Intervention Review

Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents

  1. Valeria CC Marinho1,*,
  2. Julian PT Higgins2,
  3. Stuart Logan3,
  4. Aubrey Sheiham4

Editorial Group: Cochrane Oral Health Group

Published Online: 20 OCT 2003

Assessed as up-to-date: 19 AUG 2003

DOI: 10.1002/14651858.CD002782


How to Cite

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD002782. DOI: 10.1002/14651858.CD002782.

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

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

  4. 4

    University College London Medical School, Department of Epidemiology and Public Health, London, 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: 20 OCT 2003

SEARCH

 

Abstract

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

Background

Topical fluoride therapy (TFT) in the form of varnish, gel, mouthrinse or toothpaste has been used extensively as a caries-preventive intervention for over 3 decades.

Objectives

To determine the effectiveness and safety of fluoride varnishes, gels, mouthrinses, and toothpastes 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), 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 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

There were 144 studies included. For the 133 that contributed data for meta-analysis (involving 65,169 children) the D(M)FS pooled prevented fraction estimate was 26% (95% CI, 24% to 29%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001), but the direction of effect was consistent. The effect of topical fluoride varied according to type of control group used, type of TFT used, mode/setting of TFT use, initial caries levels and intensity of TFT application, but was not influenced by exposure to water fluoridation or other fluoride sources. D(M)FS PF was on average 14% (95% CI, 5% to 23%; P = 0.002) higher in non-placebo controlled trials, 14% (95% CI, 2% to 26%; P = 0.25) higher in fluoride varnish trials compared with all others, and 10% (95% CI, -17% to -3%; P = 0.003) lower in trials of unsupervised home use compared with self applied supervised and operator-applied. There was a 0.7% increase in the PF per unit increase in baseline caries (95% CI, 0.2% to 1.2%; P = 0.004).

Authors' conclusions

The benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomized controlled trials. While the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce.

 

Plain language summary

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

Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents

The use of fluoride toothpastes, mouthrinses, gels or varnishes reduces tooth decay in children and adolescents.
Tooth decay (dental caries) is painful, expensive to treat and can seriously damage teeth. Fluoride is a mineral that prevents tooth decay. The review of trials found that children aged 5 to 16 years who applied fluoride in the form of toothpastes, mouthrinses, gels or varnishes had fewer decayed, missing and filled teeth regardless of whether their drinking water was fluoridated. Supervised use of self applied fluoride increases the benefit. Fluoride varnishes may have a greater effect but more high quality research is needed to be sure of how big a difference these treatments make, and whether they have adverse effects.

 

摘要

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

背景

局部氟化物(牙膏.漱口水.凝膠或塗漆)對兒童和青少年蛀牙之預防.

近三十年來,以凝膠.塗漆.漱口水或牙膏的方式給予局部氟化物的治療已廣泛的作為預防蛀牙的方法之一.

目標

了解含氟凝膠.塗漆.漱口水或牙膏使用在孩童蛀牙之預防效果與安全性,及可能影響其效果之因素.

搜尋策略

我們搜尋了Cochrane Oral Health Group's Trials Register (May 2000), CENTRAL (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000),加上數種電子資料庫.我們也查閱了期刊,文章的參考文獻資料,聯絡作者及相關的廠商.

選擇標準

以盲性結果評估的隨機或半隨機臨床試驗,比較至少一年使用氟化塗漆.凝膠.漱口水或牙膏.安慰劑及未進行治療的16歲以下孩童.實驗的結果以蛀牙.脫落.填補牙面(D(M)FS)的改變來評估蛀牙的增加率.

資料收集與分析

將這些研究的三分之一隨機樣本重複進行資料的列入決定,品質評估和資料提取,並且經討論或第三方達成共識.缺少的資料向研究作者取得.對於效果的初步評估方法是以預防分數(prevented fraction, PF)來看, 預防分數指的是在治療組和控制組蛀牙增加率的差異和控制組蛀牙增加率的比值,以百分比表示.隨機的效果meta分析在資料彙集後進行.異質性可能產生的原因可在隨機的效果meta迴歸分析中審視.

主要結論

本研究包含了144個研究.有133個研究提供資料進行meta分析(共包含65,169個孩童),以收集到的蛀牙.脫落.填補牙面計算得到的預防分數為26%(95% CI, 24% to 29%; p < 0.0001),有明顯的異質性並有統計上的意義,但影響的方向是一致的.局部氟化物的效果依控制組使用的類型,使用局部氟化物的種類.方法和強度,及孩童原本的蛀牙情況而不同,但並不受到飲水加氟和其他氟化物使用的影響.非安慰劑的控制組得到的蛀牙.脫落.填補牙面計算出預防分數在非安慰劑控制組試驗的平均為14%以上(95% CI, 5% to 23%; p = 0.002);使用氟化塗漆和其他種類比較起來可以達到預防分數14%以上(95% CI, 2% to 26%; p = 0.25);在家未經監督使用與在監督下自己使用或醫師使用比較,得到其預防分數為10%以下(95% CI, −17% to −3%; p = 0.003).蛀牙每增加一單位時,預防分數增加0.7%(95% CI, 0.2% to 1.2%; p = 0.004).

作者結論

從一些隨機控制實驗已有相當多的證據顯示局部氟化物的優點.這些研究之間異質性來源的檢視對於總體結論是很重要的,應該要小心說明.對於氟化物使用時可能產生的不良作用,因為研究顯示的資料不足所以我們無法得到確定的結論.

翻譯人

本摘要由臺灣大學附設醫院張欣怡翻譯。

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

總結

使用含氟牙膏,漱口水,凝膠或塗漆對於孩童或成人都有減少蛀牙的效果.蛀牙(齲齒)會使人感到疼痛,治療需要花費金錢也會嚴重的破壞牙齒結構.氟是一種礦物質可以預防蛀牙.回顧這些研究發現5歲至16歲使用含氟牙膏,漱口水,凝膠或塗漆的孩童,不論飲用水是否含氟都很少有蛀牙.脫落和填補的牙齒的情形.在監督下自己使用氟化物有很好的效果.氟化塗漆可能有較好的效果,但和其他方式的差異大小及可能的不良作用還需要更進一步的研究.