-
The Cochrane Database of Systematic... Jun 2024This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in young children could potentially lead to dental fluorosis in permanent teeth.
OBJECTIVES
To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis in permanent teeth.
SEARCH METHODS
We carried out electronic searches of the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two trials registers. We searched the reference lists of relevant articles. The latest search date was 28 July 2022.
SELECTION CRITERIA
We included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys comparing fluoride toothpaste, mouth rinses, gels, foams, paint-on solutions, and varnishes to a different fluoride therapy, placebo, or no intervention. Upon the introduction of topical fluorides, the target population was children under six years of age.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane and used GRADE to assess the certainty of the evidence. The primary outcome measure was the percentage prevalence of fluorosis in the permanent teeth. Two authors extracted data from all included studies. In cases where both adjusted and unadjusted risk ratios or odds ratios were reported, we used the adjusted value in the meta-analysis.
MAIN RESULTS
We included 43 studies: three RCTs, four cohort studies, 10 case-control studies, and 26 cross-sectional surveys. We judged all three RCTs, one cohort study, one case-control study, and six cross-sectional studies to have some concerns for risk of bias. We judged all other observational studies to be at high risk of bias. We grouped the studies into five comparisons. Comparison 1. Age at which children started toothbrushing with fluoride toothpaste Two cohort studies (260 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing at or before 12 months versus after 12 months and the development of fluorosis (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.81 to 1.18; very low-certainty evidence). Similarly, evidence from one cohort study (3939 children) and two cross-sectional studies (1484 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing before or after the age of 24 months (RR 0.83, 95% CI 0.61 to 1.13; very low-certainty evidence) or before or after four years (odds ratio (OR) 1.60, 95% CI 0.77 to 3.35; very low-certainty evidence), respectively. Comparison 2. Frequency of toothbrushing with fluoride toothpaste Two case-control studies (258 children) provided very uncertain evidence regarding the association between children brushing less than twice per day versus twice or more per day and the development of fluorosis (OR 1.63, 95% CI 0.81 to 3.28; very low-certainty evidence). Two cross-sectional surveys (1693 children) demonstrated that brushing less than once per day versus once or more per day may be associated with a decrease in the development of fluorosis in children (OR 0.62, 95% CI 0.53 to 0.74; low-certainty evidence). Comparison 3. Amount of fluoride toothpaste used for toothbrushing Two case-control studies (258 children) provided very uncertain evidence regarding the association between children using less than half a brush of toothpaste, versus half or more of the brush, and the development of fluorosis (OR 0.77, 95% CI 0.41 to 1.46; very low-certainty evidence). The evidence from cross-sectional surveys was also very uncertain (OR 0.92, 95% CI 0.66 to 1.28; 3 studies, 2037 children; very low-certainty evidence). Comparison 4. Fluoride concentration in toothpaste There was evidence from two RCTs (1968 children) that lower fluoride concentration in the toothpaste used by children under six years of age likely reduces the risk of developing fluorosis: 550 parts per million (ppm) fluoride versus 1000 ppm (RR 0.75, 95% CI 0.57 to 0.99; moderate-certainty evidence); 440 ppm fluoride versus 1450 ppm (RR 0.72, 95% CI 0.58 to 0.89; moderate-certainty evidence). The age at which the toothbrushing commenced was 24 months and 12 months, respectively. Two case-control studies (258 children) provided very uncertain evidence regarding the association between fluoride concentrations under 1000 ppm, versus concentrations of 1000 ppm or above, and the development of fluorosis (OR 0.89, 95% CI 0.52 to 1.52; very low-certainty evidence). Comparison 5. Age at which topical fluoride varnish was applied There was evidence from one RCT (123 children) that there may be little to no difference between a fluoride varnish application before four years, versus no application, and the development of fluorosis (RR 0.77, 95% CI 0.45 to 1.31; low-certainty evidence). There was low-certainty evidence from two cross-sectional surveys (982 children) that the application of topical fluoride varnish before four years of age may be associated with the development of fluorosis in children (OR 2.18, 95% CI 1.46 to 3.25).
