Jessica, L Kang
| Jessica, L Kang |
Jessica L Kang, David Hershkowitz, Rosa Urbina, M Shuster, Patricia Corby
Patricia Corby
Center for Clinical and Translational Research, University of Pennsylvania, School of Dental Medicine
Introduction
Dental caries remains the most prevalent pathological condition affecting children ages 9-16 years old. (1) Fluoride is traditionally used to remineralize the tooth to prevent caries. Yet, caries still remains prevalent possibly because fluoride has little effect on the oral microbiome, allowing acid producing bacteria, responsible for caries formation, to flourish. (2) Arginine, shifts the oral microbiome to a remineralization favorable pH through production of alkali byproducts. (3,4) L-Arginine is an amino acid, obtained through diet or made endogenously.(5) Potential uses of arginine for the prevention of caries have been studied as: combination of arginine and fluoride or arginine only dental products, as well as pre and probiotic supplements. (6) This literature review aims to provide oral health providers with clinical information on arginine, as a potential alternative or additive anti-caries product and how it compares to fluoride.
Methods
A search was performed using the NIH Pubmed database with the MeSh terms "Fluorides" AND "Arginine" AND "Dental Caries" from January 2013 to March 2022. 26 articles were related to the following MeSh terms and 16 were selected for this review. Studies published in English, with a RCT, meta-analysis, or systematic review design were included. Studies that were not published in English or those conducted in-vitro were excluded.
Results
Fluoride has been the only FDA-approved active toothbrushing aid for the prevention of caries, however some patients are concerned with fluoride . Currently, there is little research studying the efficacy of Arginine alone as an alternative approach for preventing caries. Nevertheless, studies have demonstrated that when combined with fluoride, arginine is proven to be safe, and it provides an additive anti-caries effect compared to fluoride alone through its remineralization properties and potential to modulate the oral microbiome to preserve oral health.
Conclusion
Many patients struggle with dental caries and choices regarding best approach for caries prevention. This review provides dental professionals up to date, evidence-based research on arginine, and how it compares to existing anti-caries fluoride oral health products. Although most studies have analyzed the anti-caries effect of a combination arginine and fluoride dental product, we are currently participating in an FDA approved phase 2, multisite clinical trial testing different concentrations of an arginine toothpaste and comparing the anti-caries effect to fluoridated toothpaste in children ages 10-14 years old.7