Objective : To answer whether an increased salivary S. mutans count is associated with higher caries.
Methods : Six databases were searched for articles (4 February 2009). Inclusion criteria : (i) titles/abstracts relevant to topic; (ii) published in English, Portuguese, Spanish; (iii) prospective cohort study; (iv) at least 2 groups / cohorts are investigated, for which a baseline salivary mutans count and a caries outcome after a period of time is reported; (v) caries outcome reported as computable datasets.
Results : Fifteen from the initial 134 articles were selected. From these, 5 were rejected and 10 articles reporting on 30 separate datasets accepted. Owing to heterogeneity, no meta-analysis was undertaken. Cohorts which differed statistically significantly (p<0.05) in their caries outcomes also differed largely in their salivary SM counts; cohorts with similar (p>0.05) caries outcomes differed little. Cohorts with S. mutans count >105 cfu/ml showed higher caries outcome. The results showed a 55% lower caries risk in subjects with S. mutans <5 x 105 cfu/ml (Relative Risk 0.45 - 95% CI 0.34, 0.59 - p<0.00001). Potential bias may have influenced study results.
Conclusion : Increased S. mutans counts are associated with higher caries outcomes. High quality cohort studies are needed to validate the current evidence.
In this article the current systematic review evidence for the caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and its clinical application in daily dental practice are discussed.