The use of toothpastes containing different active agents in managing root caries: A systematic review with network meta-analysis

OBJECTIVE: This systematic review aimed to evaluate current evidence according to toothpastes containing different active ingredients for the management of root caries in laboratory-based, in situ and clinical studies. DATA AND SOURCES: This systematic review was conducted in accordance with Cochrane guidelines. Literature searches were performed across nine databases (up to 31.01.2024). In vitro and in situ studies were evaluated using a quality assessment tool. The Cochrane risk of bias tool (RoB2.0) was employed to assess the included clinical studies. Two reviewers independently conducted study selection, data extraction, risk of bias assessment, and certainty of evidence evaluation using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). STUDY SELECTION/RESULTS: F, when compared with standard toothpastes containing 1450 ppm sodium fluoride appeared to be effective for hardening and reversing root carious lesions (RR: 1.60; 95 % CI: 0.92 to 2.79). The pooled estimates reported that root carious lesions became hard following the use of bioactive toothpaste (1100 ppm NaF + 1 % CaSO4 + 1.1 % NH4H2PO4) in comparison to the standard toothpastes (RR: 1.81, 95 % CI: 1.39-2.36). CONCLUSION: Within the studies identified in the systematic review, toothpaste with sodium fluoride as an active ingredient in high concentration was the most effective at reducing lesion depth, improving lesion hardness, and preventing new caries. The incorporation of bioactive components that deliver calcium and phosphate (bioactive toothpaste) and the adjunctive use of fluoride with arginine may potentially manage these lesions in comparison to the standard toothpaste containing 1450 ppm sodium fluoride which might be insufficient to arrest active root caries in high-risk patients. CLINICAL RELEVANCE: The use of toothpaste containing high concentration of sodium fluoride as active ingredient by prescription only can be considered as the first-line non-invasive therapy for arresting active root caries. Alternatively, over-the-counter toothpastes either containing fluoride with arginine or bioactive ingredients could potentially be an optimum option for patients who cannot tolerate or decline to use high-fluoride prescriptions.