Efficacy of Probiotic Milk for Caries Regression in Preschool Children: A Multicenter Randomized Controlled Trial

Caries Res. 2020;54(5-6):491-501. doi: 10.1159/000509926. Epub 2020 Nov 23.


This multicenter double-blind randomized controlled trial aimed to determine the efficacy of daily or triweekly consumption of reconstituted milk powder, containing Lactobacillus paracaseiSD1, in preschool children for caries prevention. A 6-month intervention was conducted in 487 children (aged 37.6 ± 9.2 months) with ≤4 decayed teeth from 8 childcare centers. Using stratified block randomization, participants were randomly allocated into 3 groups, comprising: (1) daily probiotic, receiving probiotic milk once daily, (2) triweekly probiotic, randomly receiving probiotic milk 3 days a week and the placebo milk for the remaining 4 days, and (3) placebo, receiving milk without probiotics. Each tooth surface was assessed for caries status using the modified Nyvad criteria at baseline (T0), 6 (T6) and 12 (T12) months after T0. Study outcomes were caries transition, including caries progression and regression during the T0-T6, T6-T12 and T0-T12 periods. Negative binomial regression with a generalized linear model was used to estimate the caries outcomes, which were reported as incidence rate ratios (IRRs) and 95% confidence intervals (CIs). At baseline, caries prevalence and mean decayed surfaces were 81.9% and 7.29 ± 7.60, respectively. Three groups were balanced at baseline with an overall dropout rate of 25.2%. After adjusting for age, sex, and the number of noncavitated and cavitated caries at baseline, a decreased caries risk during T0-T6 was shown in both the daily and triweekly probiotic groups (adjusted IRR 0.83, 95% CI 0.72-0.96 in both groups) and during T0-T12 (adjusted IRR 0.84, 95% CI 0.76-0.94, and adjusted IRR 0.86, 95% CI 0.76-0.96, respectively) compared to the placebo group. In contrast, significantly increased regressive surfaces were demonstrated during T0-T6 by adjusted IRR 1.76 (95% CI 1.25-2.48) and 2.01 (95% CI 1.42-2.85) and during T0-T12 by adjusted IRR 1.98 (95% CI 1.50-2.61) and 1.92 (95% CI 1.45-2.55) for the daily and triweekly groups, respectively. In conclusion, probiotic milk consumption either daily or triweekly can modestly prevent new caries, but considerably reverse carious lesions, suggesting that a daily or triweekly dose interval is sufficient to reverse carious lesions.

Keywords: Early childhood caries; Lactobacillus paracasei; Preschool children; Prevention; Probiotics.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • Child, Preschool
  • Dental Caries Susceptibility
  • Dental Caries* / epidemiology
  • Dental Caries* / prevention & control
  • Double-Blind Method
  • Humans
  • Lactobacillus
  • Middle Aged
  • Milk
  • Probiotics* / therapeutic use