Microbial alteration after intensive fluoride varnish treatment in children with early childhood caries: An exploratory study.

Socioeconomic status (SES) has a significant effect on the burden of early childhood caries (ECC), yet addressing SES disparities remains challenging. This study aimed to identify and quantify the most impactful mediator linking SES effect to the occurrence of ECC using advanced causal mediation analysis, to inform targeted interventions that reduce SES-related disparities in ECC. Data were drawn from the Study of Mothers' and Infants' Life Events, a cohort of 2,182 mother-child dyads recruited from Adelaide's 3 largest public hospitals (2013-2014). Baseline questionnaires captured family SES, while ECC clinical indicators were assessed at age 5 y. Three mediation pathways linking SES and ECC were examined including dietary intake represented by free sugar intake (FSI); oral hygiene practices, including toothbrushing habits and plaque presence; and dental visiting patterns. Mediation effects were quantified as natural indirect effects (NIE) using causal mediation analysis based on the counterfactual framework, with validation via 5-fold cross-validation to ensure robustness. FSI was the only pathway with a significant mediation effect. Each 1-standard-deviation increase or decrease in SES was associated with a corresponding 6% reduction or increase in ECC risk at age 5 y through the mediating effect of FSI at age 2 y. The NIE of FSI accounted for 52% of SES's total effect on ECC. In contrast, oral hygiene and dental visiting patterns showed no significant mediation effects. Reducing early childhood FSI could mitigate half of SES-related disparities in ECC. Targeted interventions focusing on FSI reduction hold promise for lowering ECC risk, with future research needed to evaluate their effectiveness.Knowledge Transfer Statement:Clinicians and policymakers should prioritize nutrition education and sugar reduction initiatives as key components of early prevention in pediatric dentistry, especially for low-SES populations. Incorporating FSI screening into routine visits enables medical and dental practitioners to educate caregivers on the impact of free sugars on dental health.

Artificial intelligence (AI) is increasingly applied in pediatric dentistry for caries detection, risk prediction, anomaly identification, and treatment planning. However, the quality, consistency, and overlap of evidence from existing systematic reviews have not been comprehensively evaluated. To synthesize evidence from systematic reviews on AI in pediatric dentistry, focusing on diagnostic performance, methodological quality, and overlap of primary studies. PubMed/MEDLINE and the Cochrane Database of Systematic Reviews were searched up to 31 August 2025. Methodological quality was assessed using AMSTAR-2, and overlap was quantified using the corrected covered area (CCA) with the GROOVE tool. Seven systematic reviews (109 primary studies) were included-four on early childhood caries, one each on dental anomalies, cleft lip and palate, and caries risk prediction. AI, particularly convolutional neural networks for imaging, achieved pooled sensitivities and specificities of 80%-83% and Area Under the Curve (AUCs)of 0.87-0.91. Most reviews were of low or critically low quality due to lack of protocol registration and limited bias assessment. GROOVE analysis indicated moderate overlap (CCA = 8.27%). AI demonstrates promising diagnostic performance in pediatric dentistry, particularly for image-based tasks, but current evidence remains preliminary and should be interpreted with caution. PROSPERO registration number: CRD420251142904.

The comparative effectiveness of silver diamine fluoride and fluoride varnish in arresting early childhood caries remains insufficiently established. Therefore, it is of interest to evaluate caries arrest among 90 children treated with either silver diamine fluoride or fluoride varnish. Hence, participants were divided into two groups, with clinical assessment of caries arrest at baseline and follow-up using standardized criteria. Silver diamine fluoride showed a higher caries arrest rate than fluoride varnish, reflecting its combined antimicrobial and remineralization effects. Thus, we show comparative clinical evidence supporting silver diamine fluoride as a more effective minimally invasive approach for managing early childhood caries.

