Another approach is to prevent S. mutans from accumulating
to pathologic levels through topical application of
antimicrobial agents. This approach was recently applied in
a group of Puerto Rican babies at high risk for ECC.64 The
study population consisted of 83 subjects who were 12 to
19 months of age at the time of their entry into the study.
Inclusion criteria for the study included unremarkable
medical history, presence of 4 PMIs with no visible defects,
caries-free status (accordingly to clinical criteria), use of a
nursing bottle containing a cariogenic substance at naptime
or bedtime, and 2 consecutive S. mutans-positive cultures
from pooled PMI plaque. The subjects were randomly
assigned to 2 groups. In the experimental group (n = 39),
a 10% povidone–iodine solution was applied to the dentition
bimonthly for 1 year; in the control group (n = 44)
a placebo solution was applied in the same manner.
Treatment failure was defined as the appearance of one or
more white spot lesions on any of the PMIs during the
study period. Using the Kaplan–Meier procedure, the
authors estimated that 91% ± 5% of experimental subjects
and 54% ± 9% of control subjects experienced 12 months
of disease-free survival (log-rank test, 2-sided p = 0.001).
Therefore, bimonthly topical application of a 10%
povidone–iodine solution to the dentition of babies at high
risk for ECC increased disease-free survival. It is important
to determine, through larger and more in-depth clinical
trials, if this effect remains after the antimicrobial agent is
withdrawn before introducing 10% povidone–iodine therapy
into clinical practice as a primary prevention modality
for ECC