Strontium and caries: a long and complicated relationship.

Investigations into the role of strontium (Sr) in caries prevention have attracted great interest in the research community in the past, with their peak in the 1970-80s. To this date, no clear indication of the relative importance of Sr in caries prevention has been provided. A vast number of animal caries, epidemiological and mechanistic studies have been conducted. Although there is much discrepancy, the majority of studies suggest that Sr exhibits some cariostatic properties, predominantly in the presence of fluoride. An optimum Sr concentration of 5-10 ppm in drinking water has been proposed as a direct result of several epidemiological caries studies. Despite these results, no direct link can be established between Sr and caries prevention as, to date, no relevant, randomized controlled trials have been reported. The extrapolation of potential cariostatic properties of Sr from epidemiological studies is difficult due to the co-presence of several other trace elements in the water of the study areas, with many of these elements being attributed cariostatic properties in their own right. Furthermore, the role of caries risk factors was not taken into consideration. There is a clear need for further research, especially on the mineral phases in the dental hard tissues, plaque and plaque fluid associated with Sr as these may give rise to a better understanding of this subject matter. Based on the current data, the cariostatic properties of Sr, or at least those proposed by some authors, cannot be supported.