E-Mail karger@karger.com Review Caries Res 2016;50:383–393 DOI: 10.1159/000446249 Arginine and Caries Prevention: A Systematic Review Álfheiður Ástvaldsdóttir a Aron Naimi-Akbar a, b Thomas Davidson c Agneta Brolund d Laura Lintamo d Anna Attergren Granath d Sofia Tranæus a, d, e Pernilla Östlund d, e a Department of Dental Medicine, Karolinska Institutet, and b Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, c Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, d Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, and e Health Technology Assessment – Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden relation to any additional caries-preventive effect. The litera- ture review also disclosed some questionable research eth- ics: 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 treat- ment – fluoride toothpaste – which has a well-documented effect. This contravenes the fundamental principles of re- search ethics. Conclusion: At present there is insufficient ev- idence in support of a caries-preventive effect for the inclu- sion of arginine in toothpastes. More rigorous studies, and studies which are less dependent on commercial interests, are required. © 2016 S. Karger AG, Basel Caries is one of the most common childhood diseases. The disease arises as the result of a complex interaction of many factors. All tooth surfaces are covered with a thin biofilm to which bacteria adhere and mature. As well as substrate in the saliva, the biofilm bacteria may also utilize dietary sugars as a substrate, producing acid, mainly lactic acid. Bacterial activity leads to a drop in the pH, which eventually leads to the dissolution of the hy- droxyapatite crystals of the enamel. In periods of no sug- Key Words Arginine · Arginine-fluoride toothpaste · Caries · Caries prevention · Dental care Abstract Objectives: To evaluate the available evidence that the use of arginine-containing dental care products prevents the de- velopment of new caries lesions and the progression of ex- isting lesions. Search Methods: We performed a systematic literature search of databases including PubMed, the Coch- rane Library and EMBASE. Selection Criteria: 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 sub- jects. Data Collection and Analysis: Two review authors in- dependently assessed trials for risk of bias and evaluated overall study quality using the GRADE classification. Main Results: 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 chil- dren. 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 Received: January 28, 2016 Accepted: March 16, 2016 Published online: July 12, 2016 Álfheiður Ástvaldsdóttir Department of Dental Medicine, Karolinska Institutet PO Box 4064 SE–14104 Huddinge (Sweden) E-Mail Alfheidur.Astvaldsdottir  @  ki.se © 2016 S. Karger AG, Basel 0008–6568/16/0504–0383$39.50/0 www.karger.com/cre