Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis
Autor: | Cynthia K.Y. Yiu, Pei Liu, Kar Yan Li, Edward C. M. Lo, Gillian Hm Lee, Divesh Sardana, Sheetal Manchanda |
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Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
business.industry Dental Caries Susceptibility Network Meta-Analysis Psychological intervention Bias assessment Dental Caries medicine.disease Cariostatic Agents Topical fluoride Fluorides Data extraction Internal medicine Meta-analysis Child Preschool medicine Humans Clinical significance Fluorides Topical business Child General Dentistry Evidence-based dentistry Early childhood caries |
Zdroj: | Journal of dentistry. 116 |
ISSN: | 1879-176X |
Popis: | Objectives : To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis. Data : Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years. Sources : Eight electronic databases and grey literature. Study selection : After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as “high risk” and remaining as “low risk”. Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application. Conclusion : Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies. Clinical significance : The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up. |
Databáze: | OpenAIRE |
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