Gupta A, Sharda S, Shafiq N, Kumar A, Goyal A
Oral Health Sciences Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Pharmacology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Eur Arch Paediatr Dent. 2020 Dec;21(6):629-646. doi: 10.1007/s40368-020-00561-7. Epub 2020 Oct 1.
To compare the effectiveness of topical fluoride-antibacterial agent combined therapy versus topical fluoride monotherapy in preventing dental caries among 1- to 16-year-old children.
PubMed, EbscoHost, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were searched for randomised controlled trials. The trials should have assessed the caries-preventive effectiveness of topical fluoride-antibacterial agent (Povidone Iodine/Chlorhexidine/Xylitol/Triclosan/Cetylpyridinium Chloride) combined therapy versus topical fluoride monotherapy among children. Out of 3475 records that were screened, full text of 41 articles was assessed for potential inclusion. Sixteen trials that fulfilled the eligibility criteria were subjected to qualitative synthesis. The risk of bias was assessed using the Cochrane Collaboration's tool. Continuous data from nine trials were pooled using Inverse Variance test in meta-analysis function of Review Manager (version 5.4). GRADE approach was used to analyse the certainty of evidence. Statistical heterogeneity was quantified using the I statistic. A p-value of < 0.05 was considered as statistically significant.
With respect to the caries increment, combined therapy showed superior caries-preventive effectiveness than topical fluoride monotherapy [SMD - 0.12, 95% CI (- 0.2 to - 0.04), p = 0.004; (I = 20%, p = 0.29)]. No significant difference was noted between the two groups for the post-intervention salivary S mutans count [SMD - 0.11, 95% CI (- 0.33 to 0.1), p = 0.3; (I = 0%, p = 0.77)].
The pooled analysis indicates towards an added benefit of topical fluoride-antibacterial agent combined therapy over topical fluoride monotherapy in preventing dental caries incidence among children. However, the results may be interpreted with caution since the evidence generated is of low certainty and is driven by two studies on Xylitol, thus it demands further good quality trials.
比较局部用氟化物-抗菌剂联合治疗与局部用氟化物单一疗法在预防1至16岁儿童龋齿方面的有效性。
检索了PubMed、EbscoHost、Scopus、Web of Science和Cochrane对照试验中央注册库，查找随机对照试验。这些试验应评估局部用氟化物-抗菌剂（聚维酮碘/氯己定/木糖醇/三氯生/西吡氯铵）联合治疗与局部用氟化物单一疗法对儿童龋齿预防效果。在筛选的3475条记录中，评估了41篇文章的全文以确定是否可能纳入。16项符合纳入标准的试验进行了定性综合分析。使用Cochrane协作工具评估偏倚风险。在Review Manager（版本5.4）的荟萃分析功能中，使用逆方差检验汇总了9项试验的连续数据。采用GRADE方法分析证据的确定性。使用I统计量对统计异质性进行量化。p值<0.05被认为具有统计学意义。
在龋齿增量方面，联合治疗显示出比局部用氟化物单一疗法更好的龋齿预防效果[标准化均数差（SMD）-0.12，95%置信区间（CI）（-0.2至-0.04），p = 0.004；（I = 20%，p = 0.29）]。两组干预后唾液变形链球菌计数无显著差异[SMD -0.11，95%CI（-0.33至0.1），p = 0.3；（I = 0%，p = 0.77）]。
汇总分析表明，局部用氟化物-抗菌剂联合治疗在预防儿童龋齿发病率方面比局部用氟化物单一疗法具有额外益处。然而，由于所产生的证据确定性较低且由两项关于木糖醇的研究驱动，因此对结果的解释应谨慎，这需要进一步的高质量试验。
