Effect of professional flossing with NaF or SnF<sub>2</sub>gel on approximal caries in 13-16-year-old schoolchildren

Gisselsson, Hans; Birkhed, Dowen; Emilson, Claes‐Göran

doi:10.1080/000163599429020

Cited by 14 publications

(6 citation statements)

References 8 publications

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“…7 Twenty-five trials were included, conducted between 1964 and 1996 (only five during the 1980s and one in the 1990s). Twelve trials were conducted in the United States, [26][27][28][29][30][31][32][33][34][35][36][37] four in Europe, [38][39][40] four in Brazil, [41][42][43][44] and one in each of the following countries: UK, 45 Canada, 46 Israel, 47 Hawaii, 48 and Venezuela. 49 The study conducted by Marthaler 38 was treated as two independent trials because the results for the two age groups involved were reported separately as distinct studies.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Controlled Trials on the Effectiveness of Fluoride Gels for the Prevention of Dental Caries in Children

Marinho

Higgins²,

Logan³

et al. 2003

Journal of Dental Education

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Fluoride gels have been widely used since the 1970s. The aim of this review was to assess the effectiveness and safety of fluoride gels in the prevention of dental caries in children and to examine factors potentially modifying their effectiveness. Relevant randomized or quasi-randomized trials were identified without language restrictions by searching multiple databases, reference lists of articles, and journals and by contacting selected authors and manufacturers. Trials with blind outcome assessment comparing fluoride gel with placebo or no treatment for at least one year and involving children under seventeen years of age were selected. Inclusion decisions, quality assessment, and data extraction were duplicated in a random sample of one third of studies, and consensus was achieved by discussion or a third party. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses. The main outcome was caries increment measured by the change in decayed, missing, and filled permanent tooth surfaces (D(M)FS). The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increment between the treatment and control groups expressed as a percentage of the mean increment in the control group. Potential adverse effects and unacceptability of treatment were also recorded. Twenty-five studies were included, involving 7,747 children. For the twenty-three that contributed data for meta-analysis, the D(M)FS pooled prevented fraction estimate was 28 percent (95 percent CI, 19 percent to 37 percent; p<0.0001). There was clear heterogeneity, confirmed statistically (p<0.0001). The effect of fluoride gel varied according to type of control group used, with D(M)FS PF on average being 19 percent (95 percent CI, 5 percent to 33 percent; p<0.009) higher in non-placebo controlled trials. Only two trials reported on adverse events. There is clear evidence of a cariesinhibiting effect of fluoride gel. The best estimate of the magnitude of this effect, based on the fourteen placebo-controlled trials, is a 21 percent reduction (95 percent CI, 14 to 28 percent) in D(M)FS. This corresponds to an NNT of two (95 percent CI, 1 to 3) to avoid one D(M)FS in a population with a caries increment of 2.2 D(M)FS/year, or an NNT of twenty-four (95 percent CI, 18 to 36) based on an increment of 0.2 D(M)FS/year. However, further work is needed to identify and quantify potential harmful effects of fluoride gels.Dr.

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Section: Resultsmentioning

confidence: 99%

Systematic Review of Controlled Trials on the Effectiveness of Fluoride Gels for the Prevention of Dental Caries in Children

Marinho

Higgins²,

Logan³

et al. 2003

Journal of Dental Education

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“…Across all KQs, 3 systematic reviews (total of 20 684 participants) of 54 unique trials (53 publications) and 23 additional studies (in 27 publications; total of 15 026 participants) were included (Figure 3). One study assessed diagnostic accuracy of screening; the systematic reviews and other 22 studies (19 randomized clinical trials and 3 nonrandomized trials) addressed preventive interventions.…”

Section: Resultsmentioning

confidence: 99%

“…Only 1 trial was assessed as low risk of bias. 44 Methodological limitations in the other trials included use of a quasirandomized design (7 trials), 21,22,29,[31][32][33]38 unclear randomization or allocation concealment methods (19 trials), open-label design (10 trials), and high attrition (14 trials).…”

