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Fluorides for the prevention of white spots on teeth during fixed brace treatment

  • Review
  • Intervention

Authors


Abstract

Background

White spots can appear on teeth during fixed brace treatment because of early decay around the brace attachments. Fluoride is effective at reducing decay in susceptible individuals and is routinely prescribed in various different forms to patients during orthodontic treatment.

Objectives

To evaluate the effectiveness of fluoride in preventing white spots during orthodontic treatment and to compare the different modes of delivery of fluoride.

Search methods

We searched the Cochrane Oral Health Group's Trials Register (January 2004); CENTRAL (The Cochrane Library 2002, Issue 3); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to July 2003). Authors of trials were contacted for further data.

Selection criteria

Trials were selected if they met the following criteria: a randomised or quasi-randomised clinical trial, involving the use of a fluoride-containing product compared with no use or use of a non-fluoride control and enamel demineralisation was assessed during or after orthodontic treatment.

Data collection and analysis

Six reviewers independently, in duplicate, extracted data. The primary outcome was the difference in the presence or absence of white spots between experimental and control patients for parallel design studies, and between experimental and control quadrants, for split-mouth design studies. Potential sources of heterogeneity were examined. Sensitivity analyses were undertaken for the items assessed for quality and publication bias.

Main results

The primary outcome of the review was the presence or absence of white spots by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Other outcomes such as differences in size and severity of white spots, any patient based outcomes, such as perception of white spots could not be included because there were insufficient data.

Fifteen trials, with 723 participants, provided data for this review. None of the studies fulfilled all of the methodological quality assessment criteria.

There is some evidence that a daily sodium fluoride mouthrinse reduces the severity of enamel decay surrounding a fixed brace (weighted mean difference for lesion depth -70.0; 95% CI -118.2 to -21.8) and that use of a glass ionomer cement for bracket bonding reduces the prevalence (Peto OR 0.35; 95% CI 0.15 to 0.84) and severity of white spots (weighted mean difference for mineral loss -645 vol%.μm; 95% CI -915 to -375) compared with composite resins.

Authors' conclusions

There is some evidence that the use of topical fluoride or fluoride-containing bonding materials during orthodontic treatment reduces the occurrence and severity of white spot lesions, however there is little evidence as to which method or combination of methods to deliver the fluoride is the most effective. Based on current best practice in other areas of dentistry, for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

摘要

背景

氟化物對於固定矯正治療期間牙齒白斑(white spots)之預防

白斑可能出現在進行矯正治療的牙齒上,這是因為固定矯正器周圍的早期齲齒所導致.氟化物對於容易齲齒的族群,具有有效降低齲齒的效果,所以在矯正治療過程中,氟化物通常會以各種形式使用於進行矯正治療的病患.

目標

評估氟化物於矯正治療期間預防白斑產生的效果,並且比較不同塗氟模式的效果.

搜尋策略

我們搜尋了Cochrane Oral Health Group's Trials Register (to 22 August 2002); CENTRAL (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to week July 2003).並且與這些實驗的作者聯繫以取得更進一步的資料

選擇標準

被選擇的實驗必須符合以下的準則:使用隨機對照試驗(randomized clinical trials)或半隨機對照試驗(quasirandomized clinical trials),使用含有氟化物成分的產品與未使用此產品或是使用不含氟化物的產品相互比較,並在矯正期間或結束矯正之後評估牙釉質去礦化的情形.

資料收集與分析

有六位回顧人員各自獨立來攫取資料.主要希望能在平行設計試驗(parallel design studies)與閉口設計試驗(splitmouth design studies)中,了解實驗組與對照組之間,對於白點的出現是否具有差異存在.此外會檢驗可能來源的異質性.另外會進行敏感性分析(Sensitivity analyses)以評估這些項目的品質與出版偏差(publication bias).

主要結論

本回顧主要的結果就是了解病人於治療結束後是否有白斑的出現.次要的結果則包括對牙釉質之礦物質的喪失與病灶深度的定量評估.其他的結果例如白斑的大小與嚴重程度之差異,以及關於病人本身的結果例如對白斑的認知,則沒有包括在內,因為目前還缺乏足夠的資料.本回顧涵蓋了15個實驗,723個受試者的資料.其中並沒有一個研究完全滿足方法學品質(methodological quality)的評估標準.目前有一些證據顯示,每天使用含氟化鈉的漱口水將能降低矯正器周圍的牙釉質齲齒的嚴重程度(礦物質喪失之加權平均差(weighted mean difference)−70.0; 95% CI −118.2 to −21.8),以及使用玻璃離子體黏著劑(glass ionomer cement)來黏結矯正器相較於複合樹脂能降低白斑之盛行率(Peto OR 0.35; 95% CI 0.15 to 0.84),與嚴重程度(礦物質喪失之加權平均差 −645 vol%.μm; 95% CI −915 to −375).

作者結論

目前有一些證據指出於矯正治療期間,採取局部塗氟的方式或是使用含有氟化物的黏著材料能降低白斑病灶的發生與嚴重程度.然而,對於使用那一種方法或合併哪一些方法來提供氟化物會最有效,目前仍僅有少許的證據.根據其他牙科領域中目前經過實証的臨床結果,我們建議配戴固定矯正器的患者每天使用含有0.05%氟化鈉漱口水來漱口.為了得到更高的品質,需要更多臨床研究來了解不同傳遞氟化物給矯正病人的模式.

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

目前有一些證據顯示每天使用含氟漱口水或是使用含有氟化物的黏著劑,將能在固定式矯正治療期間降低齲齒的發生.如果固定矯正器沒有善加清潔,齲齒會以不美觀的白斑形式發生在牙齒上.文獻回顧發現日常使用氟化鈉漱口水能於固定式矯正期間降低牙齒上齲齒之深度.此外,使用含氟化物的黏著劑也能降低白斑的數量,以及減少因齲齒而流失的齒質的量.目前還需要更高品質的研究來確定,於固定式矯正治療期間那一種將氟化物塗佈於病患牙齒上的方式是最好的,以及是否有任何不良影響.根據其他牙科領域中目前經過實証的臨床結果,我們建議配戴固定矯正器的患者每天使用含有0.05%氟化鈉漱口水來漱口.

Plain language summary

Fluorides for the prevention of white spots on teeth during fixed brace treatment

There is some evidence that a daily fluoride mouthrinse or a fluoride-containing cement will reduce tooth decay if used during treatment with fixed braces.
Tooth decay, in the form of unsightly white spots, can occur on teeth being straightened with fixed braces if they are not cleaned properly. The review found that a daily sodium fluoride mouthrinse reduces the depth of decay that develops on a tooth during treatment with fixed braces. Also, one fluoride-containing cement reduced the number of white spots and the amount of tooth material lost to decay. More high quality research is needed to be sure which is the best way to get the fluoride to the tooth surface in patients during treatment with braces and whether there are any adverse effects. Based on current best practice in other areas of dentistry for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse.

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