Wang Yu, Li Jialing, Sun Weibin, Li Huang, Cannon Richard D, Mei Li
Department of Preventive Dentistry, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
PLoS One. 2017 Aug 7;12(8):e0182221. doi: 10.1371/journal.pone.0182221. eCollection 2017.
To assess the effect of non-fluoride agents on the prevention of dental caries in primary dentition.
Medline, Web of Science, Embase, Cochrane Library, CBM and CNKI databases were searched to identify all the relevant articles published prior to 16 December 2016. Grey literature was also searched. Randomized controlled human clinical trials in which non-fluoride agents were delivered by any method were considered.
Of the 1,236 studies screened, 39 full articles were scrutinized and 14 selected for inclusion in the final sample. Five chemical agents, namely arginine, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), chlorhexidine, triclosan and xylitol were investigated in these included studies. The cariostatic effects of non-fluoride agents in vivo were evaluated in comparison with fluoride or placebos in randomized controlled trials. There is evidence that the use of certain doses of xylitol may be effective in arresting dental caries in primary dentition. However, quantitative synthesis could not be carried out because of the clinical and methodological heterogeneity of the included studies.
A study at low risk of bias indicated that daily use of xylitol wipes is a useful adjunct for caries control in young children, however, this conclusion should be interpreted with caution as this study had a very limited sample size. Chlorhexidine and CPP-ACP may be more effective than a placebo in managing caries in primary dentition, but their effectiveness is borderline when compared with fluoride. Arginine-containing mint confection and 0.3% triclosan varnish were found to reduce caries development in primary teeth but the evidence was at high risk of bias. High quality randomized controlled trials are needed in order to make a conclusive recommendation.
评估非氟化物制剂对预防乳牙龋齿的效果。
检索了Medline、科学网、Embase、Cochrane图书馆、中国生物医学文献数据库和中国知网数据库，以确定2016年12月16日前发表的所有相关文章。还检索了灰色文献。纳入了通过任何方法使用非氟化物制剂的随机对照人体临床试验。
在筛选的1236项研究中，对39篇全文进行了详细审查，并选择了14篇纳入最终样本。在这些纳入研究中，研究了五种化学制剂，即精氨酸、酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）、氯己定、三氯生和木糖醇。在随机对照试验中，将非氟化物制剂在体内的防龋效果与氟化物或安慰剂进行了比较。有证据表明，使用一定剂量的木糖醇可能对阻止乳牙龋齿有效。然而，由于纳入研究的临床和方法学异质性，无法进行定量综合分析。
一项低偏倚风险的研究表明，每天使用木糖醇擦拭巾是控制幼儿龋齿的有用辅助方法，然而，由于该研究样本量非常有限，这一结论应谨慎解读。氯己定和CPP-ACP在管理乳牙龋齿方面可能比安慰剂更有效，但与氟化物相比，其有效性处于临界状态。含精氨酸的薄荷糖和0.3%的三氯生清漆被发现可减少乳牙龋齿的发生，但证据存在高偏倚风险。需要高质量的随机对照试验才能做出确定性推荐。