AUTHORS' CONCLUSIONS
Most evidence identified mild fluorosis as a potential adverse outcome of using topical fluoride at an early age. There is low- to very low-certainty and inconclusive evidence on the risk of having fluorosis in permanent teeth for: when a child starts receiving topical fluoride varnish application; toothbrushing with fluoride toothpaste; the amount of toothpaste used by the child; and the frequency of toothbrushing. Moderate-certainty evidence from RCTs showed that children who brushed with 1000 ppm or more fluoride toothpaste from one to two years of age until five to six years of age probably had an increased chance of developing dental fluorosis in permanent teeth. It is unethical to propose new RCTs to assess the development of dental fluorosis. However, future RCTs focusing on dental caries prevention could record children's exposure to topical fluoride sources in early life and evaluate the dental fluorosis in their permanent teeth as a long-term outcome. In the absence of these studies and methods, further research in this area will come from observational studies. Attention needs to be given to the choice of study design, bearing in mind that prospective controlled studies will be less susceptible to bias than retrospective and uncontrolled studies.
Topics: Fluorosis, Dental; Humans; Randomized Controlled Trials as Topic; Child, Preschool; Fluorides, Topical; Child; Toothpastes; Bias; Case-Control Studies; Cariostatic Agents; Cohort Studies; Cross-Sectional Studies; Fluorides
PubMed: 38899538
DOI: 10.1002/14651858.CD007693.pub3 -
BMC Oral Health Jun 2024Biosurfactants are amphiphilic compounds produced by various microorganisms. Current research evaluates diverse types of biosurfactants against a range of oral pathogens.
BACKGROUND
Biosurfactants are amphiphilic compounds produced by various microorganisms. Current research evaluates diverse types of biosurfactants against a range of oral pathogens.
OBJECTIVES
This systematic review aims to explore the potential of microbial-derived biosurfactants for oral applications.
METHODOLOGY
A systematic literature search was performed utilizing PubMed-MEDLINE, Scopus, and Web of Science databases with designated keywords. The results were registered in the PROSPERO database and conducted following the PRISMA checklist. Criteria for eligibility, guided by the PICOS framework, were established for both inclusion and exclusion criteria. The QUIN tool was used to assess the bias risk for in vitro dentistry studies.
RESULTS
Among the initial 357 findings, ten studies were selected for further analysis. The outcomes of this systematic review reveal that both crude and purified forms of biosurfactants exhibit antimicrobial and antibiofilm properties against various oral pathogens. Noteworthy applications of biosurfactants in oral products include mouthwash, toothpaste, and implant coating.
CONCLUSION
Biosurfactants have garnered considerable interest and demonstrated their potential for application in oral health. This is attributed to their surface-active properties, antiadhesive activity, biodegradability, and antimicrobial effectiveness against a variety of oral microorganisms, including bacteria and fungi.
Topics: Surface-Active Agents; Humans; Anti-Infective Agents; Biofilms; Mouth; Mouthwashes; Toothpastes
PubMed: 38898470
DOI: 10.1186/s12903-024-04479-0 -
Dentistry Journal Mar 2024The objective was to systematically review studies that evaluated the effect of charcoal-based dentifrices (CbDs) and conventional whitening toothpastes (CWTs) on the... (Review)
Review
The Effect of Charcoal-Based Dentifrice and Conventional Whitening Toothpaste on the Color Stability and Surface Roughness of Composite Resin: A Systematic Review of In Vitro Studies.
