Xylitolhaltige Produkte zur Vorbeugung von Zahnkaries bei Kindern und Erwachsenen
Appendices
Appendix 1. Cochrane Oral Health Group Trials Register Search Strategy
1 MeSH DESCRIPTOR Tooth Demineralization
2 ((teeth and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)):ti,ab) AND (INREGISTER)
3 ((tooth and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)):ti,ab) AND (INREGISTER)
4 ((dental and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)):ti,ab) AND (INREGISTER)
5 ((enamel and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)):ti,ab) AND (INREGISTER)
6 ((dentin and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)):ti,ab) AND (INREGISTER)
7 ((root and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*)):ti,ab) AND (INREGISTER)
8 MeSH DESCRIPTOR Dental Plaque Index
9 ((("dental plaque" or DMF or DFS or DFT or DMFT) and (index or indices)):ti,ab) AND (INREGISTER)
10 MeSH DESCRIPTOR Dental Plaque
11 (((dental or tooth or teeth) and plaque):ti,ab) AND (INREGISTER)
12 (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11) AND (INREGISTER)
13 MeSH DESCRIPTOR Sugar Alcohols
14 (("sugar alcohol*" or polyol*):ti,ab) AND (INREGISTER)
15 MeSH DESCRIPTOR Sweetening Agents
16 (sweetener*:ti,ab) AND (INREGISTER)
17 MeSH DESCRIPTOR Xylitol
18 (xylitol:ti,ab) AND (INREGISTER)
19 (#13 or #14 or #15 or #16 or #17 or #18) AND (INREGISTER)
20 (#12 and #19) AND (INREGISTER)
Appendix 2. Cochrane Central Register of Controlled Clinical Trials (CENTRAL) search strategy
#1 [mh "Tooth demineralization"]
#2 (tooth near/5 (cavit* or caries or carious or decay* or lesion or deminerali* or reminerali*))
#3 (teeth 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 [mh "Dental plaque index"]
#9 (("dental plaque" or DMF or DFS or DFT or DMFT) near/3 (index or indices))
#10 [mh "Dental plaque"]
#11 ((dental or tooth or teeth) and plaque)
#12 {or #1‐#11}
#13 [mh "Sugar alcohols"]
#14 ("sugar alcohol*" or polyol*)
#15 [mh ^"Sweetening agents"]
#16 sweetener*
#17 [mh Xylitol]
#18 xylitol
#19 {or #13‐#18}
#20 #12 and #19
Appendix 3. MEDLINE (OVID) search strategy
1. (teeth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
2. (tooth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
3. (dental adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
4. (enamel adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
5. (dentin adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
6. (root adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
7. exp TOOTH DEMINERALIZATION/
8. Dental plaque index/
9. (("dental plaque" or DMF or DFS or DFT or DMFT) adj2 (index or indices)).mp.
10. Dental plaque/
11. ((dental or tooth or teeth) adj3 plaque).mp.
12. or/1‐11
13. exp Sugar Alcohols/
14. ("sugar alcohol$" or polyol$).mp.
15. Sweetening Agents/
16. sweetener$.mp.
17. Xylitol/
18. xylitol.mp.
19. or/13‐18
20. 12 and 19
The above search will be linked with the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying reports of randomised controlled trials (2008 revision) (as published in box 6.4.c in theCochrane Handbook for Systematic Reviews of Interventions, version 5.1.0, updated March 2011) (Higgins 2011).
1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. drug therapy.fs.
6. randomly.ab.
7. trial.ab.
8. groups.ab.
9. or/1‐8
10. exp animals/ not humans.sh.
11. 9 not 10
Appendix 4. EMBASE (Ovid) search strategy
1. (teeth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
2. (tooth adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
3. (dental adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
4. (enamel adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
5. (dentin adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
6. (root adj5 (cavit$ or caries or carious or decay$ or lesion$ or deminerali$ or reminerali$)).mp.
7. Dental caries/
8. (("dental plaque" or DMF or DFS or DFT or DMFT) adj2 (index or indices)).mp.
9. Tooth plaque/
10. ((dental or tooth or teeth) adj3 plaque).mp.
11. or/1‐10
12. exp Sugar Alcohol/
13. ("sugar alcohol$" or polyol$).mp.
14. exp Sweetening Agent/
15. sweetener$.mp.
16. Xylitol/
17. xylitol.mp.
18. or/12‐17
19. 11 and 18
The above subject search was linked to the Cochrane Oral Health Group filter for identifying RCTs in EMBASE via OVID:
1. random$.ti,ab.