Kerman is Iran's largest province, with a population exceeding three million and documented socioeconomic disparities in oral health outcomes. This systematic review and meta-analysis aimed to characterize temporal trends in dmft/DMFT indices across six age groups in Kerman province over nearly three decades. This study was conducted in accordance with the PRISMA 2020 guidelines. English and Persian databases, including PubMed, Scopus, Embase, Web of Science, and SID, were searched up to April 2026. This search was supplemented by a manual review of dental master's theses from Kerman Dental School and national oral health reports. Cross-sectional studies reporting dmft/DMFT indices in the general healthy population of Kerman province were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Pooled estimates and 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using I2 and Q statistics. Subgroup analyses by time period (prior to 2015 versus 2015 to present) and univariable meta-regression with four pre-specified covariates were performed to explore sources of heterogeneity. The certainty of evidence was assessed using the GRADE framework. A total of 49 studies (comprising 26 peer-reviewed articles, 19 theses, and 4 national reports) were included. The pooled dmft was 3.55 (95% CI: 3.26-3.84) for children aged 3-6years, 5.12 (95% CI: 4.74-5.50) for 6-year-olds, and 4.09 (95% CI: 2.73-5.46) for 9-year-olds. Pooled DMFT values were 2.04 (95% CI: 1.70-2.39) for 12-year-olds and 2.61 (95% CI: 1.38-3.84) for the 12-15-year age group. In adults aged 35-44years, the pooled DMFT was 13.80 (95% CI: 10.80-16.78). Meta-regression and subgroup analysis revealed a significant increasing temporal trend in the 3-6-year group (+ 0.21 units per year; p < 0.001), while geographic location significantly predicted caries levels in 6-year-olds (p < 0.001). Heterogeneity was very high across all age groups (I2 > 94%, p < 0.001). The certainty of evidence was rated as very low for all age groups using the GRADE framework. The dental caries burden in Kerman province remains high across all age groups, with a significant worsening trend in early childhood caries. Due to the very low certainty of current evidence, a standardized provincial oral health survey is needed. Future strategies should prioritize expanded water fluoridation and targeted community-based preschool interventions.

Early childhood caries (ECC) is a prevalent dental disease with significant public health burdens. Oral microbiota plays a key role in caries development. Although several studies have compared the oral microbiota before and after caries treatment, few have investigated the dynamic changes in oral microbial communities beyond 3months. This 6-month prospective study monitored dynamic changes in the dental plaque microbiome, salivary pH, and oral hygiene status among children with ECC undergoing caries management. The outcomes were assessed at baseline (T0), immediately post-treatment (T1), and at 1-month, 3-month, and 6-month follow-ups (T2-T4). Children's oral hygiene status improved significantly after ECC management (p < 0.001). Their salivary pH levels increased at T1 but returned to the initial level during follow-up visits. Higher Chao1 scores were observed at T2, T3, and T4 when compared to T0 and T1 (p < 0.001). The principal coordinate analysis revealed distinct clustering patterns between baseline and post-treatment visits. Significant differences were observed in the relative abundance of Corynebacterium (p < 0.01), Corynebacterium matruchotii (p < 0.01), and Selenomonas noxia (p < 0.05) during the study period. The relative abundance of Corynebacterium and Corynebacterium matruchotii was significantly higher at T3 and T4 when compared to T1 (p < 0.01). Additionally, Saccharibacteria was positively correlated with children's dmfs scores and negatively correlated with children's salivary pH values. The above findings possibly indicated that comprehensive ECC management might be associated with dynamic changes in the oral microbiome. Further well-designed randomized controlled trials are warranted to determine the impact of dental treatment on oral microbiota dynamics. KEY POINTS: • Dynamic changes observed in the oral microbiome following dental treatment • Abundance of Saccharibacteria associated with children's caries status and salivary pH values • Children's oral health-related behaviors improved after comprehensive dental management.

Staging-Dependent Dysbiosis of Plaque Microbiota in Early Childhood Caries.

