Nonfluoridated Remineralizing Agents in Pediatric Dentistry: A Narrative Review

Background: Conventional fluoride-based therapies, though widely accepted, pose limitations in pediatric populations due to potential toxicity, fluorosis risk, and compliance issues. This has driven the search for alternative nonfluoridated remineralizing agents. Aim: To evaluate and summarize the mechanism, evidence, and clinical relevance of nonfluoridated remineralizing agents in pediatric dentistry. Methodology: This narrative review compiles and analyzes scientific literature, experimental studies, and clinical trials on agents such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), cheese, xylitol, novamin, and grape seed extract. The review draws exclusively from validated references to ensure scientific integrity. Results: CPP-ACP demonstrated consistent subsurface enamel remineralization and synergy with fluoride. Cheese effectively increased salivary flow, plaque pH, and calcium levels. Xylitol reduced cariogenic bacterial activity while stabilizing calcium phosphate ions. Novamin facilitated hydroxycarbonate apatite formation and occluded dentinal tubules. Grape seed extract enhanced collagen stability and mineral deposition in root caries lesions. Conclusion: Nonfluoridated agents offer effective, biocompatible, and child-friendly alternatives for managing early carious lesions, especially in fluoride-sensitive populations. They are promising tools for minimally invasive pediatric dental care. Clinical significance: This review emphasizes the role of nonfluoridated remineralizing agents in supplementing or substituting fluoride in children, with benefits in compliance, safety, and therapeutic efficacy. How to cite this article: Nanawati A, Dave BH. Nonfluoridated Remineralizing Agents in Pediatric Dentistry: A Narrative Review. Int J Clin Pediatr Dent 2026;19(3):412-418.