Research in to the anti-caries effect of arginine, an amino acid that occurs naturally in saliva and a range of food products, has been underway since the 1980s. It has recently it has been introduced as an additive to toothpaste and other dental products.

The aim of this review was to evaluate the evidence supporting the caries-preventive effect of the addition of arginine to dental care products, with special reference to preventing the development of new caries lesions and the progression of existing caries lesions, in children and adults.

Methods

THe PubMed, the Cochrane Library, Centre for Reviews and Dissemination (CRD) and Embase databases were searched.  
Randomised controlled trials (RCTs) of treatment with arginine in fluoride-containing dental products that measured dental caries incidence or progression in children, adults and elderly subjects were considered. Two reviewers independently assessed relevance and quality. Individual study quality was assessed using the GRADE criteria as strong, moderate, limited or insufficient.

Results

• 7 studies met the inclusion criteria
• 5 studies involved children and 2 adults
• Both adult studies and I child study were at high risk of bias, the other 4 child studies were considered to be at moderate risk.
• These 4 studies compared fluoride toothpaste (1,450 parts per million, ppm) with the addition of arginine (1.5%)with 1,450 ppm Fluoride toothpaste as a control.
• For caries incidence
  • In children only 1 study was included providing very low quality evidence that the addition of arginine to fluoride toothpaste had any effect.
  • In adults no studies were included.
• For caries progression
  • In children 3 studies were included providing very low quality evidence.
  • In adults no studies were included.
• Arginine toothpaste is about 40% more expensive than conventional toothpaste.

Conclusions

The authors concluded:-

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.

Comments

The review was conducted for the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) and follows a robust methodology. The review found little high quality evidence had states in the discussion that:-

There is currently no reason to recommend arginine-fluoride toothpaste in preference to conventional fluoride toothpaste.

They highlight a number of concerns relating to the primary studies. The involvement of employees of commercial companies in the included studies, lack of pre-published trial protocols, poor description of randomisation processes. There were also concerned regarding the use of QLF to measure caries progression and the fact that most of the included studies were only of 6-month duration. An earlier systematic review of arginine containing formulation by Li et al (Dental Elf – 10^th Dec 2015) included 10 studies again rating the quality of the available evidence as low and noting that they were all industry sponsored.

Links

Primary paper

 Ástvaldsdóttir Á, Naimi-Akbar A, Davidson T, Brolund A, Lintamo L, Attergren Granath A, Tranæus S, Östlund P. Arginine and Caries Prevention: A Systematic Review. Caries Res. 2016 Jul 12;50(4):383-393. [Epub ahead of print] PubMed PMID: 27403876.

Other references

 GRADE Criteria

Dental Elf – 10^th Dec 2015

Arginine in combination with calcium bases and fluoride in toothpaste may be better than fluoride alone