2. factorial$.ti,ab.
3. (crossover$ or cross over$ or cross‐over$).ti,ab.
4. placebo$.ti,ab.
5. (doubl$ adj blind$).ti,ab.
6. (singl$ adj blind$).ti,ab.
7. assign$.ti,ab.
8. allocat$.ti,ab.
9. volunteer$.ti,ab.
10. CROSSOVER PROCEDURE.sh.
11. DOUBLE‐BLIND PROCEDURE.sh.
12. RANDOMIZED CONTROLLED TRIAL.sh.
13. SINGLE BLIND PROCEDURE.sh.
14. or/1‐13
15. (exp animal/ or animal.hw. or nonhuman/) not (exp human/ or human cell/ or (human or humans).ti.)
16. 14 NOT 15
Appendix 5. CINAHL (EBSCO) search strategy
S19 (S12 or S13 or S14 or S15 or S16 or S17) AND (S11 AND S18)
S18 S12 or S13 or S14 or S15 or S16 or S17
S17 xylitol
S16 (MH Xylitol)
S15 sweetener*
S14 (MH "Sweetening agents")
S13 ("sugar alcohol*" or polyol*)
S12 (MH "Sugar alcohols")
S11 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10
S10 ((dental or tooth or teeth) and plaque)
S9 (("dental plaque" or DMF or DFS or DFT or DMFT) and (index or indices))
S8 (MH "Dental Plaque")
S7 (root and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
S6 (dentin and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
S5 (enamel and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
S4 (dental and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
S3 (teeth and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
S2 (tooth and (cavit* or caries or carious or decay* or lesion or deminerali* or reminerali*))
S1 (MH "Tooth demineralization+")
Appendix 6. Web of Science Conference Proceedings search strategy
#14 #9 and #13
#13 #10 or #11 or #12
#12 TS=sweetener*
#11 TS=("sugar alcohol*" or polyol*)
#10 TS=xylitol
#9 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8
#8 TS=((dental or tooth or teeth) and plaque)
#7 TS=(("dental plaque" or DMF or DFS or DFT or DMFT) and (index or indices))
#6 TS=(root and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#5 TS=(dentin and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#4 TS=(enamel and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#3 TS=(dental and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#2 TS=(teeth and (cavit* or caries or carious or decay* or lesion* or deminerali* or reminerali*))
#1 TS=(tooth and (cavit* or caries or carious or decay* or lesion or deminerali* or reminerali*))
Appendix 7. Proquest Dissertations and Theses search strategy
all((tooth or teeth or dental) and (decay or caries)) AND all(xylitol)
Appendix 8. US National Institutes of Health Trials Register (ClinicalTrials.gov) search strategy
xylitol and caries
Appendix 9. WHO International Clinical Trials Registry Platform search strategy
tooth decay and xylitol or caries and xylitol
Study flow diagram.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Adults: xylitol lozenges versus control lozenges, Outcome 1 Caries increment at 33 months follow‐up (DFS).
Comparison 2 Children: xylitol lozenges versus no treatment, Outcome 1 Caries increment at 4 years follow‐up (DMFS).
Comparison 2 Children: xylitol lozenges versus no treatment, Outcome 2 Number with caries increment at 4 years follow‐up (as opposed to none/no change).
Comparison 3 Children: xylitol topical oral syrup versus control syrup (very low dose xylitol), Outcome 1 Number of decayed primary teeth at 1 year follow‐up.
Comparison 4 Children: xylitol sucking tablets versus no treatment, Outcome 1 Caries increment at 2 years follow‐up (dmfs).
Comparison 4 Children: xylitol sucking tablets versus no treatment, Outcome 2 Number with caries increment at 2 years follow‐up (as opposed to none/no change).
Comparison 5 Children: xylitol plus fluoride toothpaste versus fluoride toothpaste, Outcome 1 Caries increment at 2.5 to 3 years follow‐up (Prevented Fraction).
Comparison 5 Children: xylitol plus fluoride toothpaste versus fluoride toothpaste, Outcome 2 Caries increment at 2.5 to 3 years follow‐up (DFS).
Comparison 6 Children: xylitol tablets versus control (sorbitol) tablets, Outcome 1 Number with caries increment at 4 years follow‐up (as opposed to none/no change).
