Flúor para la prevención de la caries dental temprana (lesiones blancas desmineralizadas) durante el tratamiento con aparatología fija
Información
- DOI:
- https://doi.org/10.1002/14651858.CD003809.pub3Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 12 diciembre 2013see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud oral
- Copyright:
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- Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Philip Benson wrote the protocol and co‐ordinated the review. Philip Benson, Fiona Dyer, Peter Germain, Declan Millett and Nicola Parkin independently and in duplicate assessed the eligibility of trials, extracted data and assessed the quality of the trials. Philip Benson contacted authors, entered the data, carried out the statistical analysis (with help from Helen Worthington) and wrote the review. Declan Millett proofread the review.
For the 2013 update of this review, Philip Benson and Susan Furness contacted authors, assessed risk of bias, extracted and entered data, carried out the statistical analysis (with help from Helen Worthington) and wrote the text of the review.
Sources of support
Internal sources
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School of Clinical Dentistry, University of Sheffield, UK.
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Dental School, University College Cork, Ireland.
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School of Dentistry, The University of Manchester, UK.
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MAHSC, UK.
The Cochrane Oral Health Group is supported by the Manchester Academic Health Sciences Centre (MAHSC) and the NIHR Manchester Biomedical Research Centre.
External sources
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Cochrane Oral Health Group Global Alliance, UK.
All reviews in the Cochrane Oral Health Group are supported by Global Alliance member organisations (British Association of Oral Surgeons, UK; British Orthodontic Society, UK; British Society of Paediatric Dentistry, UK; British Society of Periodontology, UK; Canadian Dental Hygienists Association, Canada; National Center for Dental Hygiene Research & Practice, USA; Mayo Clinic, USA; New York University College of Dentistry, USA; and Royal College of Surgeons of Edinburgh, UK) providing funding for the editorial process (http://ohg.cochrane.org/).
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National Institute for Health Research (NIHR), UK.
CRG funding acknowledgement:
The NIHR is the largest single funder of the Cochrane Oral Health Group.Disclaimer:
The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
Declarations of interest
No interests to declare.
Acknowledgements
Thanks are due to Helen Worthington (Cochrane Oral Health Group) for invaluable help with the statistics and to Sylvia Bickley and Anne Littlewood, Trials Search Co‐ordinators for the Cochrane Oral Health Group, for carrying out the searches for the review.
Our thanks to Helen Worthington for her assistance with the 2013 update of this review.
For help with the translations of foreign papers, our thanks go to Regina Mitezki (German), Luisa Fernandez Mauleffinch (Spanish) and Dr Mikako Hayashi (Japanese).
We would also like to thank the following investigators who replied to our requests for additional information about their trials: PA Banks (Fairfield General Hospital, Burnley), AJ Borislow (Albert Einstein Medical Center), JP Fricker (Westmead Centre Dental Clinical School), G Pauw (University of Ghent), JDB Featherstone (University of California at San Fransisco), CR Mattick (University of Newcastle upon Tyne), L Mitchell (St Luke's Hospital, Bradford), B Øgaard (University of Oslo), RC Pascotto (State University of Maringa), M Persson (Umeå University), AL Sonis (Harvard School of Dental Medicine), C Stecksen‐Blicks, PJ Turner (University of Birmingham) and S Twetman (Umeå University).
We acknowledge the contribution of Suzy Vine, who assessed the eligibility of trials, extracted data and assessed the quality of the trials in the original version of this review.
For their help as referees of the original review, we express our thanks to Jayne Harrison, Sylvia Bickley, Helen Worthington, Anne‐Marie Glenny, Lee Hooper, Richard Ellwood, Sue Higham and Aubrey Sheiham. Our thanks to the referees for the 2013 update: Scott Deacon, Ruth Floate, Anne Littlewood, Phil Riley and Helen Worthington.
Version history
| Published | Title | Stage | Authors | Version |
| 2019 Nov 17 | Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment | Review | Philip E Benson, Nicola Parkin, Fiona Dyer, Declan T Millett, Peter Germain | |
| 2013 Dec 12 | Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment | Review | Philip E Benson, Nicola Parkin, Fiona Dyer, Declan T Millett, Susan Furness, Peter Germain | |
| 2004 Jul 19 | Fluorides for the prevention of white spots on teeth during fixed brace treatment | Review | Philip E Benson, Nicola Parkin, Declan T Millett, Fiona Dyer, Suzy Vine, Anwar Shah | |
| 2002 Jul 22 | Fluorides for the prevention of white spots on teeth during fixed brace treatment | Protocol | Philip E Benson, Nicola Parkin, Declan DT Millett, Fiona Dyer, Suzy Vine, Anwar Shah | |
Differences between protocol and review
In the 2013 update of this review, controlled clinical trials (quasi‐randomised) were excluded.
A point of clarification was added to the inclusion criteria for this review. For a randomised controlled trial to be included, demineralised white lesions (DWLs) must be assessed on teeth remaining in the mouth. Studies that evaluated demineralisation of extracted teeth were excluded from the 2013 update of this review because they measured the effects of short‐term exposure to fluoride (four to six weeks between application and extraction of the teeth). Furthermore, it was decided that evaluation of demineralisation must take place at the end of treatment with fixed orthodontic appliances (debonding).
As stated in the Discussion of the previous version of this review, the use of a split‐mouth study design to evaluate these interventions is potentially inappropriate. It is unlikely that the fluoride released will be confined to only the quadrants or the specific teeth in which the experimental material has been placed, and some 'contamination' of teeth in the control quadrants is inevitable. This will reduce the difference in outcome between experimental and control teeth and will reduce the power of the trial to find a difference. Indeed split‐mouth studies included in the previous version of this review found no difference between teeth with fluoridated bracket adhesives and those without, supporting the view that this design is inappropriate for evaluating topical fluorides. Split‐mouth studies were excluded from the 2013 update of this review, and the Methods sections of this review was amended to remove methods that were used to deal with split‐mouth studies.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Fluoride varnish versus placebo varnish, Outcome 1 Number of participants with new DWLs.
Comparison 2 Amine fluoride/stannous fluoride toothpaste/mouthrinse combination versus sodium fluoride toothpaste/mouthrinse combination, Outcome 1 White spot index.
Comparison 2 Amine fluoride/stannous fluoride toothpaste/mouthrinse combination versus sodium fluoride toothpaste/mouthrinse combination, Outcome 2 Visible plaque index.
Comparison 2 Amine fluoride/stannous fluoride toothpaste/mouthrinse combination versus sodium fluoride toothpaste/mouthrinse combination, Outcome 3 Gingival bleeding index.
Comparison 3 Intraoral fluoride‐releasing glass bead device versus mouthrinse‐only control, Outcome 1 Number of participants with new DWLs.
| Fluoride varnish versus placebo varnish for the prevention of demineralised white lesions on teeth during fixed brace treatment | ||||||
| Patient or population: Participants undergoing orthodontic treatment with fixed appliances Comparison: Placebo varnish | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo varnish | Fluoride varnish | |||||
| Number of patients with new demineralised white lesions | Study population | RR 0.31 | 253 | ⊕⊕⊕⊝ | ||
| 640 per 1000 | 198 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence. | ||||||
| 1 A single study with 253 participants evaluated this outcome. Risk of bias was assessed as low. However, this finding should be interpreted with caution until the study has been replicated. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with new DWLs Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 White spot index Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2 Visible plaque index Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3 Gingival bleeding index Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants with new DWLs Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 1.1 Fluoride‐releasing intraoral device versus fluoride mouthrinse | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