Selenomonas sputigena is an anaerobic, gram-negative bacterium found in the human mouth and upper respiratory tract. This organism is emerging as an important contributor to human health and disease. In the oral cavity, S. sputigena contributes to periodontitis and is associated with early childhood caries. Much of our current understanding of the genus Selenomonas and its relation to human health derives from studies of a single species, S. sputigena, and is further limited to the type strain, ATCC 35185. As S. sputigena is emerging as a significant contributor to human health, we sought to characterize the S. sputigena ATCC 33150 strain. Genomic analyses revealed that ATCC 33150, previously described as S. sputigena, is a novel Selenomonas sp., and we propose the name Selenomonas lamontii. Phenotypic comparison to S. sputigena reveals that S. lamontii grows more slowly and to a lower density in vitro. S. lamontii is more motile than S. sputigena and does not form surface-attached biofilms. Re-analysis of existing metagenomic data revealed the consistent presence of ATCC 33150 across all samples, with significantly elevated relative abundance in periodontitis-associated saliva compared to healthy donor controls. Collectively, we have identified ATCC 33150 as a new Selenomonas sp. and conducted one of the first direct comparative studies of traits relevant to colonization and persistence among Selenomonas spp.IMPORTANCERecognizing that strain ATCC 33150, historically described as Selenomonas sputigena, is a previously undescribed species has important implications for microbial systematics, physiology, and pathogenesis. Accurate taxonomic assignment underpins all downstream biological interpretation (e.g., comparative genomics, microbiome composition studies, virulence studies, and metabolic modeling). The identification of a novel species, therefore, refines the phylogenetic framework of the genus Selenomonas, enables more precise genotype-phenotype correlations, and may uncover previously unrecognized adaptations relevant to oral biofilm ecology and host interactions. Beyond taxonomy, this discovery strengthens the foundation and rigor of future mechanistic studies and provides context for discrepancies in previous studies involving this strain and ATCC 35185.

To provide contemporary national evidence on the effectiveness of community water fluoridation (CWF) for the prevention of early childhood caries (ECC) among 4-year-old children in Aotearoa New Zealand (NZ), and to examine potential effect modification by ethnicity and other sociodemographic characteristics. A national repeated cross-sectional study was conducted using routinely collected B4 School Check data (2010-2022). Children aged 4 years were linked to a national spatial dataset of water distribution zones and council-reported fluoridation histories to classify exposure over the assessment year and preceding 3 years. ECC was identified via the 'lift-the-lip' screening. Multilevel mixed-effects modified Poisson regression models, with children nested within meshblocks, estimated incidence rate ratios (IRRs), adjusting for ethnicity, area-level deprivation, age, sex, rurality, and assessment year. Two-factor interactions were examined. Among 630 926 children, 14.2% had ECC. In crude analyses, ECC appeared more common in fluoridated areas; however, after adjustment for sociodemographic characteristics, CWF was associated with a lower rate of ECC (IRR = 1.13; 95% CI: 1.11-1.15 for non-fluoridated vs. fluoridated). A significant interaction between CWF and ethnicity was observed. The protective association was strongest among European/Other children (IRR = 1.25; 95% CI: 1.21-1.29) and attenuated among Māori and Asian children, with minimal effect among Pacific children. The ethnicity-weighted population attributable fraction was 4.4%, equating to approximately 282 ECC cases annually. Findings are consistent with CWF being an effective population-level oral health intervention. However, its association with caries experience varies by ethnicity, highlighting the importance of addressing structural inequities alongside universal preventive strategies.

Parental factors influencing children's oral health in Saudi Arabia: a narrative review.

This questionnaire-based study aimed to assess parent-reported caries (PRC) at ages 2-5 years and identify potential influencing factors using an exploratory, repeated cross-sectional analysis within an ongoing birth-cohort study. Parental factors included health, socioeconomic status, maternal age and dental check-up attendance. Child factors included birth mode and weight, antibiotic, probiotic, bottle use, early dentition, weaning age, oral hygiene, diet, body mass index (BMI) and mouth-breathing. Environmental factors included sibling caries, contact with other children, pets, or farms. Families (n = 1296) who completed the 2-year caries questionnaire were included, corresponding numbers were 1276 at 3 years, 993 at 4 years, and 768 at 5 years. A subgroup comprised children who had visited a dentist since their last birthday (n = 735, at 2 years, n = 951, 891 and 662 at 3, 4 and 5 years respectively). PRC rate was 0.4%, 1.3%, 2.7% and 4.4% for ages 2-5. Rates were 0.4%, 1.6%, 3.3% and 4.7% for the subgroup at the same ages. At Age 2, maternal migration background, lower paternal education and unemployment, late weaning, infrequent maternal dental check-ups and pet contact were associated with PRC. Except for paternal education, the same factors remained associated in the subgroup. At Age 3, single-parent status, maternal physical health, late weaning, sibling caries and pet contact were significantly associated with PRC. With the addition of infrequent maternal dental check-ups, the same factors remained associated in the subgroup. At Age 4, early dentition, mouth-breathing aged 1 were associated with PRC. Including late weaning, the same factors remained significantly associated in the subgroup. At Age 5, poor dietary and toothbrushing behaviour aged 2, younger mother, low BMI aged 1, infrequent maternal dental check-ups, pet contact, and pacifier hygiene were associated with PRC. Except dietary behaviour aged 2, with the addition of paternal employment, the same factors were significantly associated in the subgroup. This study identifies key parental, child, and environmental risk factors for early childhood caries, revealing novel factors for further investigation and targeted prevention.

