Fluoride mouthrinses for preventing dental caries in children and adolescents

  • Review
  • Intervention

Authors


Abstract

Background

Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and individually at home.

Objectives

To determine the effectiveness and safety of fluoride mouthrinses in the prevention of dental 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 mouthrinse 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. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean 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

Thirty-six studies were included. For the 34 that contributed data for meta-analysis (involving 14,600 children) the D(M)FS pooled PF was 26% (95% confidence interval (CI), 23% to 30%; P < 0.0001). Heterogeneity was not substantial, but confirmed statistically (P = 0.008). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found in metaregression analyses. A funnel plot of the 34 studies indicated no relationship between prevented fraction and study precision. There is little information concerning possible adverse effects or acceptability of treatment in the included trials.

Authors' conclusions

This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.25 D(M)FS per year, 16 children will need to use a fluoride mouthrinse (rather than a non-fluoride rinse) to avoid one D(M)FS; in populations with a caries increment of 2.14 D(M)FS per year, 2 children will need to rinse to avoid one D(M)FS. There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials.

摘要

背景

含氟漱口水對於兒童與青少年齲齒的預防

含氟漱口水已被廣泛地使用在學校計劃以及居家的齲齒預防

目標

確認含氟漱口水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

我們查詢Cochrane Oral Health Group's Trials Register (2000年5月),the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966年到2000年1月),加上其他幾個資料庫。我們查詢學刊,參考論文並且與所特定的作者和製造商聯繫。

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,在十六歲以下的小朋友身上比較含氟漱口水與有無安慰劑的使用,試驗期間至少一年.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

隨機抽樣三分之一的研究重覆納入與否、質量評估和數據提取,並認定需經由討論或第三方才可達到共識。連繫作者以了解遺漏的資料.主要結果為預防分數(prevented fraction, PF), 即是以控制組為基準,治療組與控制組齲齒平均增加量差的百分比。可合併的數據利用隨意作用整合分析處理。利用隨意整合回歸分析潛在的異質性。

主要結論

共有36個研究,其中34個試驗(涉及14,600個孩子)的數據作整合分析,結果齲齒牙,喪失牙和被填補的牙表面 D (M) FS的預防分數是26% (95%信賴區間(CI), 23%到30%; p < 0.0001)。異質性並不顯著,但統計上具有意義, p = 0.008。 由整合回歸分析顯示, D(M)FS預防分數與原本齲齒嚴重度,背景的氟暴露,漱口頻率及氟濃度無關。34個研究的漏斗圖(funnel plot)顯示預防分數與研究之正確性無相關.而在這些研究中,有關可能的副作用與接收度的資料相當少.

作者結論

本篇回顧顯示,在有監督及定期使用含氟漱口水的情況下,兩種主要濃度及漱口頻率可明顯降低兒童齲齒。在齲齒年增率為0.25 D(M)FS的族群中,須有16個兒童使用漱口水可降低1個D(M)FS產生,在齲齒年增率為2.14D(M)FS的族群中,須有2個兒童使用漱口水以避免1個D(M)FS產生。在含氟漱口水試驗中,副作用和可接受度數據的完整報告是有必要的。

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

即使飲用水加氟及使用含氟牙膏,兒童按常規使用漱口水可降低齲齒發生。氟化物是防止蛀牙的無機物.自從普遍使用含氟化物牙膏和飲用水加氟之後,額外使用氟化物的價值被受到質疑。含氟漱口水是個濃縮溶液,需要定期使用以得其效果。回顧試驗發現,不管是否有其他氟化物的使用,規律的使用含氟漱口水可減少兒童齲齒的產生。在高齲齒率的小朋友中每2位有1位(在低齲齒率的小朋友中每16位有1位)使用漱口水,齲齒會降低.然而,更多研究關於漱口水的副作用和接受度的也是需要去研究。

Plain language summary

Fluoride mouthrinses for preventing dental caries in children and adolescents

Regular supervised use of fluoride mouthrinses by children would reduce their tooth decay, even if they drink fluoridated water and use fluoridated toothpaste.
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 mouthrinse is a concentrated solution that needs to be used regularly to have an effect. The review of trials found that regular use of fluoride mouthrinse reduces tooth decay in children, regardless of other fluoride sources. One in two children with high levels of tooth decay (and one in 16 with the lowest levels) would have less decay. However, more research is needed on adverse effects and acceptability of mouthrinses.

Ringkasan bahasa mudah

Ubat kumur mulut berfluorida untuk pencegahan karies dalam kalangan kanak-kanak dan remaja

Pengawalseliaan penggunaan ubat kumur mulut berfluorida yang teratur untuk kanak-kanak boleh mengurangkan kerosakan gigi walaupun mereka meminum air berfluorida dan menggunakan ubat gigi berfluorida.
Fluorida mempunyai mineral yang mencegah kerosakan gigi (karies gigi). Sejak penggunaan meluas ubat gigi berfluorida dan air berfluorida, nilai penambahan fluorida telah dipersoalkan. Ubat kumur berfluorida adalah larutan pekat yang perlu diguna secara teratur untuk mendapatkan kesan. Sorotan kajian mendapati penggunaan ubat kumur mulut berfluorida secara teratur mengurangkan karies dalam kalangan kanak-kanak, tanpa mengira sumber fluorida lain. Satu daripada dua kanak-kanak yang mempunyai tahap kerosakan gigi yang tinggi (dan satu daripada 16 dengan tahap kerosakan yang rendah) akan mengalami kurang kerosakan gigi. Namun, lebih banyak kajian tentang kesan buruk dan penerimaan ubat kumur mulut diperlukan.

Catatan terjemahan

Diterjemahkan oleh Noorliza Mastura Ismail (Melaka Manipal Medical College). Untuk sebarang pertanyaan mengenai terjemahan ini, sila hubungi noorliza.mastura@manipal.edu.my. Disunting oleh Norhayati Mohd Noor (Universiti Sains Malaysia). Untuk sebarang pertanyaan mengenai suntingan ini, sila hubungi hayatikk@usm.my

Laički sažetak

Fluoridne vodice za ispiranje usne šupljine u sprječavanju zubnoga karijesa kod djece i adolescenata

Redovita nadzirana uporaba vodica za ispiranje s fluoridima kod djece smanjuje nastanak zubnoga karijesa, čak i ako piju fluoridiranu vodu ili koriste fluoridnu zubnu pastu.Fluor je mineral koji sprječava nastanak zubnoga karijesa. Zbog masovne uporabe fluoridnih zubnih pasti i fluoridacije vode, istražuje se vrijednost dodatnih fluorida. Vodice za ispiranje usta s fluoridima koncentrirane su otopine koje se trebaju redovito koristiti kako bi se postigao učinak. Ovaj Cochrane sustavni pregled istraživanja otkrio je da redovita uporaba fluoridnih vodica za ispiranje kod djece smanjuje nastanak zubnoga karijesa, i to neovisno o drugim izvorima fluorida. Jedno od dvoje djece s visokim razinama zubnoga karijesa (i jedno na 16 s najnižim razinama) imalo bi manje karijesa. Ipak, potrebno je više istraživanja o štetnim učincima i prihvatljivosti vodica za ispiranje.

Bilješke prijevoda

Cochrane Hrvatska
Prevela:Tina Poklepović Peričić
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr