Non-Cochrane · intervention · PM26831727
Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic review.
Gao Sherry Shiqian, Zhang Shinan, Mei May Lei, et al. · BMC oral health · 2016 · PubMed · doi:10.1186/s12903-016-0171-6
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
15
current version
GRADE rated
0
No studies
0
Included studies
17
linked below
No studies 0 · 0%Ungraded 15 · 100%Very low 0 · 0%Low 0 · 0%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 | Children with dental caries (early enamel caries/white spot lesions or dentine caries) | Children with early enamel caries or dentine caries (17 RCTs; 10 remineralisation, 7 arresting) |
| Intervention | Professionally applied topical fluoride therapy | Professionally applied fluorides: 5% NaF varnish, 6% NaF + 6% CaF2, NaF gel, 1.23% APF gel, 0.9% silicon tetrafluoride, silver diamine fluoride (10%, 12%, 30%, 38%), nano-silver fluoride |
| Comparison | Not specified | Mostly single-arm/baseline; some versus no treatment or versus glass ionomer and tooth-brushing |
| Outcomes | Remineralisation of early enamel caries; arresting of dentine caries | Proportion of remineralised early enamel caries; proportion of arrested dentine caries; lesion dimensional change |
| Study designs | Clinical trials in children | 17 randomised clinical trials |
| Timing | Not specified | Follow-up varied; SDF applied one-off, every 6 months, or annually (up to 36 months) |
Search date: Publications from 1948 to 2014 (search date not reported). Databases: PubMed; Cochrane Library; ISI Web of Science; Embase
Questions and results
Professionally applied 5% sodium fluoride (NaF) varnish vs Untreated lesions (single-arm before vs after proportion)
Population: Children with early enamel caries or white spot lesions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralisation of early enamel caries (proportion of lesions remineralised) Professionally applied 5% sodium fluoride varnish remineralised about two-thirds of early enamel caries lesions in children (pooled proportion 63.6%, 95% CI 36.0% to 91.2%; 4 studies); certainty was not GRADE-rated and heterogeneity was very high (I2=96%). Source: Abstract; Results (Group 1); Fig. 2 · same question in other reviews | Proportion 0.636 [0.360, 0.912] | 4 studies | Ungraded |
Dimensional change (size) of early enamel caries lesions Population: Children with white spot lesions / early enamel caries In one trial, professionally applied sodium fluoride varnish significantly reduced the size of early enamel caries lesions compared with no fluoride treatment; ungraded. Source: Results (Group 1); Discussion; ref [28] · same question in other reviews | One clinical trial (Du 2012) evaluating dimensional change reported that the average size of early enamel caries in children receiving professional NaF therapy was significantly smaller than in those with no fluoride… | 1 study | Ungraded |
6% sodium fluoride with 6% calcium fluoride varnish vs No treatment
Population: Children with early enamel caries (permanent dentition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reversal / remineralisation of early enamel caries One trial found 6% sodium fluoride plus 6% calcium fluoride varnish significantly reversed early enamel caries versus no treatment; ungraded and not meta-analysed. Source: Results (Group 1); Discussion; ref [25] · same question in other reviews | One study (Xhemnica 2008) reported a significant reversal of early enamel caries using 6% NaF with 6% calcium fluoride compared with no treatment; this study was excluded from the meta-analysis. | 1 study | Ungraded |
0.9% silicon tetrafluoride (SiF4) vs Not specified
Population: Children with white spot lesions / early enamel caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralisation of white spot lesions One trial found professionally applied silicon tetrafluoride did not remineralise white spot lesions; ungraded. Source: Results (Group 1); Discussion; ref [19] · same question in other reviews | One study found that silicon tetrafluoride could not remineralise white spot lesions. | 1 study | Ungraded |
Sodium fluoride (NaF) gel vs Not specified
Population: Children with early (incipient) enamel caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralisation of early enamel caries One trial found sodium fluoride gel significantly remineralised early enamel caries; ungraded. Source: Results (Group 1); Discussion; ref [20] · same question in other reviews | One study using sodium fluoride gel showed a significant remineralising effect on early enamel caries. | 1 study | Ungraded |
1.23% acidulated phosphate fluoride (APF) gel vs Not specified
Population: Children with incipient (early) enamel caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralisation of early enamel caries One trial found acidulated phosphate fluoride gel did not remineralise early enamel caries; ungraded. Source: Results (Group 1); Discussion; ref [21] · same question in other reviews | One double-blind randomised trial found acidulated phosphate fluoride gel was not effective to remineralise early enamel caries. | 1 study | Ungraded |
10% silver diamine fluoride (SDF) vs Glass ionomer restoration and tooth-brushing
Population: Children with early enamel caries in erupting permanent first molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralisation of early enamel caries One pilot study found 10% silver diamine fluoride worked about as well as glass ionomer restoration and tooth-brushing for remineralising early enamel caries; ungraded. Source: Results (Group 1); Discussion; ref [22] · same question in other reviews | A pilot study found 10% silver diamine fluoride therapy, glass ionomer restoration, and tooth-brushing had a similar effect in remineralising early enamel caries. | 1 study | Ungraded |
Professionally applied 38% silver diamine fluoride (SDF) vs Active dentine caries at baseline (single-arm before vs after proportion)
Population: Children with active dentine caries (primary and permanent teeth)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Arrest of dentine caries (proportion of surfaces arrested) Professionally applied 38% silver diamine fluoride arrested about two-thirds of active dentine caries surfaces in children (pooled proportion 65.9%, 95% CI 41.2% to 90.7%; 5 studies); certainty was not GRADE-rated and heterogeneity was very high (I2=96%). Source: Abstract; Results (Group 2); Fig. 3 · same question in other reviews | Proportion 0.659 [0.412, 0.907] | 5 studies | Ungraded |
