Arginine and Caries Prevention: A Systematic Review

Álfheiður Ástvaldsdóttir, Aron Naimi-Akbar, Thomas Davidson, Agneta Brolund, Laura Lintamo, Anna Attergren Granath, Sofia Tranæus, Pernilla Östlund

To evaluate the available evidence that the use of arginine-containing dental care products prevents the development of new caries lesions and the progression of existing lesions. We performed a systematic literature search of databases including PubMed, the Cochrane Library and EMBASE. We selected randomized controlled trials of treatment with arginine in fluoride-containing dental products measuring dental caries incidence or progression in children, adults and elderly subjects. Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE classification. Due to conflicts of interest and weak transferability to Swedish conditions, no conclusions can be drawn from studies on the effects of arginine-fluoride toothpaste in children. Arginine-containing toothpaste costs about 40% more than basic fluoride toothpaste; to determine whether it is more cost-effective, the higher cost must be considered in relation to any additional caries-preventive effect. The literature review also disclosed some questionable research ethics: in several of the studies, the children in the control group used non-fluoride toothpaste. Toothpaste without fluoride is not as effective against dental caries as the standard treatment - fluoride toothpaste - which has a well-documented effect. This contravenes the fundamental principles of research ethics. At present there is insufficient evidence in support of a caries-preventive effect for the inclusion of arginine in toothpastes. More rigorous studies, and studies which are less dependent on commercial interests, are required.