Clinical Oral Investigations

, Volume 22, Issue 2, pp 583–596 | Cite as

Can oral ADS activity or arginine levels be a caries risk indicator? A systematic review and meta-analysis

  • Mohammed Nadeem Ahmed Bijle
  • Cynthia Kar Yung Yiu
  • Manikandan Ekambaram



The objective of this study was to evaluate the association between salivary and plaque arginine levels/ADS activities with dental caries.

Materials and methods

A systematic search was performed as per PRISMA statement using PubMed, Scopus, Cochrane Library, and Web of Science. Published studies that investigated adults and children (P) with caries-active status (E) and caries-free status (C), whereby arginine levels/ADS activity (O) was measured in saliva/plaque to analyze exposure-outcome association compared to the control group were deemed eligible for inclusion. Quality assessment was performed using combined Newcastle-Ottawa Scale and Modified RTI Item Bank scale. Meta-analysis was performed for effect size, precision estimation, and subgroup effects analysis.


Of 233 records identified, seven (κ = 1.00) were included for qualitative synthesis (systematic review) and four for quantitative synthesis (meta-analysis). No specific bias could be identified in five studies assessed as per the Modified RTI Item Bank scale. Two studies received lower scores on the Newcastle Ottawa scale. Plaque ADS activity in adults (effect size = 0.93, p = 0.008), salivary ADS activity in adults and children (effect size = 0.85, p < 0.001), and salivary ADS activity in adults (effect size = 0.87, p < 0.001) identified a statistically significant effect size. Subgroup analysis demonstrated non-significant variance (Q value = 0.042, p = 0.838) between saliva and plaque ADS activities of adults.


The results of this review suggest the salivary and plaque ADS activities appear to be promising caries risk indicators for adults, while results remain inconclusive in children.

Clinical relevance

Measuring ADS activities (saliva or plaque) can be a potential caries risk indicator in adults. The protocol was registered on PROSPERO database: CRD42017060701.


Arginine Arginine deiminase system Dental caries Plaque Saliva 



The authors of this review thank Samantha Kar Yan Li (Statistician, Faculty of Dentistry, The University of Hong Kong) for her support to perform meta-analysis. We gratefully acknowledge and express gratitude towards her kind gesture.

Author’s contribution

M. N. A. B.: Contributed to the conduct of the literature search, data extraction, qualitative analysis, and meta-analysis; writing all the drafts of the manuscript; and critically reading and approving the final manuscript.

C. K. Y. Y.: Co-contributed to the conduct of the literature search, data extraction, and qualitative analysis; writing of second and final draft of the manuscript; and critically reading and approving the final manuscript.

M. E.: Co-contributed to the conduct of literature search, data extraction, and qualitative analysis; writing of second and final draft of the manuscript; and critically reading and approving the final manuscript.


The systematic review and meta-analysis was supported by HKU seed fund for basic research 201611159314. The funders have no role in this systematic review and meta-analysis.

Compliance with ethical standards

Conflicts of interests

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

784_2017_2322_MOESM1_ESM.docx (27 kb)
Supplemental File S1 (DOCX 27 kb).
784_2017_2322_MOESM2_ESM.docx (30 kb)
Supplemental File S2 (DOCX 29 kb).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Dentistry Unit, Pediatric Dentistry and Orthodontics, Faculty of DentistryThe University of Hong KongHong KongHong Kong

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