study","volume":"9","author":"Anushree","year":"2015","journal-title":"J Clin Diagn Res"},{"key":"R28-20260826","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.14219\/jada.archive.2004.0372","article-title":"The antimicrobial potential of 14 natural herbal dentifrices: Results of an in vitro diffusion method study","volume":"135","author":"Lee","year":"2004","journal-title":"J Am Dent Assoc"},{"key":"R29-20260826","doi-asserted-by":"crossref","first-page":"711","DOI":"10.13005\/bpj\/1424","article-title":"Evaluation of concentration dependent antimicrobial efficacy of herbal and non herbal dentifrices against salivary microflora \u2013 An in vitro study","volume":"11","author":"Bedre","year":"2018","journal-title":"Biomed Pharmacol J"},{"key":"R30-20260826","first-page":"52","article-title":"Salivary fluoride concentration following toothbrushing with 1450 ppm fluoride toothpaste containing different fluoride formulations","volume":"22","author":"Albahrani","year":"2022","journal-title":"BMC Oral Health"},{"key":"R31-20260826","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1186\/s12903-023-03195-5","article-title":"Clinical correlation of salivary alpha-amylase levels with pain intensity in patients undergoing emergency endodontic treatment","volume":"23","author":"Teja","year":"2023","journal-title":"BMC Oral Health"},{"key":"R32-20260826","first-page":"1","article-title":"Salivary alpha amylase activity and its association with early childhood caries and rampant caries experience: A cross sectional study","author":"Padmanabhan","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"R33-20260826","doi-asserted-by":"crossref","first-page":"106136","DOI":"10.1016\/j.archoralbio.2024.106136","article-title":"Salivary alpha amylase as a diagnostic biomarker for dental caries \u2013 A systematic review and meta analysis","volume":"170","author":"Savitha Priyadarsini","year":"2025","journal-title":"Arch Oral Biol"},{"key":"R34-20260826","doi-asserted-by":"crossref","first-page":"e16365","DOI":"10.2196\/16365","article-title":"The effects of gamification and oral self-care on oral hygiene in children: Systematic search in app stores and evaluation of apps","volume":"8","author":"Fija\u010dko","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"R35-20260826","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/froh.2023.1125070","article-title":"App based oral health promotion interventions on modifiable risk factors associated with early childhood caries: A systematic review","volume":"4","author":"Ajay","year":"2023","journal-title":"Front Oral Health"},{"key":"R36-20260826","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1089\/tmj.2018.0034","article-title":"Development and evaluation of a mobile oral health application for preschoolers","volume":"25","author":"Campos","year":"2019","journal-title":"Telemed J E Health"}],"container-title":["Journal of Indian Society of Pedodontics and Preventive Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jisppd.jisppd_155_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:04:40Z","timestamp":1787745880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jisppd.jisppd_155_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jisppd.jisppd_155_26","relation":{},"ISSN":["0970-4388","1998-3905"],"issn-type":[{"value":"0970-4388","type":"print"},{"value":"1998-3905","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-04-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}