Review supports effectiveness of fluoride toothpastes in reducing caries in pre-school children

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Despite improvements dental caries remains a significant oral health problem. In some areas increases in caries prevalence has been reported in pre-school children in contracts with other age group. The resultant pain, sepsis and the need for extraction have significant impact on quality of life.  Cochrane and other systematic reviews have shown that use of standard fluoride toothpastes (1000–1500 ppm) reduces the incidence of dental caries between 24–29% in children’s permanent teeth.  The aim of this review was to assess the effect of fluoride toothpastes on the prevention of caries in the primary dentition of preschool children.

The Cochrane Central Register of Controlled Trials, Medline, Web of Science, Embase, LILACS and BBO databases were searched together with a Brazilian database of thesis and dissertations (Banco de Teses CAPES), a Brazilian register approved projects involving human beings (SISNEP), two registers of ongoing trials (Current Controlled Trials and Clinical-Trials.gov) and hand searches of a number of dental journals. Study selection and data extraction was conducted independently by two authors with risk of bias being assessed using the Cochrane collaboration tool.  Individual or cluster randomized or quasi-randomized clinical trials with a minimum follow up period of 1 year were included. meta-analyses of the prevented fractions (PF) were performed.

Eight studies were included in the review

dmfs increment meta-analysis

  • 2 studies comparing low F toothpastes and no intervention yielded a pooled PF of 40% (95% CI 5–75),
  • 5 studies comparing standard F toothpastes and placebo or no intervention yielded a pooled PF of 31% (95% CI 18–43).

dmft increment meta-analysis

  • 2 studies comparing low F toothpastes and no intervention yielded a pooled PF of 24% (95% CI -17 to 66).
  • 1 study compared standard F toothpaste and no intervention reported caries incidence by means of the dmft index, the PF was 16% (95% CI 8–25).

NNT (numbers needed to treat)for a beneficial outcome were

  • 11 (95% CI 7–20), for high caries incidence (70%),
  • 15 (95% CI 10–28) medium caries (50%)
  • 37 (95% CI 26–59) for low caries (20%) incidence

The authors concluded that

Standard fluoride toothpastes are effective in reducing dental caries in the primary teeth of preschool children and thus their use should be recommended to this age group.

Comment

The 2003 Cochrane review by Marinho et al  brought together 74 studies on fluoride toothpaste involving over 40,000 children. However ,the only studies involving children 5-16 years of age were included so it good to see that this review which focuses on  studies with outcomes up to the age of 7 was able to include some new studies involving younger children.

Links

Santos APP, Nadanovsky P, Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of pre-school children. Community Dent Oral Epidemiol 2012. © 2012 John Wiley & Sons A/S

Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VCC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007868. DOI: 10.1002/14651858.CD007868.pub2

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278.

Twetman S, Axelsson S, Dahlgren H, Holm AK, Källestål C, Lagerlöf F, Lingström P, Mejàre I, Nordenram G, Norlund A, Petersson LG, Söder B. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand. 2003 Dec;61(6):347-55. Review. PubMed PMID: 14960006.

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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