Early childhood caries (ECC) is a major public health issue influenced by nutritional, behavioral, and sociodemographic factors. However, the independent effects and dose-response patterns of key risk factors remain unclear. This study aimed to analyze the associations between nutritional and dietary factors and ECC using nationally representative data, and to explore the nonlinear relationship between calcium intake and ECC. Data from 2564 children aged 2 to 6 years were obtained from the National Health and Nutrition Examination Survey 2009 to 2014. Weighted chi-square tests compared baseline characteristics between ECC and non-ECC groups. Multivariate logistic regression assessed the effects of age, calcium, fat, vitamin D, and other factors on ECC. Restricted cubic spline regression explored the nonlinear association between calcium intake and ECC. Forest plots and correlation analyses evaluated the strength of these associations. Significant differences were observed between groups in ethnicity, breastfeeding history, age, calcium and fat intake. Caries prevalence was higher in Mexican Americans (29.1%), breastfed children (61.4%), and 6-year-olds (29.4%). Children with ECC had lower calcium intake (838 vs 893 mg) and higher fat intake. Regression analysis showed that ECC risk increased with age (odds ratio = 6.319, P < .001). Restricted cubic spline analysis revealed a significant nonlinear relationship between calcium intake and ECC (P = .011), with an inflection point at 1000 mg/day. Below this threshold, increased calcium intake was associated with reduced ECC risk; above it, the effect plateaued. Vitamin D was not significantly associated with ECC. This study identifies 1000 mg/day as a potential threshold for calcium intake in reducing ECC risk. Increasing age and insufficient calcium intake are independent risk factors for ECC. These findings support the development of targeted interventions focusing on dietary optimization, oral microbiota regulation, and feeding behavior adjustment in high-risk pediatric populations.

Japan's marked decline in early childhood caries (ECC) has been documented through uniquely comprehensive national dental examinations, with standardized population surveys conducted continuously for more than four decades. This perspective discusses how Japan achieved sustained reduction in ECC despite the absence of community water fluoridation and historically limited use of toothpaste with effective fluoride concentration in infancy. Drawing on national surveillance and epidemiological evidence, I consider how changes in dietary patterns, caregiver practices, oral health behaviours, and broader social conditions may have contributed to a less cariogenic environment for young children. Importantly, this experience does not diminish the established effectiveness of fluoride-based interventions; rather, it highlights complementary, system-level factors operating over long time horizons. Japan's experience may inform context-sensitive ECC prevention strategies, particularly in settings where fluoride use is limited, unevenly implemented, or difficult to sustain.

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

The study aims to determine the Early Childhood Caries (ECC) prevalence in the Olomouc region, Czech Republic, and to evaluate the associated risk factors in a group of children aged up to six years. A cross-sectional epidemiological study on ECC prevalence and risk factors was conducted in the Olomouc region, Czech Republic, from January to December 2024. The cohort involved 104 children aged up to six years who received a dental examination in their kindergartens, following parental written informed consent and a questionnaire completion. ECC prevalence was assessed, and risk factors were identified after data processing and analysis. Despite existing preventive measures, ECC prevalence remains high, indicating the need for more targeted prevention addressing the main risk factors, such as consumption of sweet and sour beverages, and lower family income in families. Conversely, oral hygiene from the eruption of the first tooth, positively related to the prevalence of ECC, should be promoted.

