Sonesson Mikael, Twetman Svante
Department of Orthodontics, Faculty of Odontology, Malmö University, Carl Gustavs väg 34, Malmö, SE-205 06, Sweden.
Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland.
BMC Oral Health. 2025 Jul 2;25(1):1058. doi: 10.1186/s12903-025-06374-8.
Orthodontic patients are often instructed to use fluoride mouthrinses (FMR) to prevent caries during treatment with fixed orthodontic appliances (FOA). The aim of this study was to examine the caries preventive effect of FMR during FOA treatment based on randomized controlled trials.
An information specialist searched five databases up to September 30, 2024. We included trials with parallel groups (intervention vs. control) and a minimum duration of six months. Based on the abstracts, the authors independently selected and reviewed full text papers, extracted key outcome data, and assessed the risk of bias. The primary outcome was incidence of enamel caries on subject level. We conducted a narrative synthesis and pooled comparable data in a random effects model.
We identified 22 studies of which seven, involving 704 patients, met the inclusion criteria. Five and two studies had moderate and high risk of bias, respectively. In all studies, FMR was additive to daily use of fluoride toothpaste. The intervention varied from twice daily to twice weekly and the duration ranged from six to 26 months. Five studies were included in a meta-analysis. The aggregated data showed a small risk difference of - 0.07 (95% CI -0.14; -0.01) in initial caries development adjacent to bracket base between the experimental and the control groups.
This review found insufficient support for a general recommendation to use FMR during treatment with fixed orthodontic appliances in populations with regular use of fluoride toothpaste. This does not rule out the possibility that individual orthodontic patients may benefit from FMR after comprehensive risk assessment. Further investigations with standardized interventions and duration, reporting a core outcome set are required to clarify the effectiveness of fluoride mouthrinses in orthodontic patients.
正畸患者在使用固定正畸矫治器（FOA）治疗期间，常被指导使用含氟漱口水（FMR）来预防龋齿。本研究的目的是基于随机对照试验，探讨FMR在FOA治疗期间的防龋效果。
一名信息专家检索了截至2024年9月30日的五个数据库。我们纳入了平行组试验（干预组与对照组），且最短持续时间为6个月。基于摘要，作者独立筛选并审阅全文论文，提取关键结局数据，并评估偏倚风险。主要结局是个体水平上釉质龋的发生率。我们进行了叙述性综合分析，并在随机效应模型中汇总可比数据。
我们识别出22项研究，其中7项研究（涉及704名患者）符合纳入标准。分别有5项和2项研究存在中度和高度偏倚风险。在所有研究中，FMR是对每日使用含氟牙膏的补充。干预频率从每日两次到每周两次不等，持续时间从6个月到26个月不等。5项研究被纳入荟萃分析。汇总数据显示，实验组和对照组之间，托槽基底附近初始龋发展的风险差异较小，为-0.07（95%CI -0.14；-0.01）。
本综述发现，对于经常使用含氟牙膏的人群，在固定正畸矫治器治疗期间普遍推荐使用FMR的依据不足。这并不排除个别正畸患者在进行全面风险评估后可能从FMR中获益的可能性。需要进行标准化干预和持续时间、报告核心结局集的进一步研究，以阐明含氟漱口水对正畸患者的有效性。
