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Cochrane Database of Systematic Reviews

Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children

Information

DOI:
https://doi.org/10.1002/14651858.CD011850.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 23 October 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Oral Health Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Rena Takahashi

    Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

  • Erika Ota

    Global Health Nursing, St. Luke's International University, Graduate School of Nursing Sciences, Tokyo, Japan

  • Keika Hoshi

    Department of Hygiene, Kitasato University, School of Medicine, Minami‐ku, Sagamihara, Japan

  • Toru Naito

    Department of Geriatric Dentistry, Fukuoka Dental College, Fukuoka, Japan

  • Yoshihiro Toyoshima

    Human Resource Department, Hibiya Employee Clinic, The Dai‐ichi Life Insurance Company, Limited, Tokyo, Japan

  • Hidemichi Yuasa

    Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Japan

  • Rintaro Mori

    Correspondence to: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

    [email protected]

  • Eishu Nango

    Department of General Medicine, Tokyo Kita Medical Center, Tokyo, Japan

Contributions of authors

Erika Ota (EO) conceived and drafted the full review. Rena Takahashi (RT) and Keika Hoshi (KH) were responsible for the selection of studies. RT and EO were responsible for data extraction and management. KH, Yoshihiro Toyoshima (YT) and EO were responsible for the risk of bias assessment. KH, Hidemichi Yuasa (HY), YT and Rintaro Mori (RM) commented on and supervised the protocol and review. All review authors read and approved the final version.

Sources of support

Internal sources

  • National Center for Child Health and Development, Japan.

    Grant 26A‐5

External sources

  • National Institute for Health Research (NIHR), UK.

    This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, the NIHR, the NHS or the Department of Health

  • Cochrane Oral Health Global Alliance, Other.

    The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (oralhealth.cochrane.org/partnerships‐alliances). Contributors over the past year have been the American Association of Public Health Dentistry, USA; the British Association for the Study of Community Dentistry, UK; the British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; the Centre for Dental Education and Research at All India Institute of Medical Sciences, India; the National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; NHS Education for Scotland, UK; and the Swiss Society for Endodontology, Switzerland

  • Ministry of Health Labour and Welfare, Japan.

    Health Labour Sciences Research Grant (No. 13800128)

  • School of Dentistry, The University of Manchester, UK.

  • The Clinical Research Program for Child Health and Development from the Japan Agency for Medical Research and Development (AMED), Japan.

Declarations of interest

Rena Takahashi: none known.
Erika Ota: none known.
Keika Hoshi: none known.
Toru Naito: none known.
Yoshihiro Toyoshima: none known.
Hidemichi Yuasa: none known.
Rintaro Mori: none known.
Eishu Nango: none known.

Acknowledgements

We would like to thank Cochrane Oral Health for their help in developing this review. We thank Valeria Marinho, Helen Worthington, Annetta Tsang and Derek Richards for their comments on the draft. We would also like to thank Emma Barber for her editorial assistance in preparing the protocol for this review, and Anne Littlewood for developing the search strategy.

Version history

Published

Title

Stage

Authors

Version

2017 Oct 23

Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children

Review

Rena Takahashi, Erika Ota, Keika Hoshi, Toru Naito, Yoshihiro Toyoshima, Hidemichi Yuasa, Rintaro Mori, Eishu Nango

https://doi.org/10.1002/14651858.CD011850.pub2

2015 Aug 28

Fluoride supplementation in pregnant women for preventing dental caries in the primary teeth of their children

Protocol

Rena Takahashi, Erika Ota, Keika Hoshi, Toru Naito, Yoshihiro Toyoshima, Hidemichi Yuasa, Rintaro Mori

https://doi.org/10.1002/14651858.CD011850

Differences between protocol and review

Fluorosis added as a primary outcome of the review. Adverse effects other than fluorosis added as secondary outcomes in the review.

