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Topical fluorides in the prevention of dental caries in children - A systematic review

Marinho, Valeria, Coelho Catao; (2003) Topical fluorides in the prevention of dental caries in children - A systematic review. Doctoral thesis (Ph.D), UCL. Green open access

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Abstract

The effectiveness of topical fluorides on dental caries has been extensively reviewed in a number of traditional narrative reviews which often provide different estimates of effectiveness based on selected published literature, and rarely explore the causes of variability in reported effectiveness in a formal way. Recent studies, focusing mainly on the evaluation of specific topical fluoride interventions, have used the meta-analytical approach to synthesize studies results. However, there has been no systematic investigation evaluating and comparing the effectiveness of the main forms of topical fluoride used for caries prevention and examining formally the main factors that may influence their effectiveness. The aim of this thesis was to evaluate objectively and quantitatively the effectiveness and safety of topical fluoride therapy (TFT) in the form of toothpastes, mouthrinses, gels and varnishes in the prevention of dental caries in children. A secondary aim was to examine the sources of heterogeneity that may influence effectiveness, including the initial level of caries, background exposure to fluoride and intervention features. With regard to the clinical effectiveness of TFT three basic questions were asked: Is TFT effective for children and adolescents? Is one of the forms of TFT more effective than another? Are combinations of TFT more effective than one TFT used alone? A comprehensive search was carried out, in order to identify all relevant studies for inclusion irrespective of language. It involved searching a wide range of databases and other sources for controlled trials. Study selection, data extraction and quality assessment were performed based on pre-designed and pilot tested forms and were duplicated in one third of studies. The main outcome measure was caries increment, as measured by the D(M)FS index. The primary measure of effect was the prevented fraction (PF) - the difference in mean caries increment between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed throughout for estimation of treatment effects. Potential sources of heterogeneity were investigated in random effects metaregression analyses. Regular toothbrushing with fluoride toothpaste, supervised regular use of mouthrinse, fluoride gels applied professionally or self-applied under supervision a few times a year, and fluoride varnishes applied two to four times a year were associated with clear reductions in caries increment. For fluoride varnishes, results were largely based on trials with no treatment controls, and for the other modalities results were based on a substantial body of evidence from placebo-controlled trials. Based on the direct evidence from the trials, no conclusion could be reached about any effects that fluoride toothpaste might have on fluorosis, or about any potential adverse effects of TFT. The caries preventive effect of TFT varied according to type of control group (DMFS PF being substantially higher in nonplacebo controlled trials), and increased with supervised use of self-applied TFT, higher initial caries levels, higher fluoride concentration and frequency of application, but was not influenced by exposure to water fluoridation. In adjusted indirect comparisons, caries reductions were likely to be greater with the use of fluoride varnish; no significant differences in effectiveness were indicated for the other TFT modalities. Evidence from head to head comparisons did not indicate that fluoride varnish is more effective than other fluorides; compared with each other, fluoride toothpaste and mouthrinse, and toothpaste and gel appear to be effective to a similar degree. Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste alone. It was concluded that the benefits of TFT are well established, but further research is needed on potential adverse effects.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Topical fluorides in the prevention of dental caries in children - A systematic review
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
URI: https://discovery.ucl.ac.uk/id/eprint/10100068
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