Calcium-Based Caries Preventive Agents: A Meta-evaluation of Systematic Reviews and Meta-analysis

Bijle et al., 2018 | J Evid Based Dent Pract | Meta Analysis

Citation

Bijle Mohammed Nadeem Ahmed, Yiu Cynthia Kar Yung, Ekambaram Manikandan. Calcium-Based Caries Preventive Agents: A Meta-evaluation of Systematic Reviews and Meta-analysis. J Evid Based Dent Pract. 2018-Sep;18(3):203-217.e4. doi:10.1016/j.jebdp.2017.09.003

Abstract

OBJECTIVE: This article aims to assess systematic reviews and/or meta-analyses on calcium-based caries preventive agents, evaluating reported evidence, thereby summarizing a critical appraisal on the subject. MATERIALS AND METHODS: A systematic search was done using PubMed, Cochrane Library, and Web of Science. Systematic reviews and/or meta-analyses addressing PICO: P: any age or gender; I: calcium-based caries preventive agents; C: with/without control; and O: any early caries lesion measures were included. Inter-reviewer reliability was assessed using Cohen's kappa coefficient. RESULTS: One hundred sixty-four records were identified, of which 10 (κ = 1.00) were included for quality evaluation. Seven reviews were systematic reviews (only), whereas 3 were meta-analyses. None of the articles provided with an "a priori" review design. Majority of the reviews (7 of 10) were of high quality as assessed by Assessing the Methodological Quality of Systematic Reviews, whereas 3 articles were scored as moderate quality of evidence. All the included meta-analyses were of high-quality evidence as assessed by meta-evaluation of meta-analysis: 10 appraisal questions for biologists. Eight reviews addressed the intervention: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)/casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP). Two reviews were performed on arginine-containing formulations. Majority of the high-quality systematic reviews were inconclusive over the effects of CPP-ACP/CPP-ACFP. CONCLUSION: This meta-evaluation suggests that CPP-ACP/CPP-ACFP can be considered as an adjunct to fluorides but not as an alternative until long-term well-designed clinical trials assessed by systematic reviews and meta-analysis are available. Arginine-containing dentifrice with an insoluble calcium base and fluoride seem to be a promising agent, but more well-designed non-industry-supported clinical trials can provide better insights in future.

Key Findings

One hundred sixty-four records were identified, of which 10 (κ = 1.00) were included for quality evaluation. Seven reviews were systematic reviews (only), whereas 3 were meta-analyses. None of the articles provided with an "a priori" review design. Majority of the reviews (7 of 10) were of high quality as assessed by Assessing the Methodological Quality of Systematic Reviews, whereas 3 articles were scored as moderate quality of evidence. All the included meta-analyses were of high-quality evide

Outcomes Measured

Requires manual extraction

Population

Field	Value
Population	See abstract
Sample Size	See abstract
Age Range	See abstract
Condition	See abstract

MeSH Terms

Humans
Calcium
Cariostatic Agents
Dental Caries
Fluorides
Meta-Analysis as Topic
Reproducibility of Results
Systematic Reviews as Topic
Tooth Remineralization

Evidence Classification

Level: Meta Analysis
Publication Types: Journal Article, Meta-Analysis, Systematic Review
Vertical: calcium

Provenance

PMID: 30077374
DOI: 10.1016/j.jebdp.2017.09.003
PMCID: Not in PMC
Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09