Topical fluorides and decalcification around fixed orthodontic appliances

doi:doi:10.1038/sj.ebd.6400398

Abstract

Data sources

Medline, Embase, Cochrane Library databases and the York Centre for Reviews and Dissemination Database of Abstracts of Reviews of Effectiveness were searched back to their inception. To identify recent nonindexed literature, a search by hand was also made of abstracts of articles published in proceedings of international, British, Australian, New Zealand, continental European, Japanese, Scandinavian and South American divisions of the International Association for Dental Research and of journals publishing orthodontic and fluoride research. Manufacturers of fluoride preparations were contacted to identify relevant unpublished data.

Study selection

Studies were included if they were conducted on human subjects (not extracted teeth) undergoing orthodontic treatment with fixed appliances; if the study design included comparison groups (randomised controlled trials, clinical trials, and prospective observational studies with concurrent or historical comparison groups); if they used topical fluoride; and if they had a valid, clearly described and reproducible outcome measure of decalcification both before and after orthodontic treatment (ie, severity of white spot lesions, decayed or missing teeth and teeth with filled surfaces). Nonhuman, laboratory-based studies not using fixed appliances or topical fluorides were excluded.

Data extraction and synthesis

Studies were considered against predetermined criteria. Initially, titles and abstracts were evaluated by two reviewers, and if there was any doubt the article was retrieved. All excluded titles and abstracts were rechecked by a third examiner. All studies that met the criteria were read by two reviewers to ensure that defined outcome measures were used. Those not meeting the appropriate outcome-measure requirement or lacking a comparison group were excluded. Included studies were double-extracted onto data extraction sheets. Disagreements were resolved by the third team member. Effect modifiers were identified, eg, level of water fluoridation, caries status, oral hygiene and age, and recorded if reported. From the data presented in the studies it was not possible to calculate the confidence intervals of the mean difference between groups so the results were described qualitatively. A preventive fraction (PF), ie, the difference in caries increments between treatment and control groups expressed as a proportion of the increment in the control group, was calculated. Note that these must be viewed with extreme caution because they have no confidence intervals.

Results

Searches identified 503 titles and abstracts: 143 relevant articles were retrieved of which 45 were excluded because of study design, 76 because they did not meet the inclusion criteria, and nine because they did not contain data for decalcification at baseline. This left 13 articles of which only six could be included because of missing data. As these studies used different methodologies and reporting strategies, it was not possible to undertake a meta-analysis, so a qualitative analysis was carried out.

Conclusions

The use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and nonfluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any one method was superior. There was some evidence that the potency of fluoride preparations might be important.

Summary Trial/Orthodontics