Professionally Applied Topical Fluoride and Restorative Care in Insured Children

Eklund, Stephen A.; Pittman, James L.; Heller, Keith E.

doi:10.1111/j.1752-7325.2000.tb03289.x

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…Many dentists are not following these recommendations. A study of more than 15 000 insured children in Michigan showed that two-thirds were receiving fluoride treatments at every recall visit, by dentists who provide this service at least 98% of the time with each recall examination, without selectivity 5 . Against this backdrop of use, change in disease prevalence, potential adverse effects, and the availability of other caries preventive modalities, sev- So, should fluoride gel be used, and if so, how?…”

Section: Commentarymentioning

confidence: 99%

Fluoride gel applications reduce caries incidence

Weintraub

2002

Evid Based Dent

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Question: Do fluoride gels reduce dental caries?Objective: To determine the effectiveness and safety of fluoride gels in the prevention of dental caries in children and to determine the relationship to initial caries severity, background exposure to fluoride, and the mode and frequency of gel use.Data Sources: The purpose was to identify all relevant studies from 1965. Electronic searching of the MEDLINE, EMBASE, SCISEARCH, SSCISEARCH, ISTP, BIOSIS, CINAHL, ERIC, Dissertation Abstracts, LILACS/BBO databases and of the Cochrane Controlled Trial and Medline registers has been attempted. Furthermore, all eligible trials, meta-analyses and review articles were scanned for relevant references. In addition 7 journals were hand searched and personal contact with authors and manufacturers was achieved while searching for unpublished data.Study Selection: Exclusively RCTs and quasi-RCTs with blind outcome assessments, comparing groups applying fluoride gel with placebo or no treatment groups consisted of children up to 16 years old at baseline were included in this review. Studies were excluded where the participants were selected on the basis of special health conditions, were carrying orthodontic bands (or other appliances), and/or used additional caries preventive agents (eg chlorhexidine or sealants etc.), as well as studies that provided results only on plaque/ gingivitis, calculus, dentin hypersensitivity or physiological fluoride. Data Extraction and Synthesis:The first reviewer assessed the quality of all included studies. The second reviewer duplicated the process for a random sample of 1/3 of them. In addition, the 2nd reviewer independently assessed any study that could not be classified by the first. A third reviewer was consulted to resolve any disagreement. Attempts were made to contact authors of trials that could not be classified in order to ascertain whether the inclusion criteria were met. Agreement was good for allocation (kappa=0.61) and blinding (kappa=0.73). There was a considerable difference in the quality of the 25 studies in this review. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses.Results: Twenty-five studies were included, involving 7747 children. For all the 23 trials, that contributed data for meta-analyses, combined the DMFS pooled prevented fraction estimate was 0.28, suggesting a substantial benefit from the use of fluoride gel. Statistically significant heterogeneity was observed (p50.0001). Univariate meta regression analysis suggested no significant association between estimates of DMFS prevented fractions and length of followup, allocation concealment, blinding of outcome assessment or drop out rate. Populations with a caries incidence of 2.2 DMFS/year had an NNT=2 (95% CI=1 to 3). For populations with a caries incidence of 0.2 DMFS/yr had an NNT=24 (95% CI=18 to 36). A funnel plot suggests a balancing asymmetry with a single large study demonstrating the largest pos...

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Section: Commentarymentioning

confidence: 99%

Fluoride gel applications reduce caries incidence

Weintraub

2002

Evid Based Dent

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“…Indirect evidence from dental claims data suggest that practicing dentists may not employ caries risk assessment strategies in their practices (13,141 the growing number of recommendations to adopt this approach to caries management (15)(16)(17) may be due in part to the data requirements of the computational systems, which may represent barriers to their use by practicing dentists (18,19), or by the "vagueness" of the suggestions for implementation in the original journal supplement (20). However, a small pilot study of dentists' adoption of caries and periodontal risk assessment procedures indicated that following a brief introduction to the concepts of risk assessment presented in the journal supplement, dentists were able to assign their patients to risk categories (21).…”

Section: Introductionmentioning

confidence: 99%

Validation of a Simple Approach to Caries Risk Assessment

Bader¹,

Perrin

Maupomé

et al. 2005

J Public Health Dent

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“…Only minimal data are available regarding the application of preventive interventions by dentists, based on risk level. Despite numerous recommendations for use only in moderate‐ and high‐caries children, Eklund et al (7) reported that Michigan dentists did not apply topical fluoride based on risk. Our investigation of performance measurements in dental health maintenance organizations revealed that 13–18% of high‐caries‐risk adults received fluoride treatment at least once per year (8).…”

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confidence: 99%