Non-Cochrane · intervention · PM40066530
Postbiotics and Dental Caries: A Systematic Review.
Heidari Faezeh, Heboyan Artak, Rokaya Dinesh, et al. · Clinical and experimental dental research · 2025 · PubMed · doi:10.1002/cre2.70114
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
18
current version
GRADE rated
0
No studies
0
Included studies
21
linked below
No studies 0 · 0%Ungraded 18 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Studies on dental caries or cariogenic bacteria | In vitro cariogenic bacteria/biofilms (mainly S. mutans reference strains) and humans (children 6-12 y; adults with dental caries) (n=21) |
| Intervention | Postbiotics (e.g., cell-free supernatants, parabiotics, bacterial lysates, bacterial metabolites) and their effects on caries/cariogenic bacteria | Lactobacillus-derived postbiotics: cell-free supernatants, biosurfactants, lipoteichoic acid, bacterial lysates, and postbiotic toothpaste/lozenges/tablets (n=21) |
| Comparison | Not specified (probiotics and non-postbiotic interventions excluded) | Untreated controls (in vitro); placebo, fluoride toothpaste, or standard post-filling care (human trials) |
| Outcomes | Caries incidence, cariogenic bacterial count, or related gene expression | S. mutans growth/counts, biofilm formation, virulence gene expression, adhesion, enamel demineralization; salivary S. mutans, salivary pH, salivary IgA, plaque index, oral microbiota |
| Study designs | RCTs, quasi-experimental, observational, in vitro | In vitro (n=18); randomized controlled trials (n=3) |
| Timing | Not specified | In vitro exposure 24 h-7 days; human trials daily for 14 days-4 weeks |
Search date: October 2024. Databases: PubMed; Scopus; Web of Science; Cochrane Library
Questions and results
Lactobacillus-derived postbiotics vs Not specified
Population: Reference strains of Streptococcus mutans and cariogenic biofilms
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Streptococcus mutans growth and biofilm formation 24 h to 7 days No meta-analysis was conducted; the narrative synthesis reported inhibition of Streptococcus mutans growth and biofilm formation. Source: Results, Effects on Dental Caries; Table 2 · same question in other reviews | no estimate extracted | 12 studies | Ungraded |
Downregulation of S. mutans virulence/biofilm gene expression (gtfB, gtfC, ftf) Exposure 24 h to 7 days Population: Cariogenic bacteria (mainly Streptococcus mutans reference strains) and oral biofilms in vitro Postbiotics reduce expression of S. mutans biofilm/virulence genes (gtfB, gtfC, ftf) in vitro (ungraded narrative synthesis). Source: Results, 'Effects on Dental Caries' and Discussion; Table 2 (Savabi 2014; Salehi 2014; Jeong 2018; Wasfi 2018; Tahmourespour 2019;… · same question in other reviews | Postbiotics downregulated expression of S. mutans virulence and exopolysaccharide-synthesis genes (e.g., gtfB, gtfC, gtfD, ftf) in 10 in vitro studies; no pooled estimate. | 8 studies | Ungraded |
Proposed inhibition of S. mutans adhesion to tooth surface (mechanism; direct adherence endpoint confirmed only in Ahn 2018) Exposure 24 h to 7 days Population: Cariogenic bacteria (mainly Streptococcus mutans reference strains) and oral biofilms in vitro Postbiotics inhibit S. mutans adhesion to tooth surfaces in vitro (ungraded narrative synthesis). Source: Discussion, mechanism 'Inhibition of bacterial adhesion' (Ahn 2018; Ciandrini 2016; Salehi 2014; Savabi 2014; Tahmourespour 2019); Table 2 · same question in other reviews | Postbiotics (mainly biosurfactants and lipoteichoic acid) interfered with S. mutans adhesion to tooth/hydroxyapatite surfaces in 5 in vitro studies; no pooled estimate. | 5 studies | Ungraded |
Virulence-gene expression related to adhesion acid production and exopolysaccharide synthesis 24 h to 7 days No meta-analysis was conducted; the narrative synthesis reported reduced expression of Streptococcus mutans virulence genes. Source: Results, Effects on Dental Caries; Table 2 · same question in other reviews | no estimate extracted | 7 studies | Ungraded |
Reduced enamel demineralization Exposure 24 h to 7 days Population: Cariogenic bacteria (mainly Streptococcus mutans reference strains) and oral biofilms in vitro A single in vitro study found postbiotics reduce enamel demineralization (ungraded). Source: Results, 'Effects on Dental Caries'; Table 2 (Chen 2020) · same question in other reviews | One in vitro multispecies-biofilm study reported that a postbiotic (L. reuteri cell-free supernatant) reduced enamel demineralization, indicating a protective effect against caries; no pooled estimate. | 1 study | Ungraded |
Postbiotic toothpaste vs Fluoride toothpaste
Population: Children aged 6 to 12 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Salivary Streptococcus mutans count 4 weeks No meta-analysis was conducted; the reduction in salivary Streptococcus mutans count versus fluoride toothpaste was reported as insignificant. Source: Table 2; Results, Effects on Dental Caries · same question in other reviews | no estimate extracted | 1 study | Ungraded |
