Maguire Anne
Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK.
Evid Based Dent. 2014 Jun;15(2):38-9. doi: 10.1038/sj.ebd.6401019.
This guideline is intended to assist practitioners with decision making about the use of topical fluoride caries-preventive agents. It presents evidence-based clinical recommendations on professionally applied and prescription strength, home-use topical fluoride agents for caries prevention. Three clinical questions on the use of topical fluoride caries-preventive agents are addressed: In primary and permanent teeth, does the use of a topical fluoride compared to no topical fluoride reduce the incidence of new lesions, or arrest or reverse existing coronal and/or root caries? For primary and permanent teeth, is one topical fluoride agent more effective than another in reducing the incidence of, or arresting or reversing coronal and/or root caries?Does the use of prophylaxis before application of topical fluoride reduce the incidence of caries to a greater extent than topical fluoride application without prophylaxis? Sodium, stannous and acidulated phosphate fluoride for professional and prescription home use, including varnishes, gels, foams, rinses and prophylaxis pastes were evaluated.
The previous version of this review (2006 ADA policy) was based on assimilation of evidence from systematic reviews. However, this update synthesises primary evidence collected through systematic review and appraisal of the literature.The Cochrane Library and Medline (via PubMed) were searched. Relevant systematic reviews and other selected articles were hand-searched.Two reviewers independently screened titles and abstracts, with one reviewer assessing all manuscripts in full for meeting the inclusion criteria. Two different members of the expert panel then approved the exclusion list. Discrepancies were resolved through discussion with the Chair of the workgroup. The USPSTF grading system was used.
Five-year interval update in line with the ADA policy.
For individuals at risk of dental caries: 2.26% fluoride varnish or 1.23% fluoride (APF) gel, or prescription strength, home-use 0.5% fluoride gel or paste, or 0.09% fluoride mouth rinse for children who are aged six or over.The panel judged that the benefits outweighed the potential for harm for all professionally applied and prescription strength, home-use topical fluoride agents and age groups except for children aged under six years. Only 2.26% fluoride varnish was recommended for children less than six years old, as the panel considered the risk of adverse events (particularly nausea and vomiting) associated with swallowing all other professionally applied topical fluoride agents outweighed the potential benefits.There was insufficient data to answer the question on arresting and reversing coronal and/or root caries, so these outcomes were not addressed in the clinical recommendations.
These focused on development of standard methodologies for well-designed trials with standardised reporting and trial registration. Specific areas for research included: investigation of mechanisms of fluoride action and effects against a background fluoride exposure; investigation of specific sub-groups such as high-risk elderly; research on specific products; measure and outcome development for arrested caries; economics and dissemination/implementation to realise guideline use.
本指南旨在协助从业者就局部用氟防龋剂的使用做出决策。它针对专业应用和处方强度的家用局部用氟防龋剂提出了基于证据的临床建议。涉及了关于局部用氟防龋剂使用的三个临床问题:在乳牙和恒牙中,与不使用局部用氟相比,使用局部用氟是否能降低新龋损的发生率,或阻止或逆转现有的冠部和/或根部龋病?对于乳牙和恒牙,一种局部用氟剂在降低冠部和/或根部龋病的发生率、阻止或逆转龋病方面是否比另一种更有效?在应用局部用氟之前进行预防性洁治,是否比不进行预防性洁治而单纯应用局部用氟能更大程度地降低龋病发生率?对用于专业和处方家用的含氟制剂进行了评估,包括氟化钠、氟化亚锡和酸性磷酸氟,剂型有漆剂、凝胶、泡沫剂、漱口水和预防性糊剂。
本综述的上一版本(2006年美国牙科协会政策)基于对系统评价证据的汇总。然而,本次更新综合了通过系统评价和文献评估收集的原始证据。检索了Cochrane图书馆和Medline(通过PubMed)。对手检了相关的系统评价和其他选定的文章。两名评审员独立筛选标题和摘要,一名评审员评估所有手稿是否符合纳入标准。然后由专家小组的两名不同成员批准排除清单。通过与工作组主席讨论解决分歧。采用了美国预防服务工作组的分级系统。
按照美国牙科协会政策每五年进行一次更新。
对于有患龋风险的个体:2.26%的氟化漆或1.23%的氟化(酸性磷酸氟)凝胶,或处方强度的家用0.5%氟化凝胶或糊剂,或6岁及以上儿童用的0.09%氟化漱口水。专家组判定,对于所有专业应用和处方强度的家用局部用氟剂以及各年龄组,除6岁以下儿童外,益处大于潜在危害。仅推荐2.26%的氟化漆用于6岁以下儿童,因为专家组认为与吞咽所有其他专业应用局部用氟剂相关的不良事件(特别是恶心和呕吐)风险大于潜在益处。没有足够的数据回答关于阻止和逆转冠部和/或根部龋病的问题,因此这些结果未在临床建议中提及。
这些建议集中在为设计良好的试验制定标准方法,包括标准化报告和试验注册。具体研究领域包括:在有背景氟暴露的情况下研究氟的作用机制和效果;研究特定亚组,如高危老年人;研究特定产品;确定静止龋的测量方法和结果;经济学以及传播/实施以实现指南的应用。