Abstract

ObjectivesThis systematic review evaluates whether probiotic supplementation may provide adjunctive, strain-specific benefits in the prevention and modulation of dental caries outcomes in children and adolescents. The primary outcomes analyzed included caries incidence, lesion progression or regression (ICDAS, dmfs/DMFS), and microbiological parameters such as Streptococcus mutans and Lactobacillus counts.Materials and methodsA comprehensive literature search was performed following PRISMA 2020 guidelines across PubMed, Scopus, Web of Science, Cochrane Library, and EMBASE. Randomized controlled trials comparing probiotic interventions with placebo or standard care were included. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials. Due to considerable clinical and methodological heterogeneity among studies particularly in probiotic strain, dosage, delivery vehicle, and outcome measurement a narrative synthesis was undertaken in accordance with JBI guidance.ResultsTwelve randomized controlled trials met the inclusion criteria. Probiotic supplementation, particularly with Lactobacillus rhamnosus SP1 and L. paracasei SD1 administered via milk or tablets for 6-10 months, significantly reduced caries incidence and S. mutans counts compared with control groups. Evidence regarding the prevention of caries recurrence (secondary prevention) and the regression of white spot lesions in orthodontic patients was limited and inconsistent. The overall certainty of evidence, assessed using GRADE/ConQual, was moderate for primary prevention and low for secondary outcomes.ConclusionsProbiotic supplementation may provide modest, strain-specific adjunctive benefits for caries prevention in high-risk pediatric populations; however, the certainty of evidence remains moderate to low, and findings are inconsistent across strains, delivery vehicles, and outcomes.Clinical relevanceThe findings support the biological plausibility of probiotics in caries management and suggest a potential adjunctive role within preventive dentistry strategies, particularly in selected high-risk populations.