ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Arginine-Fluoride Dentifrice Is More Effective Than Standard Fluoride Dentifrice In Preventing Dental Caries In Children At Risk Of Caries
Clinical Question Would the use of 1.5% arginine-fluoride dentifrices, as compared to standard 1450 ppm fluoride dentifrice, result in lower caries prevalence in children at risk of caries?
Clinical Bottom Line Deamination of arginine, a semi-essential amino acid, by some oral bacteria results in ammonia production that leads to an alkaline oral environment, thus reducing the cariogenicity of oral biofilms. This effect is possibly the reason for current observation that dentifrice combining arginine (1.5%) and fluoride (1450 ppm) is more effective than 1450 ppm fluoride only dentifrice in lowering caries prevalence in children at risk of caries. This is based on two randomized clinical trials of 5,500 children in China and 331 children in Thailand, in which 1.5% arginine-fluoride dentifrice outperformed 1450 ppm fluoride dentifrice by a clinically significant margin.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26054185Li/20155,500 children (7-12 years old) in Sichuan Province, China. These children met the following criteria: were in elementary or middle school and had at least four fully erupted permanent molars and at least one erupted permanent central or lateral incisor.Randomized Controlled Trial
Key resultsAfter one year of the children using the dentifrices, there was no statistically significant difference among the groups with respect to decayed, missing, and filled teeth (DMFT) or to decayed, missing, and filled surfaces (DMFS). However, after 2 years of using the dentifrices, the children using the dentifrice composed of 1.5% arginine, 1450 ppm fluoride, and an insoluble calcium compound, had a statistically significant 20% reduction in DMFT and 19.6% reduction in DMFS when compared to the children in the group using the dentifrice that contains 1450 ppm fluoride as the only active ingredient.
#2) 23985436Srisilapanan/2013331 children (7-14 years old) in Chiang Mai, Thailand. These children met the following criteria: had one or more visible early enamel caries lesions on the upper anterior teeth.Randomized Controlled Trial
Key resultsThree months after the start of the trial, there was no statistically significant difference in caries lesion volume, as measured using quantitative light-induced fluorescence, device between the children using the 1.5% arginine-based dentifrice and those using the dentifrice containing 1450 ppm fluoride as the only active ingredient. However, after 6 months, the children using the combined arginine-fluoride-based dentifrice showed a statistically significant (p < 0.001) improvement (44.6%) in their caries status when compared to the children that used the control dentifrice containing 1450 ppm fluoride (28.9%).
Evidence Search (1.5%[All Fields] AND ("arginine"[MeSH Terms] OR "arginine"[All Fields]) AND ("dentifrices"[Pharmacological Action] OR "dentifrices"[MeSH Terms] OR "dentifrices"[All Fields] OR "dentifrice"[All Fields])) AND "1450 ppm fluoride"[All Fields] AND ("dentifrices"[Pharmacological Action] OR "dentifrices"[MeSH Terms] OR "dentifrices"[All Fields] OR "dentifrice"[All Fields])
Comments on
The Evidence
Validity: Both of these clinical trials were randomized, controlled, and were conducted in a double blind manner. In Li/2015, the children in all groups were similar at the start. They were all elementary and middle school children who had at least four fully erupted permanent molars and at least one erupted permanent central or lateral incisor. A total of 5,669 students completed all phases of the study from an initial 6,074. Therefore there was a 93.33% completion rate. All children in the study were treated the same except for the type of dentifrice used during a 2 year period. There was adequate follow-up: the first and second follow up examinations were one and two years, respectively, after the start of product use. The trial took several steps to insure that there be adequate compliance. For example, schoolteachers advised parents/guardians to help remind students about at-home tooth brushing, the school educated the students about the importance of tooth brushing, and when the students received new supplies of dentifrice and tooth brush, the clinical team checked and reviewed returned/used dentifrices. In Srisilapanan/2013, the two groups of children used in the trial were also similar at the start. All children in both the control and experimental group, started out with at least one early enamel caries lesion on the upper anterior teeth. The fluoride level in the drinking water of the areas where these children live was <0.03 ppm fluoride. Both groups of children were instructed to brush their teeth twice a day at home using the dentifrice assigned to them. On school days, the children also brushed their teeth in school after lunch under the supervision of schoolteachers. Tooth brushing was monitored and compliance was logged. All children used Colgate Extra clean Professional 35 toothbrushes and were told to cover the head of their brush with dentifrice every time they brushed their teeth. A total of 331 students completed all phases of the study from an initial 341. Therefore, there was a 97.07% completion rate. There was adequate follow-up: the first follow-up was at 3 months after the start of the trial and the second follow up was 6 months after the start of the trial. The trial took several steps to insure that there be adequate compliance such as having the children’s teachers supervise the tooth brushing procedure and log compliance of each child. Perspective: Based on these two randomized clinical trials, dentifrices containing combined arginine (1.5%) and fluoride (1450 ppm) are more efficacious in preventing caries in children at risk of caries than 1450 ppm fluoride only dentifrices. These articles, however, could have improved by using children from different parts of their respective countries. It is not clear whether the results apply to children outside the area of Sichuan Province, China and Mai, Thailand. This calls for further multi-center investigations using children across the globe in order to provide more generalizable results.
Applicability Although the subjects used in these clinical trials are of demographics, living conditions, culture and dietary habits that may differ from those of children from other parts of the globe, the findings in these studies may applicable to any children at high caries risk. The prescription and dispensary of arginine –fluoride dentifrice as an effective caries preventative measure to patients is very feasible in a clinical setting. The only potential danger is the possibility of some patient being allergic to arginine. Nonetheless, the benefit from this treatment is not only caries prevention but also arrestment and reversal of early stage caries.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry)
Keywords Arginine dentifrice; DMFT; DMFS; caries prevention
ID# 3068
Date of submission: 03/22/2016spacer
E-mail melendeze@livemail.uthscsa.edu
Author Eliana Melendez
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, PhD
Faculty mentor/Co-author e-mail Amaechi@uthscsa.edu
Basic Science Rationale
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