Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China.
Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China.
J Dent. 2022 Oct;125:104273. doi: 10.1016/j.jdent.2022.104273. Epub 2022 Sep 1.
To assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults.
DATA/SOURCES: Two independent researchers searched the English literature published up to 31st Dec 2021 in five databases (PubMed, Scopus, the Cochrane Library, EMBASE, and Web of Science) for clinical trials with a comparison group on professionally applied fluoride therapy for caries prevention or arrest at older adults aged ≥60 years with any follow-up period. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate. The Cochrane guidelines were used for the risk of bias assessment.
STUDY SELECTION/RESULTS: Five hundred and twenty-seven studies were identified, and seven studies were finally included. Five studies were rated as having 'low risk'. The root caries-prevented fraction of 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride (APF) gel were 25-71%, 64%, and 32%, respectively. Meta-analysis indicated a decrease in the number of new root caries by 0.55 (95% CI: 0.32-0.78; p < 0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33% to 49%; p < 0.001) after receiving 38% SDF application at the 24-month follow-up.
According to the findings, 5% NaF varnish and 1.23% APF gel prevented root caries, whereas 38% SDF solution prevented and arrested root caries in older adults. More well-designed clinical trials should be conducted to investigate various methods in caries prevention and arrest in older adults.
Preventive measures effective in other age groups may not suit older adults, as caries type and associated risk factors vary. To date, no systematic review has evaluated professionally applied fluoride therapy in older adults. Evidence from clinical trials in older adults could aid clinical practice and public health measures. The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42022307025.
评估专业应用氟化物疗法预防和控制老年人龋齿的临床证据。
资料/来源：两名独立研究人员在五个数据库（PubMed、Scopus、Cochrane 图书馆、EMBASE 和 Web of Science）中搜索了截至 2021 年 12 月 31 日发表的英文文献，以寻找针对年龄≥60 岁的老年人的专业应用氟化物疗法预防或控制龋齿的临床试验，随访时间不限。结局是新龋齿/预防龋齿分数和龋齿阻滞率的均数差异。采用 Cochrane 指南评估偏倚风险。
研究选择/结果：共确定了 527 项研究，最终纳入了 7 项研究。其中 5 项研究被评为“低风险”。38%的银胺氟化物（SDF）溶液、5%的氟化钠（NaF）涂料和 1.23%的酸性磷酸氟化物（APF）凝胶的根龋预防分数分别为 25-71%、64%和 32%。Meta 分析表明，在 24 个月的随访中，使用 38%的 SDF 治疗后，新根龋齿的数量减少了 0.55（95%CI：0.32-0.78；p<0.001），总根龋齿阻滞率为 42%（95%CI：33%至 49%；p<0.001）。
根据研究结果，5%的 NaF 涂料和 1.23%的 APF 凝胶预防根龋，而 38%的 SDF 溶液预防和阻滞老年人的根龋。需要开展更多设计良好的临床试验，以研究老年人龋齿预防和阻滞的各种方法。
在其他年龄组中有效的预防措施可能不适合老年人，因为龋齿类型和相关危险因素不同。迄今为止，尚无系统评价评估专业应用氟化物疗法在老年人中的应用。来自老年人临床试验的证据可以辅助临床实践和公共卫生措施。国际前瞻性注册系统评价（PROSPERO）登记号：CRD42022307025。