This study aims to evaluate the clinical effectiveness and cost-effectiveness of personalized topical fluoride intervention guided by the modified caries-risk assessment tool for preschool children (PSC-MCAT) for preschool children in Jiangnan District of Nanning City and to provide evidence to support the implementation of community-based graded oral health interventions for preschooler children. A total of 198 three-year-old children from Jiangnan District, Nanning City, were recruited and randomly assigned to a test or control group. Baseline data were collected through questionnaires and oral examinations. The test group received personalized topical fluoride treatments based on caries risk levels determined using the PSC-MCAT, whereas the control group received standard fluoride varnish application every six months. After 1.5 years of follow-up, the incidence of new caries and changes in mean dmft increment were analyzed. Cost-effectiveness analysis was conducted to assess economic benefits, and sensitivity analysis was performed to evaluate result stability. After 1.5 years, the test group demonstrated significantly lower caries incidence (50.9%) and △dmft (1.42±1.90) compared with the control group (68.9%, 2.74±2.92) (P<0.05). Cost-effectiveness analysis indicated that the incremental cost to prevent one new case of caries in the test group was 559.66 yuan, which was lower than the willingness-to-pay threshold (626.77 yuan). The cost per prevented caries lesion was 153.80 yuan, which was lower than the direct treatment cost of 200.5 yuan per lesion. Sensitivity analysis indicated a 99.8% probability that the intervention is cost-effective at a willingness-to-pay of 626.77 yuan per person. The PSC-MCAT tool is effective and cost-effective for caries risk assessment and may serve as a practical framework for caries prevention.

Early childhood exposure to cariogenic foods and drinks is a key modifiable risk factor for early childhood caries, yet national-level surveillance of dietary risk in children under two years remains limited in Kenya. This study assessed the prevalence, patterns, and factors associated with cariogenic diet exposure among young children in Kenya.We analyzed nationally representative data from the 2022 Kenya Demographic and Health Survey. A total of 7,459 children aged below two years were included in the analysis. Cariogenic diet exposure was defined as consumption of any sugar-containing foods or drinks in the previous day or night. Weighted prevalence estimates were calculated overall and by age group. Bivariate analyses assessed associations with child, maternal, household, and feeding characteristics. Multivariable logistic regression models were fitted using a hierarchical stepwise approach to identify factors associated with exposure.Overall, 21% of children under two years were exposed to a cariogenic diet. Exposure increased markedly with age, from 3.3% among infants < 6 months to 20.2% among those aged 6 to 11 months and 31.2% among children aged 12 to 23 months. The most consumed cariogenic items were sweetened tea or coffee, sweetened milk, and fried or sugary snacks. In the fully adjusted model, older child age was the strongest predictor of cariogenic diet exposure (12-23 months vs. < 6 months: OR = 27.96; 95% CI: 19.44-40.23). Compared with no maternal education, primary (OR = 1.81; 95% CI 1.30-2.53) and secondary (OR = 1.49; 95% CI 1.01-2.20) education were associated with higher odds of exposure. Children in the richest wealth bracket had two times higher odds of exposure compared with those in the poorest bracket (OR = 2.00; 95% CI 1.26-3.18), while continued breastfeeding was protective (OR = 0.57; 95% CI: 0.43-0.75).One in five Kenyan children under two years old is exposed to a cariogenic diet. Early introduction of sugar-containing foods and drinks highlights missed opportunities for prevention during complementary feeding. Integrating oral-health promotion and sugar-avoidance messaging into existing maternal, child health, and nutrition services could strengthen early childhood caries prevention and support Kenya's national oral health goals. In addition, regulating the marketing and availability of sugar-rich foods can help create healthier food environments for young children.

