Fluoride toothpastes for preventing dental caries in children and adolescents

 

Abstract

Background

Fluoride toothpastes have been widely used for over 3 decades and remain a benchmark intervention for the prevention of dental caries.

Objectives

To determine the effectiveness and safety of fluoride toothpastes in the prevention of caries in children and to examine factors potentially modifying their effect.

Search methods

We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2000, Issue 2), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers.

Selection criteria

Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride toothpaste with placebo in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).

Data collection and analysis

Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects metaregression analyses.

Main results

Seventy-four studies were included. For the 70 that contributed data for meta-analysis (involving 42,300 children) the D(M)FS pooled PF was 24% (95% confidence interval (CI), 21 to 28%; P < 0.0001). This means that 1.6 children need to brush with a fluoride toothpaste (rather than a non-fluoride toothpaste) to prevent one D(M)FS in populations with caries increment of 2.6 D(M)FS per year. In populations with caries increment of 1.1 D(M)FS per year, 3.7 children will need to use a fluoride toothpaste to avoid one D(M)FS. There was clear heterogeneity, confirmed statistically (P < 0.0001). The effect of fluoride toothpaste increased with higher baseline levels of D(M)FS, higher fluoride concentration, higher frequency of use, and supervised brushing, but was not influenced by exposure to water fluoridation. There is little information concerning the deciduous dentition or adverse effects (fluorosis).

Authors' conclusions

Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established. Taken together, the trials are of relatively high quality, and provide clear evidence that fluoride toothpastes are efficacious in preventing caries.

 

Plain language summary

Fluoride toothpastes for preventing dental caries in children and adolescents

Children who brush their teeth at least once a day with a toothpaste that contains fluoride will have less tooth decay.
Tooth decay (dental caries) is painful, expensive to treat and can sometimes lead to serious damage to teeth. Fluoride is a mineral that prevents tooth decay. The review of trials found that children aged 5 to 16 years who used a fluoridated toothpaste had fewer decayed, missing and filled permanent teeth after three years (regardless of whether their drinking water was fluoridated). Twice a day use increases the benefit. No conclusion could be reached about the risk that using fluoride toothpastes could mottle teeth (fluorosis), an effect of chronic ingestion of excessive amounts of fluoride when children are young.

 

摘要

背景

含氟牙膏對於兒童與青少年齲齒的預防

含氟化物的牙膏已被廣泛的使用超過30年，並且至今依然是預防齲齒的基準。

目標

確認含氟牙膏對於兒童的齲齒預防的效率及安全，並去檢查潛在因素以改進它的效果．

搜尋策略

我們搜尋了Cochrane Oral Health Group's Trials Register(2000年5月)資料庫, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000)資料庫， MEDLINE (1966年到2000年1月)，加上幾個其他數據庫。我們查詢學刊，參考論文並且與所選擇的作者和製造者聯繫。

選擇標準

隨機化或半隨機化的對照試驗並採取盲性的結果評估，將含氟化物牙膏與安慰劑或不治療在十六歲以下的小朋友身上，去做試驗至少一年．主要的結果是測量齲齒增加量以齲齒牙，喪失牙和被填補的牙表面(D (M) FS)的數值計算。

資料收集與分析

包括決定、質量評估和數據提取在隨意抽樣研究的三分之一中被複製，並且認定需經由討論或第三方才可達到。連絡作者以了解遺漏的數據．主要的成效測量是預防分數(prevented fraction, PF)即治療組與對照組間齲齒增加的差異，以對照組增加的百分比表示。匯集的資料以隨意整合分析處理。異質性的潛在來源在隨意整合回歸分析來檢查。

主要結論

74個實驗中，有70個研究數據做整合分析(涉及42,300個兒童),其齲齒牙，喪失牙和被填補的牙表面(D (M) FS)的預防分數是24% (95%信賴區間(CI)為 21%到28%; p < 0.0001)。這代表了要在年增率2.6D(M)FS 的人口中減少1個D(M)FS,需要有1.6個小朋友使用含氟牙膏刷牙(而不是非氟化物牙膏)。在年增率1.1D(M)FS的人口中,要降低1個D(M)FS,需要有3.7個兒童使用含氟牙膏.這是有非常清楚的關聯性且統計上已被證實(p<0.0001)．含氟牙膏的效果與原始的 D(M)FS 值,氟濃度,使用頻率,有無監督刷牙等有關,但與飲水加氟的暴露無關.然而對於乳牙齒列或副作用(氟中毒, fluorosis)的資料則不多。

作者結論

經過超過半個世紀的研究支持，含氟化物牙膏的好處已被堅定地建立。試驗具有相當好的品質，而且清楚的證明使用含氟化物牙膏可防止齲齒的產生。

翻譯人

本摘要由臺灣大學附設醫院吳怡樺翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

兒童至少每天使用含氟牙膏一次會減少的蛀牙。蛀牙(齲齒)是痛苦，治療昂貴並可能有時對牙齒造成嚴重的破壞。氟化物是防止蛀牙的無機物．這篇回顧發現，5−16歲的兒童使用含氟化物牙膏3年之後，會有較低的齲齒，喪失及被填補的恆牙(不管飲用水是否有加氟)．若一天使用兩次效果會增加，對於兒童從小時候,經由牙膏慢性攝取過量的氟,造成氟斑齒(氟中毒)的風險,則未有結論.