Increased salivary IgA Daily for 14 days to 4 weeks Population: Children aged 6-12 years Postbiotics increase salivary IgA (immune modulation) in human trials (ungraded narrative synthesis). Source: Results and Discussion, mechanism 'Modulation of immune responses' (Basir 2022; Lin 2022); Table 2 · same question in other reviews | Postbiotic toothpaste significantly increased salivary IgA versus fluoride toothpaste (Basir 2022); the review also cites Lin 2022 for postbiotic immune modulation/IgA; no pooled estimate. | 1 study | Ungraded |
Improved caries prognosis via restored oral microbiota 14 days Population: Patients after dental filling Adjuvant postbiotics after dental filling improve caries prognosis by restoring the oral microbiota in one RCT (ungraded). Source: Results, 'Effects on Dental Caries'; Table 2 (Liu 2024) · same question in other reviews | One RCT reported that adjuvant postbiotic tablets after dental filling improved caries prognosis by restoring oral microbiota diversity, structure and function and reducing potentially pathogenic bacteria (Liu 2024);… | 1 study | Ungraded |
Reduced dental plaque index 4 weeks Population: Adults with dental caries Postbiotic lozenges reduce plaque index in one adult RCT (ungraded). Source: Results, 'Effects on Dental Caries'; Table 2 (Lin 2022) · same question in other reviews | One RCT in adults reported a significant reduction in plaque index with postbiotic/heat-killed lozenges versus placebo (Lin 2022); no pooled estimate. | 1 study | Ungraded |
Increased salivary pH 4 weeks Population: Children aged 6-12 years Postbiotic toothpaste raises salivary pH in one pediatric RCT (ungraded). Source: Results, 'Effects on Dental Caries' and Discussion (pH buffering); Table 2 (Basir 2022) · same question in other reviews | Postbiotic toothpaste significantly increased salivary pH versus fluoride toothpaste in children (Basir 2022); postbiotics are also proposed to buffer acidic pH; no pooled estimate. | 1 study | Ungraded |
Reduced salivary S. mutans counts Daily for 14 days to 4 weeks Population: Humans at risk of dental caries (children aged 6-12 years; adults with dental caries) Postbiotic products reduce salivary S. mutans counts in human trials, though not always significantly (ungraded narrative synthesis). Source: Results, 'Effects on Dental Caries'; Table 2 (Basir 2022; Lin 2022; Liu 2024) · same question in other reviews | Three RCTs reported reduced salivary S. mutans counts after postbiotic intervention; the reduction was statistically significant in Lin 2022 but non-significant in Basir 2022; no pooled estimate. | 3 studies | Ungraded |
Salivary immunoglobulin A and pH 4 weeks No meta-analysis was conducted; postbiotic toothpaste was reported to increase salivary immunoglobulin A and pH versus fluoride toothpaste. Source: Table 2; Results, Effects on Dental Caries · same question in other reviews | no estimate extracted | 1 study | Ungraded |
Heat-killed probiotic and postbiotic oral lozenges vs Placebo
Population: Adults with dental caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Salivary Streptococcus mutans count and plaque index 4 weeks No meta-analysis was conducted; postbiotic lozenges were reported to reduce salivary Streptococcus mutans counts and plaque index versus placebo. Source: Table 2; Results, Effects on Dental Caries · same question in other reviews | no estimate extracted | 1 study | Ungraded |
Inactivated-bacteria tablets vs Not specified
Population: Patients after dental filling
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries prognosis and oral-microbiota diversity structure and function 14 days No meta-analysis was conducted; postbiotic tablets were reported to improve caries prognosis and restore oral-microbiota diversity structure and function. Source: Table 2; Results, Effects on Dental Caries · same question in other reviews | no estimate extracted | 1 study | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction of preformed S. mutans biofilms In vitro | no estimate extracted | 2 studies | Ungraded |
Inhibition of S. sobrinus growth and biofilm formation (incl. ftf/gtfB/gtfC expression) In vitro | no estimate extracted | 1 study | Ungraded |
Inhibition of mixed-species S. mutans-C. albicans biofilm and C. albicans virulence-gene (HWP1/ALS1/ALS3) downregulation In vitro (interkingdom) | no estimate extracted | 1 study | Ungraded |
Altered cariogenic-biofilm composition/architecture with reduced abundance of cariogenic species In vitro (multispecies biofilm) | no estimate extracted | 1 study | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Partial Yes | no |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: No · RCT: No | RCT: No · NRSI: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: N/A | RCT: N/A · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 21
