The aim of this systematic literature review was to identify research-based evidence for an effect of antimicrobial therapeutic approaches on the cariogenic microbiota and early childhood caries (ECC) outcomes. Additionally, we reviewed methods used to perform microbial assessments in clinical studies of ECC.

Multiple database searches were conducted; only clinical cohort studies and randomized controlled trials published from 1998 to 2014 were selected for the review. A total of 471 titles and abstracts were identified; 114 studies met the inclusion criteria for a full review, and finally 41 studies were selected for the meta-analyses.

Moderate reductions in cariogenic bacterial levels, mainly in mutans streptococci (MS), were demonstrated following the use of antimicrobial agents. The results varied depending on the different approaches used. In most of the reviewed studies MS levels were reduced after treatment, but the bacterial regrowth occurred once the treatment had ceased, and new caries lesions developed, particularly in high-risk children. Relatively consistent findings suggested that anti-cariogenic-microbial interventions in mothers significantly reduced MS acquisition by children. However, studies of the long-term benefits of ECC prevention are lacking.

Based on the meta-analyses, antimicrobial interventions and treatments show temporary reductions in MS colonization levels. However, insufficient evidence suggest that the approaches used produced sustainable effects on cariogenic microbial colonization, caries reduction, and ECC prevention.