Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
J Dent Res. 2020 May;99(5):514-522. doi: 10.1177/0022034520903036. Epub 2020 Feb 8.
The goal of this systematic review and network meta-analysis was to compare the relative effects of toothpaste formulations for dentin hypersensitivity (DH), tested in randomized controlled trials (RCTs). We searched 7 databases to February 2019. Paired reviewers independently screened studies, extracted data, and performed risk of bias assessment. The outcome of interest was painful response measured through tactile, cold, and air stimuli. We conducted a random-effects Bayesian network meta-analysis using standardized mean difference (SMD) and their credible intervals (CIs) as the measure of effect for each pain stimuli. We assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included 125 RCTs (12,541 patients). For tactile stimulus, the following active ingredients showed large beneficial effects compared to fluoride with moderate certainty of evidence (SMD; 95% CI): potassium + stannous fluoride (SnF) (3.05; 1.69-4.41), calcium sodium phosphosilicate (CSP) (2.14; 0.75-3.53), SnF (2.02; 1.06-2.99), potassium + hydroxyapatite (2.47; 0.3-4.64), strontium (1.43; 0.46-2.41), and potassium (1.23; 0.48-1.98). For cold stimulus, CSP showed large beneficial effects compared to fluoride (3.93; 0.34-7.53) with moderate certainty; for air stimulus, arginine (2.22; 1.45-2.99), potassium + hydroxyapatite (2.44; 0.33-4.55), potassium + SnF (2.28; 0.87-3.69), CSP (1.98; 0.99-2.98), and SnF (1.9; 1.03-2.77) showed large beneficial effects compared to fluoride with moderate to high certainty. Most toothpaste formulations showed evidence of superiority against placebo or fluorides (amine fluoride, sodium monofluorophosphate, or sodium fluoride). CSP was most beneficial for all 3 stimuli with high to moderate certainty. SnF alone and potassium combined with SnF or hydroxyapatite were beneficial for tactile and air stimulus with high to moderate certainty. Arginine was beneficial for air stimulus, and strontium and potassium were beneficial for tactile stimulus, with moderate certainty.
本系统评价和网络荟萃分析的目的是比较牙本质敏感症（DH）牙膏配方的相对效果，这些配方已在随机对照试验（RCT）中进行了测试。我们检索了 7 个数据库，截止到 2019 年 2 月。配对审查员独立筛选研究，提取数据，并进行偏倚风险评估。我们感兴趣的结果是通过触觉、冷觉和气流刺激来测量的疼痛反应。我们使用标准化均数差（SMD）及其可信区间（CI）作为每个疼痛刺激的效应测量指标，进行了随机效应贝叶斯网络荟萃分析。我们使用推荐评估、制定与评价（GRADE）方法评估证据确定性。我们纳入了 125 项 RCT（12541 名患者）。对于触觉刺激，以下活性成分与氟化物相比具有较大的有益效果，证据确定性为中等（SMD；95%CI）：钾+锡酸钠氟化物（SnF）（3.05；1.69-4.41）、硅酸钙二钠（CSP）（2.14；0.75-3.53）、SnF（2.02；1.06-2.99）、钾+羟磷灰石（2.47；0.3-4.64）、锶（1.43；0.46-2.41）和钾（1.23；0.48-1.98）。对于冷刺激，CSP 与氟化物相比具有较大的有益效果（3.93；0.34-7.53），证据确定性为中等；对于气流刺激，精氨酸（2.22；1.45-2.99）、钾+羟磷灰石（2.44；0.33-4.55）、钾+SnF（2.28；0.87-3.69）、CSP（1.98；0.99-2.98）和 SnF（1.9；1.03-2.77）与氟化物相比具有较大的有益效果，证据确定性为中等至高度。大多数牙膏配方对安慰剂或氟化物（胺氟化物、单氟磷酸钠或氟化钠）表现出优越性。CSP 对所有 3 种刺激均具有最高到中等确定性的最大益处。SnF 单独和钾与 SnF 或羟磷灰石联合使用对触觉和气流刺激具有较高到中等确定性的益处。精氨酸对气流刺激有益，锶和钾对触觉刺激有益，证据确定性为中等。