The objective was to systematically review studies that evaluated the effect of charcoal-based dentifrices (CbDs) and conventional whitening toothpastes (CWTs) on the color stability (CS) and/or surface roughness (SR) of composite resin (CR). The question we focused on was "Do CbD and CWT affect the CS and/or SR of CR?" Indexed databases were searched without language and time restrictions up to and including May 2023 using different keywords. Original experimental studies were included. The risk of bias (RoB) was assessed using the Quality Assessment Tool for In Vitro Studies. Ten in vitro studies performed on CR were included. The number of CR samples assessed ranged between 18 and 200. In one study, CbDs altered the CS and SR of CR, whereas another study showed no difference in changes in the SR and CS of CR when CbDs were compared with CWTs. One study showed that compared with CWTs, CbDs caused changes in the CS of CR but changes in SR were similar between the two dentifrices. One study showed that CbDs and CWTs improved the overall color and enhanced the SR of CR. Three studies had a high RoB, five had a medium RoB, and two had a low RoB. Compared to CWTs, CbDs appeared to affect the CS of CR, but the SR of CR induced by both dentifrices remained consistent. Further well-designed and power-adjusted studies are needed.
PubMed: 38534282
DOI: 10.3390/dj12030058 -
Frontiers in Public Health 2023This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.
Topics: Child; Adult; Humans; Child, Preschool; Toothpastes; Fluorides; Health Promotion; Health Personnel; Eating
PubMed: 37927882
DOI: 10.3389/fpubh.2023.1279915 -
Cureus Aug 2023The aim of this study is to review the potential of strontium-doped nanohydroxyapatite (SrnHAP) as a biomaterial for remineralizing early carious lesions. Publications... (Review)
Review
The aim of this study is to review the potential of strontium-doped nanohydroxyapatite (SrnHAP) as a biomaterial for remineralizing early carious lesions. Publications from 2012 to 2022 were included based on the patient/population, intervention, comparison, and outcomes (PICO) framework, focusing on demineralized enamel treated with strontium-doped nanohydroxyapatite compared to other remineralizing agents, with the primary outcome being remineralization capacity. Electronic databases, namely, PubMed, Cochrane Library, and Google Scholar, were explored from March 31, 2023, to April 10, 2023. Only English language studies were included, while certain research types and studies on bovine teeth were excluded. Bias was assessed using the Cochrane methodology. Five studies were synthesized, all using extracted human maxillary premolars. Four studies focused on remineralizing enamel, while one study focused on remineralizing dentin. Among these studies, comparisons were made between different strontium concentrations and various remineralizing agents such as nanohydroxyapatite (nHAP), Acclaim, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and NovaMin. X-ray diffraction analysis was used to examine hydroxyapatite formation, while scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used for characterization. Additionally, one study evaluated the mechanical properties of partially demineralized dentin specimens. This study was registered in the PROSPERO under the ID CRD42023397413 and completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
PubMed: 37753022
DOI: 10.7759/cureus.44176 -
The Journal of Prosthetic Dentistry Aug 2023Brushing with dentifrice is the most commonly used denture cleaning method. However, it can result in the mass loss of acrylic resin and an increase in surface... (Review)
Review
STATEMENT OF PROBLEM
Brushing with dentifrice is the most commonly used denture cleaning method. However, it can result in the mass loss of acrylic resin and an increase in surface roughness, which favors the adherence of microorganisms.
PURPOSE
The purpose of this systematic review and meta-analysis of in vitro studies was to assess the influence of simulated brushing by using dentifrices and water on surface roughness and the mass loss of acrylic resins.
MATERIAL AND METHODS
Searches were performed in PubMed, Scopus, Web of Science, Lilacs, Embase, Open Gray, and Google Scholar databases in September 2022. The study selection process, data extraction, and risk of bias analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of this systematic review was registered in the Open Science Framework (DOI number 10.17605/OSF.IO/QD4GH). Meta-analysis was performed by using a random effects model (α=.05) in the RevMan (Cochrane Collaboration) software program.
