Cochrane · intervention · CD003809

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment

Benson, PE, Parkin, N, Dyer, F, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library

Oral Health Dental caries Orthodontics4 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 10 · 38.5%Ungraded 0 · 0%Very low 8 · 30.8%Low 8 · 30.8%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Participants of any age who had orthodontic treatment with fixed braces in situations where DLs were assessed on teeth remaining in the mouth at the end of orthodontic treatment (at debonding, immediately after the active fixed brace is removed). We excluded studies that evaluated demineralisation of extracted teeth (ex vivo) or that were undertaken over short periods of time i.e. less than the whole time the fixed brace was in the mouth.	Seven of the included studies were conducted in Europe, involving Sweden, the UK, the UK and Republic of Ireland, and the Netherlands. One study was undertaken in Germany and Israel and two in China. Participant age ranged from 10 years at the start of treatment to 60 years. All participants in the included trials were recruited at the start of their orthodontic treatment with fixed appliances and were followed until their fixed appliances were removed.
Intervention	Topical fluoride in the form of toothpaste, mouthrinse, gel, varnish, foam or dietary sources at any dose, frequency, duration or method of administration, and with any of the following active agents/ingredients: NaF (sodium fluoride), SMFP (sodium monofluorophosphate), SnF (stannous fluoride), APF (acidulated phosphate fluoride) and amine F (amine fluoride) applied either by a professional in the dental surgery or office, or used by the patient at home. Materials containing fluoride that is potentially released during treatment, including fluoride‐releasing composite resin‐bonding materials, compomers, glass ionomer cements and resin‐modified glass ionomers for bonding or banding, slow‐release fluoride beads/devices and fluoride‐releasing elastomeric ligatures.	Fluoride varnish (n=3); Fluoride foam (n=1); Fluoride gel (n=1); Fluoride toothpaste (n=1); Fluoride mouthrinse (n=1); Fluoride toothpaste/mouthrinse combinations (n=2); Fluoride‐releasing materials (n=2)
Comparison	Placebo/No intervention/Alternative fluoride intervention	Placebo varnish (n=2); Placebo foam (n=1); Placebo gel (n=1); Standard fluoride toothpaste (n=1); Placebo mouthrinse (n=1); Sodium fluoride toothpaste/mouthrinse combination (n=1); Light‐cured composite resin (n=1); Fluoride mouthrinse (n=1)
Outcomes	The primary outcome was the difference in the proportion of participants in the experimental and comparison groups with new DLs on the day the fixed appliance was removed. This could be assessed directly from the participant (clinically) or preferably from start and finish photographs or fluorescent images of the teeth immediately after the active fixed brace was removed. Secondary outcomes: Differences in the severity of the new DLs, as assessed by number, size and colour between experimental and control groups at the end of orthodontic treatment. Any quantitative assessment of enamel mineral loss, such as fluorescent light techniques or microradiography, used with in situ caries models at the end of treatment. Any participant‐assessed outcomes, such as perception of DLs and oral health‐related quality of life data. Adverse effects.	Number of participants with new DLs (n=7); Number of participants with more severe DLs (n=2); White spot index (n=1); Visible plaque index (n=1); Gingival bleeding index (n=1); Number of participants with adverse effects (n=1)
Study designs	Randomised controlled trials (RCTs) in which fluoride was delivered by any method to prevent the development of new enamel demineralised lesions (DLs) during fixed orthodontic treatment. As topical fluorides are distributed throughout the mouth by saliva, the use of a within‐person or split‐mouth study design to evaluate these interventions is inappropriate, due to potential carry‐across effects and any study using this design was excluded. Studies involving multiple arms would be examined and only comparisons between two fluoride interventions or fluoride versus no fluoride interventions would be included in the pairwise analysis.	NR
Timing	Not reported	Not reported

Search date: 1 February 2019. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid