Intervention Review

Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride 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: 24 NOV 2003

DOI: 10.1002/14651858.CD002781.pub2

How to Cite

Marinho VCC, Higgins JPT, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002781. DOI: 10.1002/14651858.CD002781.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

SEARCH

 

Abstract

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

Background

Topical fluoride therapy (TFT) in the form of toothpastes, mouthrinses, varnishes and gels are effective caries preventive measures. However, there is uncertainty about the relative value of these interventions when used together.

Objectives

To compare the effectiveness of two TFT modalities combined with one of them alone (mainly toothpaste) 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 in combination 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 '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.

Main results

Eleven of the 12 included studies contributed data for the meta-analyses. For the nine trials that provided data for the main meta-analysis on the effect of fluoride mouthrinses, gels or varnishes used in combination with toothpaste (involving 4026 children) the D(M)FS pooled PF was 10% (95% CI, 2% to 17%; P = 0.01) in favour of the combined regimens. Heterogeneity was not substantial in these results (I2 = 32%). The separate meta-analyses of fluoride gel or mouthrinse combined with toothpaste versus toothpaste alone favour the combined regimens, but differences were not statistically significant; the significant difference in favour of the combined use of fluoride varnish and toothpaste accrues from a very small trial and appears likely to be a spurious result. Not all other combinations of possible practical value were tested in the included studies. The only other statistically significant result was in favour of the combined use of fluoride gel and mouthrinse in comparison to gel alone (pooled DMFS PF 23%; 95% CI, 4% to 43%; P = 0.02), based on two trials. No other combinations of TFT were consistently superior to a single TFT.

Authors' conclusions

Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects could be reached, because data were scarcely reported in the trials.

 

Plain language summary

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

Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents

Additional forms of topical fluoride can reduce tooth decay in children and adolescents more than fluoride toothpaste alone, but the extra benefit is not great.
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 children and adolescents who used another form of topical fluoride in addition to fluoride toothpaste experienced some additional reduction in tooth decay compared with children who only used fluoride toothpaste. However, the additional benefit was not great, and the trials did not provide data about adverse effects.

 

摘要

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

背景

綜合局部塗氟方式(Combinations of topical fluoride)(牙膏、漱口水、氟膠、氟漆)與單一局部塗氟方式(single topical fluoride)對於兒童與青少年之齲齒預防之比較

採取牙膏、漱口水、氟漆及氟膠等形式的局部塗氟療法(Topical fluoride therapy (TFT))是預防齲齒非常有效的方法。然而,對於這些方法同時使用時的相對效果(relative value),目前還有一些不清楚的地方。

目標

比較同時結合兩種TFT方式與只使用單一TFT方式(主要為牙膏)對於預防兒童齲齒之效果。

搜尋策略

我們搜尋了the 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),加上其他數個資料庫。我們也手動搜尋了一些期刊、參考文章列表,並且與選定的文章作者及製造商聯繫。

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),來比較氟漆,氟膠,漱口水或牙膏等方法,互相結合使用在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D(M)FS(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

隨機挑選三分之一的研究,重複納入決定(inclusion decisions),品質評估(quality assessment),資料攫取(data extraction);並且會經由討論或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(PF)),它是以治療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

12項研究中的11項資料被納入統合分析。在9個提供分析資料的實驗中,含氟漱口水、氟膠與氟漆結合牙膏一起使用(包含4026位兒童),其D(M)FS之預防分率(PF)為10%(95%信賴區為2%至17%, p = 0.01),顯示合併使用的方式(combined regimens)較為有效。這些結果並未有大量的異質性(I square = 32%)。統合分析的結果發現氟膠或漱口水結合牙膏一起使用會比起單獨使用牙膏的效果要好,但是兩者之間並沒有統計上顯著之差異。只有唯一一個很小的實驗得到合併使用氟漆與牙膏具有顯著差異的效果,而這有可能是一個虛假的結果。臨床上可能使用的塗氟組合並未完全在這些實驗中被測試。根據兩個實驗的結果,另外一個具有統計上顯著差異為合併使用氟膠與漱口水會比單獨使用氟膠效果要好(pooled DMFS PF 23%; 95% CI, 4% to 43%; p = 0.02)。沒有任何其他組合的TFT會持續比單一TFT還要優越。

作者結論

局部塗氟(漱口水、氟膠或氟漆)加上含氟牙膏的使用,比起單獨使用牙膏能達到一個適度降低齲齒的效果。目前並不能得到任何有關這些預防措施的不良影響(adverse effects)的結論,因為這些實驗中幾乎沒有提供任何相關的資料。

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

對於兒童與青少年,額外的塗氟方式能比單獨使用含氟牙膏,更能降低齲齒的發生,但是其增加的效果並不是非常大。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。本實驗回顧發現兒童與青少年除了含氟牙膏之外,如果還有使用其他的局部塗氟方式,會比僅僅使用含氟牙膏的兒童減少更多齲齒的發生。然而,其增加的效益並非很大,而且這些實驗並未提供關於不良影響的相關資料。