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Dispositivos de flúor de liberación lenta para el control de la caries dental

Appendices

Appendix 1. Cochrane Oral Health's Trials Register search strategy

#1 (teeth and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)) [REFERENCE] [STANDARD]
#2 (tooth and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)) [REFERENCE] [STANDARD]
#3 (dental and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)) [REFERENCE] [STANDARD]
#4 (enamel and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)) [REFERENCE] [STANDARD]
#5 (dentin and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)) [REFERENCE] [STANDARD]
#6 (root* and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)) [REFERENCE] [STANDARD]
#7 #1 or #2 or #3 or #4 or #5 or #6 [REFERENCE] [STANDARD]
#8 fluorid* [REFERENCE] [STANDARD]
#9 (slow* and (releas* or action*)) [REFERENCE] [STANDARD]
#10 ((delay* or prolong* or control* or sustain* or timed*) and (releas* or action*)) [REFERENCE] [STANDARD]
#11 (glass and (bead* or devic*)) [REFERENCE] [STANDARD]
#12 ("copolymer acrylic reservoir" or "membrane controlled reservoir" or "copolymer membrane" or "hydroxyapatite Eudraglit") [REFERENCE] [STANDARD]
#13 #9 or #10 or #11 or #12 [REFERENCE] [STANDARD]
#14 #7 and #8 and #13 [REFERENCE] [STANDARD]

Appendix 2. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

#1 [mh "Tooth demineralization"]
#2 (teeth near/5 (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#3 (tooth near/5 (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#4 (dental near/5 (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#5 (enamel near/5 (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#6 (dentin near/5 (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#7 (root* near/5 (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#8 #1 or #2 or #3 or #4 or #5 or #6 or #7
#9 [mh Fluorides]
#10 fluorid*
#11 #9 or #10
#12 [mh ^"Delayed action preparations"]
#13 (slow* near/5 (action* or releas*))
#14 ((delay* or prolong* or control* or sustain* or timed*) near/5 (releas* or action*))
#15 ("copolymer acrylic reservoir" or "membrane controlled reservoir" or "copolymer membrane" or "hyroxyapatite Eudraglit")
#16 #12 or #13 or #14 or #15
#17 #8 and #11 and #16

Appendix 3. MEDLINE (Ovid) search strategy

1. exp Tooth demineralization/
2. (teeth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
3. (tooth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
4. (dental adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
5. (enamel adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
6. (dentin adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
7. (root adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
8. or/1‐7
9. exp Fluorides/
10. fluorid$.mp.
11. 9 or 10
12. Delayed action preparations/
13. (slow$ adj5 (releas$ or action$)).mp.
14. ((delay$ or prolong$ or control$ or sustain$ or timed$) adj5 (releas$ or action$)).mp.
15. (glass adj3 (bead$ or devic$)).mp.
16. ("copolymer acrylic reservoir" or "membrane controlled reservoir" or "copolymer membrane" or "hydroxyapatite Eudraglit").mp.
17. or/12‐16
18. 8 and 11 and 17

Appendix 4. Embase (Ovid) search strategy

1. Dental caries/
2. (teeth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
3. (tooth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
4. (dental adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
5. (enamel adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
6. (dentin adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
7. (root adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
8. or/1‐7
9. Fluoride/
10. fluorid$.mp.
11. 9 or 10
12. Delayed release formulations/
13. (slow$ adj5 (releas$ or action$)).mp.
14. ((delay$ or prolong$ or control$ or sustain$ or timed$) adj5 (releas$ or action$)).mp.
15. (glass adj3 (bead$ or devic$)).mp.
16. ("copolymer acrylic reservoir" or "membrane controlled reservoir" or "copolymer membrane" or "hydroxyapatite Eudraglit").mp.
17. or/12‐16
18. 8 and 11 and 17

Appendix 5. US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform search strategy

caries and fluoride and slow release
caries and fluoride and delayed release
caries and fluoride and controlled release
caries and fluoride and sustained release

Study flow diagram.
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Figure 1

Study flow diagram.

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

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

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Comparison 1 Slow‐release fluoride device versus control, Outcome 1 Change of caries (increase in decayed, missing, and filled permanent teeth (DMFT)) at 2 years compared to baseline.
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Analysis 1.1

Comparison 1 Slow‐release fluoride device versus control, Outcome 1 Change of caries (increase in decayed, missing, and filled permanent teeth (DMFT)) at 2 years compared to baseline.

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Comparison 1 Slow‐release fluoride device versus control, Outcome 2 Change of caries (increase in decayed, missing, and filled permanent surfaces (DMFS)) at 2 years compared to baseline.
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Analysis 1.2

Comparison 1 Slow‐release fluoride device versus control, Outcome 2 Change of caries (increase in decayed, missing, and filled permanent surfaces (DMFS)) at 2 years compared to baseline.

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Summary of findings for the main comparison. Slow‐release fluoride devices compared with control for the control of dental decay

Slow‐release fluoride devices compared with control for the control of dental decay

Patient or population: children with high risk of dental decay

Settings: low water fluoride level area, inner city school

Intervention: slow‐release fluoride devices

Comparison: control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Slow‐release fluoride device

Increase in DMFT at 2 years compared with baseline

(DMFT scale ranged from 0 to 32)

The mean was 0.91 (SD 1.36)

The mean was
0.72 lower (95% CI ‐1.23 to ‐0.21)

Not applicable

63 (1 study)

⊕⊝⊝⊝
very low1

‐

Increase in DMFS at 2 years compared with baseline

(DMFS scale ranged from 0 to 128)

The mean was 1.81 (SD 3.28)

The mean was
1.52 lower (95% CI ‐2.68 to ‐0.36)

Not applicable

63 (1 study)

⊕⊝⊝⊝
very low1

‐

Progression of caries lesion through enamel or into dentine

‐

‐

‐

‐

‐

No evidence found

Dental pain due to decay

‐

‐

‐

‐

No evidence found

Harms of slow‐release fluoride devices

‐

‐

‐

132 (1 study)

⊕⊝⊝⊝

very low1, 2

Study reported that no irritations or other harms were reported

Participant satisfaction

‐

‐

‐

‐

‐

No RCT evidence found

Retention of slow‐release fluoride devices

‐

‐

‐

132 (1 study)

⊕⊝⊝⊝

very low1

Only 63/132 (47.7%) children who were still available at 2‐year follow‐up had the devices intact

*As there was only 1 included study, the mean values in the control group was used as the assumed risk. 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).
CI: confidence interval; DMFT: decayed, missing, and filled permanent teeth; DMFS: decayed, missing, and filled permanent surfaces; RCT: randomised controlled trial; SD: standard deviation.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1Quality of the evidence was affected by serious attrition bias (only 36% of participants randomised were included in analysis), relatively small overall sample size and evidence was only obtained from a specific group of participants (children with high risk of caries, in an area with low levels of fluoride in tap water).
2Unclear how reports about harms were obtained. No suggestions from the report that these were systematically checked.

Figuras y tablas -
Summary of findings for the main comparison. Slow‐release fluoride devices compared with control for the control of dental decay
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Comparison 1. Slow‐release fluoride device versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change of caries (increase in decayed, missing, and filled permanent teeth (DMFT)) at 2 years compared to baseline Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

‐0.72 [‐1.23, ‐0.21]

2 Change of caries (increase in decayed, missing, and filled permanent surfaces (DMFS)) at 2 years compared to baseline Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

‐1.52 [‐2.68, ‐0.36]
Figuras y tablas -
Comparison 1. Slow‐release fluoride device versus control
Ir a la tabla de la revisión