Propolis-containing formulations in caries prevention - a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis evaluated the clinical efficacy of propolis-containing formulations (PCFs) in preventing dental caries (PROSPERO: CRD420251246707). METHODS: This study adhered to the PRISMA 2020 guidelines. Systematic database searches were conducted (December 11, 2025) without language or date restrictions. Eligible studies were randomized clinical trials (RCTs) assessing PCFs (dentifrices, mouthwashes, tablets, etc.) for caries-related outcomes compared with negative control or chlorhexidine-containing formulations (CHX). Standardized mean differences (SMD) were calculated using random-effects models. Meta-analyses were conducted for the outcomes plaque index (PI) and microbial counts in saliva or biofilm (MC). RoB 2 tool and GRADE were used as quality assessment tools. RESULTS: Of 1,919 identified records, 45 studies were included. Direct caries-related outcomes (caries indices) were rarely assessed and unsuitable for meta-analysis. PCFs significantly reduced PI compared with negative control (SMD[95% CI]: -1.11 [-1.52, -0.70], p < 0.01) and showed no significant difference compared with CHX (0.46 [-0.04, 0.95], p = 0.07). Similar patterns were observed for MC (PFCs vs. negative control (-1.45 [-2.43, -0.48], p = 0.004; PFCs vs. CHX: 0.38 [-0.11, 0.87], p = 0.13). Certainty of evidence was very low due to high risk of bias, inconsistency and indirectness. CONCLUSION: Propolis-containing formulations may reduce plaque indices and oral microbial counts, suggesting a potential role in caries prevention. However, high-quality studies assessing direct caries outcomes are needed to properly address the research question. CLINICAL RELEVANCE: Propolis-containing formulations are widely available and well accepted by patients. Clinicians may consider them as adjuncts to oral biofilm control but the evidence directly supporting their clinical efficacy in caries prevention is still not well established.