Section: Fluoride Gelmentioning

confidence: 99%

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Chou,

Bougatsos,

Griffin

et al. 2023

JAMA

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ImportanceDental caries is common in children and adolescents aged 5 to 17 years and potentially amenable to primary care screening and prevention.ObjectiveTo systematically review the evidence on primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force.Data SourcesMEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.Study SelectionDiagnostic accuracy of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions and systematic reviews of such studies; cohort studies on primary care oral health screening and preventive intervention harms.Data Extraction and SynthesisOne investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Random-effects meta-analysis was performed for fluoride supplements and xylitol; for other preventive interventions, pooled estimates were used from good-quality systematic reviews.Main Outcomes and MeasuresDental caries, morbidity, functional status, quality of life, harms; diagnostic test accuracy.ResultsThree systematic reviews (total 20 684 participants) and 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study (total 15 026 participants) were included. No study compared screening vs no screening. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) (mean difference, −0.73 [95% CI, −1.30 to −0.19]) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 (95% CI, 0.09-0.27) at outcomes closest to 3 years (4 trials; n = 1525), fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 (95% CI, 0.11-0.76) at 1 to 4.5 years (5 trials; n = 3902), and resin-based sealants were associated with decreased risk of carious first molars (odds ratio, 0.21 [95% CI, 0.16-0.28]) at 48 to 54 months (4 trials; n = 440). No trial evaluated primary care counseling or dental referral. Evidence on screening accuracy, silver diamine fluoride, xylitol, and harms was very limited, although serious harms were not reported.Conclusions and RelevanceAdministration of fluoride supplements, fluoride gels, varnish, and sealants in dental or school settings improved caries outcomes. Research is needed on the effectiveness of oral health preventive interventions in primary care settings and to determine the benefits and harms of screening.

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“…NaF gels have previously been found to be able to remineralize demineralized enamel in vitro and in situ [Sawyer and Donly, 2004]. Professional flossing with NaF gel in schoolchildren has also been found to be beneficial when it comes to reducing approximal caries [Gisselson et al, 1999].…”

Section: Discussionmentioning

confidence: 98%

Approximal Fluoride Concentration Using Different Fluoridated Products Alone or in Combination

2007

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The aim of the present investigation was to measure the approximal fluoride (F) concentration after using different F-containing products, either alone or in combination. Ten subjects participated on a total of 17 occasions, which were randomized, distributed and divided into two trials (called trial I and trial II). The F concentration was studied after treatment with toothpicks, dental flosses, an interdental brush dipped in 0.2 or 0.32% F gels, brushing with toothpaste containing 0.32% F and a mouthrinse with 0.2% NaF solution. The results of trial I revealed that the rinsing solution resulted in the highest approximal F values, followed by toothpicks and brushing. When brushing was combined with either flossing or toothpick, the sequence order of the two methods had less influence. However, when combined with rinsing it appeared to be better to use the floss or the toothpicks first, prior to the mouthrinse. In trial II, treatment with the gels alone, and in combination with brushing, resulted in higher approximal F concentrations compared with brushing alone. The data indicate that the order of usage when combining products may be of importance when it comes to obtaining high F levels at the approximal sites and that an interdental brush with F gel after toothbrushing may be a suitable method, called ‘Inter Dental Brush Gel Method’, to produce elevated F concentrations at approximal sites.

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Effect of professional flossing with NaF or SnF₂gel on approximal caries in 13-16-year-old schoolchildren

Cited by 14 publications

References 8 publications

Systematic Review of Controlled Trials on the Effectiveness of Fluoride Gels for the Prevention of Dental Caries in Children

Systematic Review of Controlled Trials on the Effectiveness of Fluoride Gels for the Prevention of Dental Caries in Children

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Approximal Fluoride Concentration Using Different Fluoridated Products Alone or in Combination

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Effect of professional flossing with NaF or SnF2gel on approximal caries in 13-16-year-old schoolchildren

Cited by 14 publications

References 8 publications

Systematic Review of Controlled Trials on the Effectiveness of Fluoride Gels for the Prevention of Dental Caries in Children

Systematic Review of Controlled Trials on the Effectiveness of Fluoride Gels for the Prevention of Dental Caries in Children

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Approximal Fluoride Concentration Using Different Fluoridated Products Alone or in Combination

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Effect of professional flossing with NaF or SnF₂gel on approximal caries in 13-16-year-old schoolchildren