Lintong Yu1, Xueqian Yu2, Yueyang Li3, Fengjiao Yang1, Jialan Hong4, Danchen Qin5, Guangtai Song6, Fang Hua7,8. 1. Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, 430079, China. 2. Library, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China. 3. Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China. 4. Department of Epidemiology and Public Health, University College London, London, UK. 5. Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China. 6. Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, 430079, China. gtsong@whu.edu.cn. 7. Centre for Evidence-Based Stomatology, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, 430079, China. huafang@whu.edu.cn. 8. Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. huafang@whu.edu.cn.
Abstract
OBJECTIVE: To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children. MATERIALS AND METHODS: A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach. RESULTS: A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) - 0.17, 95% confidence interval (CI) - 0.60 to 0.26, P = 0.43, I2 = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I2 = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I2 = 0%, 4 trials, 4,189 participants, low certainty evidence). CONCLUSIONS: Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions. CLINICAL RELEVANCE: The decision to apply FV to children needs to be made in light of their actual usage of RFT. TRIAL REGISTRATION: PROSPERO (CRD42020165270).
OBJECTIVE: To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children. MATERIALS AND METHODS: A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach. RESULTS: A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) - 0.17, 95% confidence interval (CI) - 0.60 to 0.26, P = 0.43, I2 = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I2 = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I2 = 0%, 4 trials, 4,189 participants, low certainty evidence). CONCLUSIONS: Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions. CLINICAL RELEVANCE: The decision to apply FV to children needs to be made in light of their actual usage of RFT. TRIAL REGISTRATION: PROSPERO (CRD42020165270).
Entities:
Keywords:
Caries; Children; Fluoride; Fluoride varnish; Professional fluoride application; Toothpaste
Authors: Rebecca L Slayton; Olivia Urquhart; Marcelo W B Araujo; Margherita Fontana; Sandra Guzmán-Armstrong; Marcelle M Nascimento; Brian B Nový; Norman Tinanoff; Robert J Weyant; Mark S Wolff; Douglas A Young; Domenick T Zero; Malavika P Tampi; Lauren Pilcher; Laura Banfield; Alonso Carrasco-Labra Journal: J Am Dent Assoc Date: 2018-10 Impact factor: 3.634
Authors: O Urquhart; M P Tampi; L Pilcher; R L Slayton; M W B Araujo; M Fontana; S Guzmán-Armstrong; M M Nascimento; B B Nový; N Tinanoff; R J Weyant; M S Wolff; D A Young; D T Zero; R Brignardello-Petersen; L Banfield; A Parikh; G Joshi; A Carrasco-Labra Journal: J Dent Res Date: 2018-10-05 Impact factor: 6.116