Theobromine for Remineralization of White Spot Lesions on Dental Enamel: A Systematic Review and Meta-analysis

Aim: This systematic review and meta-analysis evaluated theobromine's (Theobroma cacao) potential in remineralizing white spot lesions in dental enamel. Methods: This study is reported according to the PRISMA checklist and was registered in PROSPERO (CRD42023414371). In vitro tests that evaluated the remineralizing potential of theobromine compared to fluoride ion after demineralization for the formation of white spot lesions on enamel were selected, with no limitation on the year of publication. Electronic searches were performed in PubMed/MEDLINE, Scopus, and Web of Science by two independent researchers. Thirty articles were received of which six were selected according to the inclusion criteria. Results: The selected studies evaluated the Enamel Surface Microhardness (SMH), Vickers or Knoop, before and after treatment with theobromine and fluoride solutions. For the SMH Vickers, there were no differences between groups at baseline (p=1.00; p =1.00; mean difference:-0.00; CI:-11.36 to 11.36) and after treatment (p=0.51; p =0.51; mean difference: 4.12; CI:-8.16 to 16.41). The results of SMH Knoop showed differences between groups at baseline, favoring the experimental group (p=0.002; p =0.002; mean difference: 9.84; CI: 3.65 to 16.02) and after treatment favoring the control group (p=0.00001; p =0.00001; mean difference:-5.45; CI:-7.62 to-3.27). Conclusion: The use of theobromine increases the microhardness of dental enamel subjected to a demineralization process, thus being effective in the remineralization of this tissue with success equivalent to that obtained with the use of fluoride.