30% silver diamine fluoride (SDF) vs Not specified
Population: Children with active dentine caries in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Arrest of dentine caries One study reported 30% silver diamine fluoride effectively arrested dentine caries in primary teeth; ungraded. Source: Results (Group 2); Discussion; ref [16] · same question in other reviews | 30% SDF was reported as an effective intervention to arrest dentine caries on primary teeth. | 1 study | Ungraded |
12% silver diamine fluoride (SDF), single (one-off) application vs Not specified
Population: Children with active dentine caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Arrest of dentine caries One trial found a single application of 12% silver diamine fluoride did not arrest dentine caries; ungraded. Source: Results (Group 2); Discussion; ref [15] · same question in other reviews | A one-off application of 12% SDF was found ineffective to arrest caries (Yee 2009). | 1 study | Ungraded |
Nano-silver fluoride vs Not specified
Population: Children with active dentine caries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Arrest of dentine caries One randomised trial found nano-silver fluoride arrested dentine caries without the black staining seen with silver diamine fluoride; ungraded. Source: Results (Group 2); Discussion; ref [17] · same question in other reviews | A randomised trial using nano-silver fluoride found it was effective to arrest dentine caries without causing dark staining. | 1 study | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remineralisation of early enamel caries NaF varnish plus chlorhexidine or calcium fluoride vs NaF varnish alone (no significant added benefit) | no estimate extracted | 3 studies | Ungraded |
Arrest of dentine caries 38% SDF twice-yearly vs annual application (higher arrest with twice-yearly) | no estimate extracted | 1 study | Ungraded |
Arrest of dentine caries 38% SDF vs 5% NaF varnish (SDF superior) | no estimate extracted | 2 studies | Ungraded |
Arrest of dentine caries SDF vs glass ionomer restoration (SDF superior) | no estimate extracted | 2 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Partial Yes | Partial Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 17
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Zhi et al. 2012 Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. PMID:22892463 | 3 other reviews | Reversal / remineralisation of early enamel caries; Arrest of dentine caries (proportion of surfaces arrested) | not extracted yet | not extracted yet |
| dos Santos et al. 2014 A new "silver-bullet" to treat caries in children--nano silver fluoride: a randomised clinical trial. PMID:24930870 | 2 other reviews | Arrest of dentine caries | not extracted yet | not extracted yet |
| Llodra et al. 2005 Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical… PMID:16040729 | 2 other reviews | Reversal / remineralisation of early enamel caries; Arrest of dentine caries (proportion of surfaces arrested) | not extracted yet | not extracted yet |
| Braga et al. 2009 Effect of silver diammine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. PMID:19341576 | 1 other review | Remineralisation of early enamel caries | not extracted yet | not extracted yet |
| Chu et al. 2002 Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. PMID:12407092 | 1 other review | Reversal / remineralisation of early enamel caries; Arrest of dentine caries (proportion of surfaces arrested) | not extracted yet | not extracted yet |
| dos Santos et al. 2012 Paradigm shift in the effective treatment of caries in schoolchildren at risk. PMID:22251037 | 1 other review | Arrest of dentine caries | not extracted yet | not extracted yet |
| Almeida et al. 2011 Therapeutic potential of Brazilian fluoride varnishes: an in vivo study. PMID:21915515 | this review only | Remineralisation of early enamel caries (proportion of lesions remineralised) | not extracted yet | not extracted yet |
| Autio-Gold and Courts 2001 Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition. PMID:11665349 | this review only | Remineralisation of early enamel caries (proportion of lesions remineralised) | not extracted yet | not extracted yet |
| Bonow et al. 2013 Efficacy of 1.23% APF gel applications on incipient carious lesions: a double-blind randomized clinical trial. PMID:23739785 | this review only | Remineralisation of early enamel caries | not extracted yet | not extracted yet |
| De Amorim et al. 2008 Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition. PMID:18489576 | this review only | Remineralisation of early enamel caries (proportion of lesions remineralised) | not extracted yet | not extracted yet |
| Du et al. 2012 Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. PMID:21331637 | this review only | Dimensional change (size) of early enamel caries lesions | not extracted yet | not extracted yet |
| Ferreira et al. 2009 Therapeutic effect of two fluoride varnishes on white spot lesions: a randomized clinical trial. PMID:20027453 | this review only | Remineralisation of early enamel caries (proportion of lesions remineralised) | not extracted yet | not extracted yet |
| Kukleva 2002 Treatment of incipient caries in children with fluoride gel. PMID:12422628 | this review only | Remineralisation of early enamel caries | not extracted yet | not extracted yet |
| Lo et al. 2001 A community-based caries control program for pre-school children using topical fluorides: 18-month results. PMID:11808764 | this review only | Reversal / remineralisation of early enamel caries; Arrest of dentine caries (proportion of surfaces arrested) | not extracted yet | not extracted yet |
| Tranæus et al. 2001 Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children. A comparative study of… PMID:11347658 | this review only | Remineralisation of white spot lesions | not extracted yet | not extracted yet |
| Xhemnica et al. 2008 Fluoride varnish application: a new prophylactic method in Albania. Effect on enamel carious lesions in permanent dentition. PMID:18605892 | this review only | Reversal / remineralisation of early enamel caries | not extracted yet | not extracted yet |
| Yee et al. 2009 Efficacy of silver diamine fluoride for Arresting Caries Treatment. PMID:19641152 | this review only | Reversal / remineralisation of early enamel caries; Arrest of dentine caries (proportion of surfaces arrested) | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).