Fluoride varnishes for preventing dental caries in children and adolescents

  • Review
  • Intervention

Authors


Abstract

Background

Topically applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over 2 decades.

Objectives

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

Search methods

Multiple electronic database searches, reference lists of articles, journal handsearch, selected authors and manufacturers.

Selection criteria

Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride varnish with placebo or no treatment 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. Study 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

Nine studies were included, involving 2709 children. For the seven that contributed data for the main meta-analysis, the D(M)FS pooled prevented fraction estimate was 46% (95% CI, 30% to 63%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001). The pooled d(e/m)fs prevented fraction estimate was 33% (95% CI, 19% to 48%; P < 0.0001). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity or background exposure to fluorides was found in metaregression, and a funnel plot of the seven studies indicated no relationship between prevented fraction and study precision. In both methods, power is limited when only a few trials are included.

Authors' conclusions

The review suggests a substantial caries-inhibiting effect of fluoride varnish in both the permanent and the deciduous dentitions based largely on trials with no treatment controls. There is little information concerning acceptability of treatment or possible side effects in the included trials. Given the relatively poor quality of most of the included studies and the wide confidence intervals around the estimates of effect, there remains a need for further trials. It is important that these trials should be of high quality and include assessment of potential adverse effects.

摘要

背景

氟漆對於兒童與青少年齲齒的預防

局部給予氟漆已被牙醫師廣泛地使用在防止齲齒上超過20年.

目標

確認氟漆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

搜尋多個電子資料庫,參考論文,查詢學刊,特定的學者與製造商。

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,將氟漆與安慰劑或不治療分別實驗在十六歲以下的小朋友身上,做試驗至少一年.主要的結果是測量齲齒在齲齒牙,喪失牙和被填補的牙表面(D (M) FS)的增加量。

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。作者也會去聯絡遺失的數據.主要的作用是在防止補綴物的碎裂,比較做治療及控制群中平均齲齒之間的差別,並以百分比表示控制組中平均增加的齲齒量。隨意作用整合分析執行在數據可能合併的地方。潛在的異質性來源在隨意後設復原分析中被審查。

主要結論

9個試驗包含了2709個小朋友,其中7個研究的數據作整合分析, D(M)FS的PF為46% (95%信賴區間(CI)為30%到63%; p < 0.0001)。統計上已證實關聯性是真實的(p<0.0001)。合併d(e/m)fs之PF估記為 33% (95%信賴區間(CI),19%到48%; p < 0.0001)。由整合迴歸分析顯示,估計的D(M)FS預防分數(PF)與原本齲齒嚴重程度或氟暴露無統計相關.而7個研究的funnel plot顯示PF與研究之精密度無關。這兩種方法,如果包含不夠多的試驗則結果不夠有力.

作者結論

主要根據以未治療者為控制組的研究,本回顧認為氟漆對於恆牙與乳牙齒列的齲齒預防具有實質的效果。在試驗中,關於治療可接受性或試驗可能的副作用的訊息很少。由於大部份包含的研究品質不佳及寬廣的估計值信賴區間,更多的研究是有必要的.重要的是這些研究必須具有良好的品質,包括評估潛在的副作用.

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

每年由專業人員塗佈氟漆2到4次可以有效的減少兒童齲齒的產生.氟是可預防蛀牙的礦化物.自從廣泛使用含氟牙膏與飲用水加氟之後,額外給予氟化物的價值受到質疑,每年塗佈氟漆的次數可為2至4次,這篇回顧試驗發現氟漆可有效減少乳牙及恆牙蛀牙的產生.然而,未來還需要更優質的研究來證明此種治療產生的效果,並且研究其可接受度與副作用.

Plain language summary

Fluoride varnishes for preventing dental caries in children and adolescents

Fluoride varnishes applied professionally two to four times a year would substantially reduce tooth decay in children.
Fluoride is a mineral that prevents tooth decay (dental caries). Since widespread use of fluoride toothpastes and water fluoridation, the value of additional fluoride has been questioned. Fluoride varnishes can be professionally applied at a frequency from two to four times a year. The review of trials found that fluoride varnish can substantially reduce tooth decay in both milk teeth and permanent teeth. However, more high quality research is needed to be sure of how big a difference the treatment makes, and to study acceptability and adverse effects

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