Is bioactive glass toothpaste an effective alternative to fluoride toothpaste for preventing early childhood caries?

A COMMENTARY ON: Li T, Guo H, Liu C, Jiang H, Gao S, Du M. Effectiveness of Bioactive Glass-Based Toothpaste for Early Childhood Caries Prevention: A Randomized Controlled Trial. Int Dent J 2026;76:103985.

DESIGN

Double-blind, multicentre, parallel group cluster-randomised controlled trial (class-level randomisation).

CASE SELECTION: Children aged 3-4 years at risk of early childhood caries (ECC) were recruited and randomly assigned to one of two intervention groups: a fluoride‑free bioactive glass (BAG) toothpaste group and a fluoride toothpaste (800 ppm) group. Both groups were followed over 27 months to monitor the incidence of new carious lesions.

DATA ANALYSIS: Caries outcomes were evaluated using established clinical caries assessment criteria suitable for early childhood populations, with comparisons made between groups to determine differences in caries incidence and overall preventive effect. Statistical analyses were performed to evaluate group differences in caries development.

RESULTS

The trial found that the fluoride-free BAG toothpaste was effective in preventing ECC and performed comparably to the fluoride toothpaste. Both formulations provided measurable caries preventive benefits, indicating that BAG has potential as a clinically relevant alternative to fluoride for young children.

CONCLUSIONS

BAG toothpaste shows promise as a fluoride-free preventive agent for ECC. Its comparable effectiveness to fluoride toothpaste suggests it may be a useful option for children in situations where fluoride use is restricted, contraindicated, or declined by caregivers.