Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.
Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.
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DOI：
10.1002/14651858.cd007868.pub2
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发表时间：
2010-01-20
期刊：
影响因子：
--
通讯作者：
Shi, Xin
中科院分区：
文献类型：
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作者：
Walsh, Tanya;Worthington, Helen V;Shi, Xin
背景：龋齿（蛀牙）是由于牙菌斑中致龋细菌与可发酵碳水化合物（主要是糖）之间的相互作用不平衡而引起的牙齿硬组织疾病。使用含氟牙膏是预防龋齿的首要干预措施。目的：确定不同浓度氟化物牙膏在预防儿童和青少年龋齿方面的相对有效性，并检查基线龋齿水平和监督刷牙的潜在调节作用。检索策略：检索Cochrane口腔健康组试验注册、CENTRAL、MEDLINE和其他几个数据库。还检索了文章的参考文献列表。最近查册日期：2009年6月8日选择标准：随机对照试验和集群随机对照试验，比较含氟牙膏与安慰剂或不同浓度的含氟牙膏对16岁以下儿童的影响，随访期至少为1年。主要结果是恒牙列或乳牙列的龋齿增加，通过从基线开始的蛀牙（缺失）、补牙面变化(D（M)FS/ D(M)FS）来测量。数据收集和分析：纳入研究、数据提取和质量评估由审查小组的两名成员独立进行，一式两份。分歧通过讨论和协商一致或由第三方解决。主要的效果测量是预防分数（PF），即对照组的龋齿增量减去治疗组的龋齿增量，以对照组龋齿增量的比例表示。在适合汇集数据的情况下，使用网络元分析、网络元回归或元分析模型。潜在的异质性来源是先验的，并在适当的情况下通过随机效应元回归分析进行检查。主要结果：纳入75项研究，其中71项研究包括79项试验，为网络元分析、网络元回归或元分析提供了数据。对66项研究（74项试验）进行了网络荟萃分析，对混合牙列或永久牙列中的D(M)FS进行了分析，结果表明，氟化物浓度越高，含氟牙膏的龋齿预防效果越显著(在1000/1055/1100/1250百万分之一（ppm）浓度下，与安慰剂相比，D(M)FS PF为23%(95%可信区间（CrI） 19%至27%)，在2400/2500/2800 ppm浓度下，与安慰剂相比，D(M)FS PF为36%（95%可信区间（CrI） 27%至44%）。但与安慰剂相比，440/500/550 PPM及以下的浓度没有统计学意义上的显著影响。有一些证据表明存在剂量反应关系，因为随着氟浓度从基线开始增加，PF也随之增加，尽管这在统计上并不总是显著的。含氟牙膏的效果也随着D(M)FS基线水平和监督刷牙而增加，但没有达到统计学意义。六项研究评估了氟化物浓度对乳牙列的影响，由于氟化物浓度比较和结果测量的不同，结果不明确。只有少数研究对治疗方案的依从性和不良影响进行了评估。当报告时，没有观察到不同的依从性和不良影响，如软组织损伤和牙齿染色是最小的。作者的结论：这篇综述证实了与安慰剂相比，使用含氟牙膏在预防儿童和青少年龋齿方面的益处，但仅在氟浓度为1000ppm及以上时才有显著意义。不同浓度含氟牙膏的相对防龋效果随着氟浓度的升高而增强。对6岁以下儿童使用何种氟化物水平的决定应与氟中毒的风险相平衡。
BACKGROUND: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries.OBJECTIVES: To determine the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline caries level and supervised toothbrushing.SEARCH STRATEGY: A search was undertaken on Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent searches: 8 June 2009.SELECTION CRITERIA: Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline.DATA COLLECTION AND ANALYSIS: Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the caries increment of the control group minus the caries increment of the treatment group, expressed as a proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were specified a priori and examined through random-effects meta-regression analysis where appropriate.MAIN RESULTS: 75 studies were included, of which 71 studies comprising 79 trials contributed data to the network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.AUTHORS' CONCLUSIONS: This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis.