Do additional high-fluoride interventions among low caries prevalence orthodontic cases using fixed appliances reduce caries incidence?

Abstract

Design Three-arm randomised controlled trial (RCT). Three groups were contrasted: group one used only a 1,450 ppm fluoride toothpaste as an adjunctive caries prevention method. Group two used only 5,000 ppm fluoride toothpaste as an adjunctive caries prevention method. Group three was similar to group one but with the addition of a fluoride mouth rinse (0.2% sodium fluoride). The Decayed Initial Filled Surfaces (DIFS) index based on progress radiographs was used as the primary outcome variable.

Case selection Prospective orthodontic patients with a low caries prevalence are willing to participate in the RCT.

Data analysis Non-parametric statistical tests were used to compare the changes in DIFS between the groups. A Cochrane-Mantel-Haenszel method was applied to control for differences in baseline values during relative risk calculations.

Results All groups had an increase in DIFS during treatment (between 36% and 48% of the participants). Caries incidence was not significantly affected in either treatment group when considering two cut-off values for DIFS (one and two points). The same applied to the use of decayed filled teeth as the outcome variable.

Conclusions This clinical trial assessed the potential impact of supplementary, high-fluoride interventions on caries incidence during orthodontic treatment with fixed appliances. Included cases had a low caries history. Adjunctive, fluoride-based interventions had no bearing on the incidence of caries as measured through the DIFS index.