Keywords

MeSH

Medical Subject Headings Check Words

Adult; Child, Preschool; Female; Humans; Infant; Pregnancy;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 1 Children with caries in the primary teeth at 3 years.
Figures and Tables -
Analysis 1.1

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 1 Children with caries in the primary teeth at 3 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 2 Children with caries in the primary teeth at 5 years.
Figures and Tables -
Analysis 1.2

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 2 Children with caries in the primary teeth at 5 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 3 Decayed primary surfaces at 3 years.
Figures and Tables -
Analysis 1.3

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 3 Decayed primary surfaces at 3 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 4 Filled primary surfaces at 3 years.
Figures and Tables -
Analysis 1.4

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 4 Filled primary surfaces at 3 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 5 Decayed or filled primary surfaces at 3 years.
Figures and Tables -
Analysis 1.5

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 5 Decayed or filled primary surfaces at 3 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 6 Decayed primary surfaces at 5 years.
Figures and Tables -
Analysis 1.6

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 6 Decayed primary surfaces at 5 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 7 Filled primary surfaces at 5 years.
Figures and Tables -
Analysis 1.7

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 7 Filled primary surfaces at 5 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 8 Decayed or filled primary surfaces at 5 years.
Figures and Tables -
Analysis 1.8

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 8 Decayed or filled primary surfaces at 5 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 9 Fluorosis (maxillary teeth) at 5 years.
Figures and Tables -
Analysis 1.9

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 9 Fluorosis (maxillary teeth) at 5 years.

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 10 Fluorosis (mandibular teeth) at 5 years.
Figures and Tables -
Analysis 1.10

Comparison 1 Fluoride supplementation (tablets) versus placebo, Outcome 10 Fluorosis (mandibular teeth) at 5 years.

Summary of findings for the main comparison. Fluoride supplementation (tablets) compared to placebo for pregnant women for preventing dental caries in the primary teeth of their children

Fluoride supplementation (tablets) compared to placebo for pregnant women for preventing dental caries in the primary teeth of their children

Population: pregnant women for preventing dental caries in the primary teeth of their children
Setting: USA
Intervention: fluoride supplementation (tablets)
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with fluoride supplementation (tablets)

Children with caries in the primary teeth at 3 years

Study population

RR 1.46
(0.75 to 2.85)

938
(1 RCT)

⊕⊝⊝⊝
VERY LOW1, 2

At 5 years RR 0.84
(0.53 to 1.33)

30 per 1000

43 per 1000
(22 to 84)

Decayed or filled primary tooth surfaces at 3 years

The mean decayed or filled surfaces at 3 years was 0.30

MD 0.12 higher
(0.05 lower to 0.29 higher)

938
(1 RCT)

⊕⊝⊝⊝
VERY LOW2, 3

Not significant at 5 years

Fluorosis (maxillary teeth) at 5 years

Study population

RR 1.79
(0.95 to 3.40)

798
(1 RCT)

⊕⊝⊝⊝
VERY LOW1, 2

Fluorosis in mandibular teeth at 5 years RR 0.89
(0.35 to 2.29)

35 per 1000

63 per 1000
(33 to 119)

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Downgraded by 2 for imprecision: few events, and CI included appreciable benefits and harms.
2Downgraded by 1 for risk of bias: high attrition bias, and potential limitations in blinding of outcome assessment are likely to lower confidence in the estimate of effect
3Downgraded by 2 for imprecision: CI included appreciable benefits and harms.

Figures and Tables -
Summary of findings for the main comparison. Fluoride supplementation (tablets) compared to placebo for pregnant women for preventing dental caries in the primary teeth of their children
Comparison 1. Fluoride supplementation (tablets) versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Children with caries in the primary teeth at 3 years Show forest plot

1

938

Risk Ratio (M‐H, Fixed, 95% CI)

1.46 [0.75, 2.85]

2 Children with caries in the primary teeth at 5 years Show forest plot

1

798

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.53, 1.33]

3 Decayed primary surfaces at 3 years Show forest plot

1

938

Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.02, 0.12]

4 Filled primary surfaces at 3 years Show forest plot

1

938

Mean Difference (IV, Fixed, 95% CI)

0.07 [‐0.07, 0.21]

5 Decayed or filled primary surfaces at 3 years Show forest plot

1

938

Mean Difference (IV, Fixed, 95% CI)

0.12 [‐0.05, 0.29]

6 Decayed primary surfaces at 5 years Show forest plot

1

798

Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐0.17, 0.05]

7 Filled primary surfaces at 5 years Show forest plot

1

798

Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.28, 0.34]

8 Decayed or filled primary surfaces at 5 years Show forest plot

1

798

Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.42, 0.32]

9 Fluorosis (maxillary teeth) at 5 years Show forest plot

1

798

Risk Ratio (M‐H, Fixed, 95% CI)

1.79 [0.95, 3.40]

10 Fluorosis (mandibular teeth) at 5 years Show forest plot

1

798

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.35, 2.29]

Figures and Tables -
Comparison 1. Fluoride supplementation (tablets) versus placebo