Intervention Review

One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents

  1. Valeria CC Marinho1,*,
  2. Julian PT Higgins2,
  3. Aubrey Sheiham3,
  4. Stuart Logan4

Editorial Group: Cochrane Oral Health Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 23 NOV 2003

DOI: 10.1002/14651858.CD002780.pub2

How to Cite

Marinho VCC, Higgins JPT, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002780. DOI: 10.1002/14651858.CD002780.pub2.

Author Information

  1. 1

    Barts and The London School of Medicine and Dentistry, Clinical and Diagnostic Oral Sciences, Institute of Dentistry, London, UK

  2. 2

    MRC Biostatistics Unit, Cambridge, UK

  3. 3

    University College London Medical School, Department of Epidemiology and Public Health, London, UK

  4. 4

    Peninsula Medical School, Universities of Exeter & Plymouth, Institute of Health and Social Care Research, Exeter, UK

*Valeria CC Marinho, Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, Turner Street, Whitechapel, London, E1 2AD, UK. vcmarinho@yahoo.com. v.marinho@qmul.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JAN 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Topical fluorides in the form of toothpaste, mouthrinse, varnish and gel are effective caries preventive measures. However, there is uncertainty about the relative value of these interventions.

Objectives

To compare the effectiveness of one form of topical fluoride intervention with another when used for the prevention of dental caries in children.

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

Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with each other 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 'experimental' 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.

Main results

There were 17 studies included, and 15 contributed data for the meta-analyses. Fluoride toothpaste was not significantly different from mouthrinse (pooled DMFS PF 0%; 95% CI, -18% to 19%; P = 0.94), or gel (pooled DMFS PF 0%; 95% CI, -21% to 21%; P = 1), or both gel and mouthrinse (pooled DMFS PF 1%; 95% CI, -13% to 14%; P = 0.94); heterogeneity was substantial. Results from the single trial comparing toothpaste with varnish (in deciduous teeth) were inconclusive (dfs PF 5%; CI not obtainable). The pooled results from the comparisons of fluoride varnish with mouthrinse was a non-significant difference favouring varnish (DMFS PF 10%; 95% CI, -12% to 32%; P = 0.40), but this result was not robust to sensitivity analysis performed, and heterogeneity was considerable. Results from the single trial comparing varnish with gel (14%, 95% CI, -12% to 40%; P = 0.30) and the single trial comparing gel with mouthrinse (-14% DMFS PF; 95% CI, -40% to 12%; P = 0.30) were inconclusive (favoured varnish and mouthrinse respectively).

Authors' conclusions

Fluoride toothpastes in comparison to mouthrinses or gels appear to have a similar degree of effectiveness for the prevention of dental caries in children. There is no clear suggestion that fluoride varnish is more effective than mouthrinses and the evidence for the comparative effectiveness of fluoride varnishes and gels, and mouthrinses and gels is inconclusive. No conclusions about adverse effects could be reached, because no data were reported on in the trials. Acceptance is likely to be greater for fluoride toothpaste.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents

Topical fluorides such as mouthrinses and gels do not appear to be more effective at reducing tooth decay in children and adolescents than fluoride toothpaste.
Tooth decay (dental caries) is painful, expensive to treat and can seriously damage teeth. Fluoride is a mineral that prevents tooth decay. Fluoride is added to the water supply in many areas. It can also be applied in the form of toothpastes, mouthrinses, gels or varnishes. The review of trials found that fluoride toothpastes, mouthrinses and gels reduce tooth decay in children and adolescents to a similar extent. However, toothpastes are more likely to be regularly used. There is no strong evidence that varnishes are more effective than other types of topical fluoride.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

各種局部塗氟(topical fluoride)方式(牙膏,漱口水,氟膠,氟漆)對於兒童與青少年之預防齲齒效果的比較

使用牙膏,漱口水,氟漆或氟膠等局部塗氟的方式是很有效的預防齲齒的方法。然而,目前對這些方法的相對效果(relative value)還有一些不確定的部分。

目標

相互比較各種局部塗氟方式在兒童齲齒預防上的效果。

搜尋策略

我們搜尋了Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000),以及數個資料庫。我們也搜尋了一些期刊與文章後的參考文獻,並且與特定的研究者及製造商聯繫。

選擇標準

使用隨機對照試驗(randomized controlled trials)或半隨機對照試驗(quasirandomized controlled trials)加上盲性結果評估(blind outcome assessment),來相互比較氟漆,氟膠,漱口水或牙膏使用在16歲以下兒童至少一年以上期間的效果。主要的結果是藉由計算DMFS(齲齒,缺失,填補牙齒的面數)的改變來評估齲齒的增加量。

資料收集與分析

隨機選取三分之一的研究,重複納入決定(inclusion decisions),品質評估(quality assessment),與資料攫取(data extraction);並且會經由討論或參考第三方的意見來達成共識。另外會與文章的作者聯繫來獲得闕漏的資料。主要用來測量效果的方法是使用預防分率(prevented fraction),它是以實驗組與對照組之間平均齲齒增加量的差異佔對照組平均齲齒增加量的百分比來表示。最後會使用隨機效果統合分析(random effects metaanalyses)來整合資料。

主要結論

總計有17個研究其中15項資料被納入統合分析。含氟牙膏與漱口水(pooled DMFS PF 0%; 95% CI, −18% to 19%; p = 0.94),氟膠(pooled DMFS PF 0%; 95% CI, −21% to 21%; p = 1)或氟膠加漱口水(pooled DMFS PF 1%; 95% CI, −13% to 14%; p = 0.94)之間並無顯著的差異,(其彼此間具有實質的異質性)。而比較牙膏跟氟漆(使用於乳牙)之間的實驗結果則是不確定的(inconclusive)(dfs PF 5%; CI not obtainable)。氟漆與漱口水之間的比較結果亦是沒有顯著的差異(氟漆效果略高)(DMFS PF 10%; 95% CI, −12% to 32%; p = 0.40),但是這個結果並沒有強烈的表現在靈敏度的分析上,並且彼此間的異質性很大。比較氟漆與氟膠之間(14%, 95% CI, −12% to 40%; p = 0.30)以及氟膠與漱口水之間(−14% DMFS PF; 95% CI, −40% to 12%; p = 0.30)的實驗結果亦是不確定的(氟漆與漱口水效果略高)。

作者結論

含氟牙膏相較於漱口水或氟膠對於預防兒童齲齒方面表現出類似的效果。目前並沒有非常明確的建議指出氟漆具有比漱口水更好的效果,另外比較氟漆與氟膠之間,漱口水與氟膠之間效果的證據也是還不確定的。目前並沒有任何關於這些預防措施的不良影響(adverse effects)的結論,因為在這些實驗中皆未提及相關的資料。不過比較容易為世人所接受的方式則是使用含氟牙膏。

翻譯人

本摘要由臺灣大學附設醫院莊岳樵翻譯。

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

總結

一些局部塗氟的方式,例如漱口水及氟膠對於降低兒童與青少年齲齒程度方面,相較於含氟牙膏並未有較優秀的效果。齲齒是一種疼痛、治療昂貴、並會嚴重破壞牙齒的疾病。氟化物是一種能預防齲齒的礦物,飲水加氟也在許多地區施行。它亦能以牙膏、漱口水、氟膠及氟漆等形式塗佈。本實驗回顧發現對於兒童與青少年,含氟牙膏、漱口水及氟膠都能給予相似程度減少齲齒的效果。然而,含氟牙膏更能受到普遍的使用。目前並無強烈的證據顯示,氟漆具有比其他局部塗氟形式更好的效果。