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Ahn 2018 Lactobacillus plantarum lipoteichoic acid inhibits biofilm formation of Streptococcus mutans. PMID:29420616 | this review only | not stated | not extracted yet | not extracted yet |
| Banakar 2023 Antimicrobial Effects of Postbiotic Mediators Derived from Lactobacillus rhamnosus GG and Lactobacillus reuteri on Streptococcus mutans. PMID:37258481 | this review only | not stated | not extracted yet | not extracted yet |
| Basir 2022 Effect of postbiotic-toothpaste on salivary levels of IgA in 6- to 12-year-old children: Study protocol for a randomized triple-blind… PMID:36578663 | this review only | not stated | not extracted yet | not extracted yet |
| Chen 2020 Probiotic Effects on Multispecies Biofilm Composition, Architecture, and Caries Activity In Vitro. PMID:32825575 | this review only | not stated | not extracted yet | not extracted yet |
| Ciandrini 2016 Characterization of biosurfactants produced by Lactobacillus spp. and their activity against oral streptococci biofilm. PMID:27102127 | this review only | not stated | not extracted yet | not extracted yet |
| Jeong 2018 Antimicrobial and anti-biofilm activities of Lactobacillus kefiranofaciens DD2 against oral pathogens. PMID:29868163 | this review only | not stated | not extracted yet | not extracted yet |
| Jung 2021 Effects of Probiotic Culture Supernatant on Cariogenic Biofilm Formation and RANKL-Induced Osteoclastogenesis in RAW 264.7 Macrophages. PMID:33572576 | this review only | not stated | not extracted yet | not extracted yet |
| Kim (Hyun) 2022 In vitro anti-inflammatory and antibiofilm activities of bacterial lysates from lactobacilli against oral pathogenic bacteria. PMID:36416047 | this review only | not stated | not extracted yet | not extracted yet |
| Kim (Jang) 2022 Antibacterial and Antibiofilm Effect of Cell-Free Supernatant of Lactobacillus brevis KCCM 202399 Isolated from Korean Fermented Food… PMID:34675145 | this review only | not stated | not extracted yet | not extracted yet |
| Lin 2022 Impact of the food grade heat-killed probiotic and postbiotic oral lozenges in oral hygiene. PMID:35236778 | this review only | Salivary Streptococcus mutans count and plaque index | not extracted yet | not extracted yet |
| Liu 2024 Adjuvant postbiotic administration improves dental caries prognosis by restoring the oral microbiota DOI:10.26599/fshw.2022.9250217 | this review only | Caries prognosis and oral-microbiota diversity structure and function | not extracted yet | not extracted yet |
| OmerOglou 2022 The role of microbiota-derived postbiotic mediators on biofilm formation and quorum sensing-mediated virulence of Streptococcus mutans: A… PMID:35092835 | this review only | not stated | not extracted yet | not extracted yet |
| Park 2023 Antimicrobial activity of Limosilactobacillus fermentum strains isolated from the human oral cavity against Streptococcus mutans. PMID:37198248 | this review only | not stated | not extracted yet | not extracted yet |
| Rossoni 2018 Inhibitory effect of probiotic Lactobacillus supernatants from the oral cavity on Streptococcus mutans biofilms. PMID:30053602 | this review only | not stated | not extracted yet | not extracted yet |
| Salehi 2014 Effects of Lactobacillus reuteri-derived biosurfactant on the gene expression profile of essential adhesion genes (gtfB, gtfC and ftf) of… PMID:25221772 | this review only | not stated | not extracted yet | not extracted yet |
| Savabi 2014 Effects of biosurfactant produced by Lactobacillus casei on gtfB, gtfC, and ftf gene expression level in S. mutans by real-time RT-PCR. PMID:25538917 | this review only | not stated | not extracted yet | not extracted yet |
| Srivastava 2020 Lactobacillus Plantarum 108 Inhibits Streptococcus mutans and Candida albicans Mixed-Species Biofilm Formation. PMID:32759754 | this review only | not stated | not extracted yet | not extracted yet |
| Tahmourespour 2019 Lactobacillus rhamnosus biosurfactant inhibits biofilm formation and gene expression of caries-inducing Streptococcus mutans. PMID:30820202 | this review only | not stated | not extracted yet | not extracted yet |
| Wasfi 2018 Probiotic Lactobacillus sp. inhibit growth, biofilm formation and gene expression of caries-inducing Streptococcus mutans. PMID:29316223 | this review only | not stated | not extracted yet | not extracted yet |
| Yang 2021 Lactobacillus reuteri AN417 cell-free culture supernatant as a novel antibacterial agent targeting oral pathogenic bacteria. PMID:33452304 | this review only | not stated | not extracted yet | not extracted yet |
| Zhao 2023 Postbiotics Derived from L. paracasei ET-22 Inhibit the Formation of S. mutans Biofilms and Bioactive Substances: An Analysis. PMID:36770903 | this review only | not stated | not extracted yet | not extracted yet |