Comparison 7 Children: xylitol wipes versus control wipes, Outcome 1 Number with caries increment at 1 year follow‐up (as opposed to none/no change).
| Xylitol toothpaste compared with control toothpaste for preventing dental caries | ||||||
| Patient or population: children with permanent teeth Settings: schools Intervention: fluoride toothpaste containing 10% xylitol Comparison: fluoride toothpaste | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Xylitol | |||||
| Caries: increment (DFS) prevented fraction (PF) at 2.5 to 3 years follow‐up (higher DFS score indicates worse caries) | The (weighted) mean caries increment for control groups was | The mean caries increment in the xylitol groups was 0.28 lower (0.42 to 0.14 lower) | PF¹ = 0.13 (0.08 to 0.18) | 4216 | ⊕⊕⊝⊝ | The PF of 0.13 means that there was a 13% reduction in caries in the xylitol group There is no compelling evidence, from other comparisons in this systematic review, to support the use of xylitol products. The body of evidence for all other comparisons and caries outcomes is rated as being low to very low quality. This is because they are single studies with imprecision mostly due to very small sample sizes, and most of which have a high risk of bias |
| Adverse effects | Both studies reported that there were no adverse effects in either the xylitol or control group | |||||
| CI: Confidence interval; DFS: decayed filled surfaces; PF: prevented fraction | ||||||
| GRADE Working Group grades of evidence | ||||||
| ¹ The prevented fraction (PF) is calculated as follows: the mean increment in the controls minus the mean increment in the treated group divided by the mean increment in the controls ² Downgraded due to high risk of bias in the included studies (due to high attrition) and both studies were conducted by the same authors in the same population | ||||||
| Comparison (number) | Increment (Study) | PF (95% CI) | Notes |
| Adults | |||
| Xylitol lozenges versus control lozenges (1.1) | 33‐month caries increment (Bader 2013) | 0.08 (–0.03 to 0.20) | 8% reduction in caries in test group |
| Children | |||
| Xylitol lozenges versus no treatment (2.1) | 4 year caries increment (Lenkkeri 2012)
| ‐0.10 (‐0.59 to 0.39) | 10% increase in caries in test group compared to control |
|
| |||
| Xylitol topical oral syrup versus control syrup (3.1) | Caries in primary teeth over 1 year follow‐up (Milgrom 2009) | 0.58 (0.33 to 0.83) | 58% reduction in caries in test group |
|
| |||
| Xylitol sucking tablets versus no treatment (4.1) | 2 year caries increment (Oscarson 2006) | 0.53 (0.001 to 1.04) | 53% reduction in caries in test group |
|
| |||
| Xylitol plus fluoride toothpaste versus fluoride toothpaste (5.1) | 2.5 to 3 year caries increment (Sintes 1995) | 0.12 (0.06 to 0.18) | 12% reduction in caries in test group |
| 2.5 to 3 year caries increment (Sintes 2002) | 0.14 (0.05 to 0.23) | 14% reduction in caries in test group | |
| CI = confidence interval | |||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Caries increment at 33 months follow‐up (DFS) Show forest plot | 1 | 669 | Mean Difference (IV, Fixed, 95% CI) | ‐0.64 [‐1.58, 0.30] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Caries increment at 4 years follow‐up (DMFS) Show forest plot | 1 | 97 | Mean Difference (IV, Fixed, 95% CI) | 0.28 [‐0.99, 1.55] |
| 2 Number with caries increment at 4 years follow‐up (as opposed to none/no change) Show forest plot | 1 | 97 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.83, 1.26] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of decayed primary teeth at 1 year follow‐up Show forest plot | 1 | 94 | Mean Difference (IV, Fixed, 95% CI) | ‐1.10 [‐2.03, ‐0.18] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Caries increment at 2 years follow‐up (dmfs) Show forest plot | 1 | 118 | Mean Difference (IV, Fixed, 95% CI) | ‐0.42 [‐1.12, 0.28] |
| 2 Number with caries increment at 2 years follow‐up (as opposed to none/no change) Show forest plot | 1 | 118 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.72 [0.35, 1.45] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Caries increment at 2.5 to 3 years follow‐up (Prevented Fraction) Show forest plot | 2 | Prevented Fraction (Fixed, 95% CI) | 0.13 [0.08, 0.18] | |
| 2 Caries increment at 2.5 to 3 years follow‐up (DFS) Show forest plot | 2 | 4216 | Mean Difference (IV, Fixed, 95% CI) | ‐0.28 [‐0.42, ‐0.14] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number with caries increment at 4 years follow‐up (as opposed to none/no change) Show forest plot | 1 | 62 | Risk Ratio (M‐H, Fixed, 95% CI) | 3.08 [0.69, 13.65] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number with caries increment at 1 year follow‐up (as opposed to none/no change) Show forest plot | 1 | 44 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.14 [0.02, 1.07] |