RESULTS
A total of 14 studies were included in the qualitative synthesis and 2 studies in the quantitative synthesis. The manual toothbrush was the most analyzed (n=9), followed by the electric toothbrush (n=5) and denture brush (n=1). Denture base resin (n=8) was evaluated more than acrylic resin for the abrasiveness of toothpaste (n=6). Most studies used conventional toothpaste (n=12), whereas 6 used specific dentifrices. The period of brushing corresponding to 1 year was the most predominant (n=6). Surface roughness (n=13) was evaluated more than mass loss (n=4). In general, dentifrices resulted in greater surface roughness than water. According to meta-analysis results, brushing by using dentifrices reported higher mass loss values than brushing with distilled water (P<.05).
CONCLUSIONS
Brushing acrylic resins with dentifrice was more abrasive than brushing with water.
PubMed: 37612194
DOI: 10.1016/j.prosdent.2023.06.027 -
Community Dentistry and Oral... Dec 2023There is currently a lack of evidence supporting the use of valid surrogates in caries clinical trials. This study aimed at examining the validity of two surrogate... (Review)
Review
BACKGROUND
There is currently a lack of evidence supporting the use of valid surrogates in caries clinical trials. This study aimed at examining the validity of two surrogate outcomes used in randomized clinical trials for caries prevention, pit and fissure sealants and fluoridated dentifrices, according to the Prentice criteria.
METHODS
A systematic review was conducted in MEDLINE (PubMed), LILACS and Scopus databases up to 05 October 2022. The grey literature and the list of eligible studies' references were also screened. The search was conducted, selecting randomized clinical trials focussed on dental caries prevention using pit and fissure sealants or fluoridated dentifrices and with at least one surrogate endpoint for cavitated caries lesions. The risk of each surrogate endpoint and for the occurrence of cavitated caries lesions was calculated and compared. The association between each surrogate and the presence of cavitation was quantified, and each outcome was assessed graphically for validity according to the Prentice criteria.
RESULTS
For pit and fissure sealants, from 1696 potentially eligible studies, 51 were included; while for fluoridated dentifrices, of 3887 potentially eligible studies, four were included. Possible surrogates assessed were retention of sealants, presence of white spot lesions, presence of plaque or marginal discoloration around the sealants, oral hygiene index, radiographic and fluorescence caries lesion assessments. However, only the retention of sealants and the presence of white spot lesions could be evaluated for their validity according to the Prentice criteria.
CONCLUSION
Loss of retention of sealants and the presence of white spot lesions do not fulfil all of the Prentice criteria. Therefore, they cannot be considered valid surrogates for caries prevention.
Topics: Humans; Dental Caries; Pit and Fissure Sealants; Dental Caries Susceptibility; Dentifrices; Biomarkers; Randomized Controlled Trials as Topic
PubMed: 37246464
DOI: 10.1111/cdoe.12861 -
The Journal of Prosthetic Dentistry Jun 2024Scientific evidence to determine the optimal method of cleaning and disinfecting removable prostheses is lacking. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Scientific evidence to determine the optimal method of cleaning and disinfecting removable prostheses is lacking.
PURPOSE
The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of effervescent tablets in the cleaning and sanitizing of removable prostheses compared with other chemical and physical methods by assessing the reduction of biofilm, microbial levels, and material stability.
MATERIAL AND METHODS
A systematic literature search and meta-analysis was conducted in August 2021 in the MEDLINE/PubMed, Cochrane, Embase, Scopus, and Web of Science databases. Randomized and nonrandomized controlled clinical trials published in English were included without publication year limits. A total of 23 studies were included in the systematic review and 6 in the meta-analysis, which had been registered in the international prospective register of systematic reviews (PROSPERO) database (CRD42021274019). The Cochrane Collaboration tool was used to assess the risk of bias of randomized clinical trials. The physiotherapy evidence database (PEDro) scale was used to analyze the internal validity of clinical trials by assessing the quality of the data obtained. The studies included in the meta-analysis were combined by using a random-effects model with the inverse variance method. Publication bias was analyzed by using the Duvall and Tweedie trim-and-fill method.