Early childhood caries (ECC) is a multifactorial chronic disease strongly influenced by feeding behaviors and oral hygiene practices. Co-sleeping is a common caregiving practice that may increase ECC risk by facilitating nocturnal feeding and limiting adequate nighttime oral care. This study aimed to evaluate the association between co-sleeping, related behavioral factors, and the presence and severity of ECC in children aged 1 to 6 years. A retrospective observational study was conducted using clinical and radiographic records from a pediatric dentistry clinic. The sample included 150 children aged 12 to 72 months. Parents completed a validated questionnaire on feeding practices, dietary habits, oral hygiene routines, sugar intake, and co-sleeping behaviors. ECC was assessed using the decayed, missing, and filled teeth index according to World Health Organization criteria. Logistic regression analyses were performed to identify associations between co-sleeping, behavioral variables, and ECC outcomes. Co-sleeping was reported in 18.7% of children. Co-sleeping children showed significantly higher mean decayed, missing, and filled teeth index scores than non–co-sleepers (7.14 vs 3.49). Co-sleeping was significantly associated with nighttime breastfeeding on demand, higher carbohydrate consumption, and inadequate oral hygiene practices (P < .05). In most co-sleeping cases (89.3%), children fell asleep with milk remaining in the oral cavity. Co-sleeping was associated with an approximately 2-fold increase in ECC risk, and behaviors that may increase the risk and severity of ECC, particularly nocturnal feeding and insufficient oral hygiene. Targeted parental education on nighttime feeding and oral care practices may help reduce ECC risk. Prospective studies are warranted to confirm these findings.

BACKGROUND:Children’s oral and dental health are vital components of overall health, affecting their growth, education, employment, and future prospects. Early childhood caries is a prevalent issue globally, placing significant financial strain on families and healthcare systems. This study aims to explore how children use the Primary Health Care oral health package to achieve Universal Health Coverage.MATERIAL AND METHODS:This descriptive, cross-sectional study examined children’s utilization of services provided through the oral health package at PHC centers. Data on services delivered under the package were gathered from national systems and performance reports from insurance organizations. Multivariate linear regression using the Ordinary Least Squares method was used in STATA software to identify factors influencing the utilization of dental services at PHC centers.RESULTS:In 2019, 2225196 dental services were administered to children through the dental care package in 6157 PHC centers across 31 provinces. On average, each center provided 361 services. Zanjan Province had the highest rate of children’s utilization of dental services per capita in PHC centers (46,602 services per 100,000 population), which was more than seven times the lowest rate in Yazd Province (6,118). There was a positive correlation with the per capita availability of dentists, whereas a negative relationship was observed with the per capita tertiary education among the rural population.CONCLUSION:The per capita utilization of children’s dental services under the oral health package varied significantly across provinces. A notable portion of children nationwide did not access dental services at PHC levels. Although increasing the number of dentists can boost utilization, it is crucial to ensure an equitable distribution. Further national research is necessary to determine where these children are receiving the necessary dental services.

Dental black tooth stain (BTS) has been epidemiologically associated with a lower prevalence of dental caries, yet the underlying metabolic mechanisms remain poorly understood. This study aimed to characterize the metabolic profiles of dental plaque to explore the association between tooth stain and low caries risk. Dental plaque samples were collected from three groups of children: caries-free with BTS (CF-BTS), caries-free without BTS (CF), and severe early childhood caries without BTS (SECC). Metabolomic profiling was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multivariate statistical analyses, including PCA and OPLS-DA, were employed to identify differential metabolites (DMs). Metabolic pathway enrichment and metabolite source tracing were conducted using KEGG and MetOrigin databases. PCA showed excellent analytical stability, and OPLS-DA revealed distinct metabolomic profiles among groups. A total of 1,069 molecular features were detected, with 658 metabolites identified. Lipids and lipid-like molecules (39.97%) constituted the most abundant class. Venn analysis identified core differential metabolites, including irganox 259 (up-regulated in CF-BTS), Δ17-6-keto-PGF1α (up-regulated in CF-BTS), and 6-phosphogluconic acid (down-regulated in CF-BTS). MetOrigin analysis classified metabolites into host (n = 19), microbial (n = 98), and co-metabolic (n = 173) sources. KEGG enrichment indicated significant alterations in ABC transporters, pyrimidine metabolism, and neuroactive ligand-receptor interactions in BTS-associated plaque. Dental plaque associated with BTS exhibits a distinct metabolomic signature characterized by enhanced antioxidant capacity. These findings provide critical functional insights into the caries-protective mechanism of BTS and identify promising metabolic targets for the development of novel anti-caries strategies.