Slow-release fluoride devices for the control of dental decay
ABSTRACT Slow-release fluoride devices have been investigated as a potentially cost-effective method of reducing dental caries in those with high risk of disease.
To evaluate the effectiveness of different types of slow-release fluoride devices on preventing, arresting, or reversing the progression of carious lesions on all surface types of deciduous and permanent teeth.
We searched (up until February 2005) multiple electronic databases (Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE), bibliographic references of identified randomised controlled trials (RCTs), textbooks, review articles, and meta-analyses. Letters were sent to authors of identified RCTs asking for clarifications and unpublished or ongoing research. Relevant journals were handsearched for more recent reports than those obtained from databases.
Randomised or quasi-randomised controlled trials (RCTs) comparing slow-release fluoride devices with an alternative fluoride treatment, placebo, or no intervention in all age groups. The main outcomes measures sought were changes in numbers of decayed, missing, and filled teeth or surfaces (DMFT/DMFS in permanent teeth or dmft/dmfs in primary teeth) and progression of carious lesions through enamel and into dentine.
Abstracts of all reports identified were considered independently by two review authors and full reports obtained of any potentially relevant articles to allow further assessment for relevance and validity. Data extraction and quality assessment were conducted independently by two and three review authors respectively, with arbitration by the fourth. Where uncertainty existed, authors were contacted for additional information.
Only one trial involving 174 children fully met the criteria for inclusion in this review. Although 132 children were still included in the trial at the 2-year completion point, examination and statistical analysis was performed on only the 63 children who had retained the beads. Thirty-one of these were in the intervention group and 32 in the control group. Amongst these 63 children, caries increment was reported to be statistically significantly lower in the intervention group than in the placebo group (mean difference: -0.72 DMFT, 95% confidence interval -1.23 to -0.21 and -1.52 DMFS, 95% confidence interval -2.68 to -0.36)
There is some evidence of a caries-inhibiting effect of slow-release fluoride glass beads. This evidence is regarded as weak and unreliable because the results were from participants selected on the basis of bead retention rather than an intention-to-treat analysis.
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ABSTRACT: To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.PLoS ONE 01/2015; 10(2):e0117537. DOI:10.1371/journal.pone.0117537 · 3.53 Impact Factor
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ABSTRACT: Split-mouth randomized controlled trials (RCTs) are popular in oral health research. Meta-analyses frequently include trials of both split-mouth and parallel-arm designs to derive combined intervention effects. However, carry-over effects may induce bias in split- mouth RCTs. We aimed to assess whether intervention effect estimates differ between split- mouth and parallel-arm RCTs investigating the same questions.BMC Medical Research Methodology 05/2014; 14(1):64. DOI:10.1186/1471-2288-14-64 · 2.17 Impact Factor
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ABSTRACT: To ensure evidence-based decision-making in pediatric oral health, Cochrane systematic reviews that address topics pertinent to this field are necessary. We aimed to identify all systematic reviews of paediatric dentistry and oral health by the Cochrane Oral Health Group (COHG), summarize their characteristics and assess their methodological quality. Our second objective was to assess implications for practice in the review conclusions and provide an overview of clinical implications about the usefulness of paediatric oral health interventions in practice. We conducted a methodological survey including all paediatric dentistry reviews from the COHG. We extracted data on characteristics of included reviews, then assessed the methodological quality using a validated 11-item quality assessment tool (AMSTAR). Finally, we coded each review to indicate whether its authors concluded that an intervention should be implemented in practice, was not supported or was refuted by the evidence, or should be used only in research (inconclusive evidence). We selected 37 reviews; most concerned the prevention of caries. The methodological quality was high, except for the assessment of reporting bias. In 7 reviews (19%), the research showed that benefits outweighed harms; in 1, the experimental intervention was found ineffective; and in 29 (78%), evidence was insufficient to assess benefits and harms. In the 7 reviews, topical fluoride treatments (with toothpaste, gel or varnish) were found effective for permanent and deciduous teeth in children and adolescents, and sealants for occlusal tooth surfaces of permanent molars. Cochrane reviews of paediatric dentistry were of high quality. They provided strong evidence that topical fluoride treatments and sealants are effective for children and adolescents and thus should be implemented in practice. However, a substantial number of reviews yielded inconclusive evidence.BMC Oral Health 04/2014; 14(1):35. DOI:10.1186/1472-6831-14-35 · 1.15 Impact Factor