RESULTS
With regard to biofilm reduction, the standardized mean difference estimated with the 4 studies combined in the meta-analysis was P=.012: mean difference=-1.92; 95% confidence interval=-3.45 to -0.38, indicating a "large" effect of the combination of brushing and effervescent tablet versus brushing alone. To estimate the reduction in the total bacteria levels in the 3 combined studies, a "large" effect size was obtained for the combination of brushing and using an effervescent tablet versus brushing alone, P<.001: mean difference=-4.43; 95% confidence interval=-8.29 to -0.55. Finally, when the 3 studies were combined to assess the reduction of Candida or fungal infection, a "moderate" effect size was obtained for the combination of brushing combined with the use of an effervescent tablet, P<.001: mean difference=-0.78; 95% confidence interval=-1.19 to -0.37.
CONCLUSIONS
The combination of brushing and the use of effervescent tablets versus brushing alone had a significantly higher effect on reducing biofilm and bacterial counts and a moderate effect on reducing Candida. Regarding color and dimensional stability, few studies were found, with the results depending on the concentration of the product and the immersion time of the device.
Topics: Humans; Biofilms; Tablets; Denture, Partial, Removable; Denture Cleansers
PubMed: 36870893
DOI: 10.1016/j.prosdent.2023.01.031 -
International Journal of Paediatric... Sep 2023Dental caries is one of the most prevalent chronic diseases among preschool children globally. Different preventive agents and combinations have been studied. However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental caries is one of the most prevalent chronic diseases among preschool children globally. Different preventive agents and combinations have been studied. However, the rank of the effectiveness of clinical interventions is equivocal.
AIM
To summarize and rank the effectiveness of clinical interventions using different agents for primary prevention of early childhood caries (ECC).
DESIGN
Two reviewers independently searched PubMed, Embase, and Cochrane Library to identify randomized controlled trials with at least 12-month follow-up. The network meta-analysis (NMA) on different agents was based on a random-effects model and frequentist approach. Standardized mean differences (SMD) with 95% CI of the caries increment were calculated in terms of either dmft or dmfs and used in the NMA. Caries incidences at the child level were compared using odds ratios (ORs) with 95% CI. The effectiveness of the agents was ranked using the surface under the cumulative ranking curve (SUCRA).
RESULTS
After screening 3807 publications and selection, the NMA finally included 33 trials. These trials used either a single or combination of agents such as fluorides, chlorhexidine, casein phosphopeptide-amorphous calcium phosphate, probiotics, xylitol, and triclosan. Compared with control, fluoride foam (FF; SMD -0.69, 95% CI: -1.06, -0.32) and fluoride salt (F salt; SMD -0.66, 95% CI: -1.20, -0.13) were effective in preventing caries increment. Probiotic milk plus low fluoride toothpaste (PMLFTP; OR 0.34, 95% CI: 0.15, 0.77), FF (OR 0.48, 95% CI: 0.37, 0.63), fluoride varnish (FV; OR 0.63, 95% CI: 0.48, 0.81), and fluoride varnish plus high fluoride toothpaste (FVHFTP; OR 0.73, 95% CI: 0.57, 0.93) were effectively preventing caries incidence. According to the SUCRA, FF ranked first in preventing caries increment, whereas PMLFTP ranked first in preventing caries incidence.
CONCLUSION
Fluoride foam, F salt, PMLFTP, FV, and FVHFTP all effectively reduce caries increment or caries incidence in preschool children, but the evidence indicates low degree of certainty. Considering the relatively small number of studies, confidence in the findings, and limitations in the study, clinical practitioners and readers should exercise caution when interpreting the NMA results.
Topics: Child, Preschool; Humans; Dental Caries; Fluorides; Cariostatic Agents; Fluorides, Topical; Network Meta-Analysis; Toothpastes; Dental Caries Susceptibility
PubMed: 36718540
DOI: 10.1111/ipd.13055