Lewis D W, Ismail A I
CMAJ. 1995 Mar 15;152(6):836-46.
To make recommendations, based on current evidence, for practising physicians and dentists on interventions for the prevention of dental caries in their patients.
Systemic fluoride administration, professionally administered fluoride, use of fluoride mouth rinses, fissure sealants, oral-hygiene practices, dietary practices, identification of groups at a high risk of dental caries, and early diagnosis and treatment.
Reduced prevalence of dental caries and fluorosis, longer retention of teeth and lower treatment costs.
Several MEDLINE searches were conducted for articles published from January 1980 to December 1992, including relevant review articles.
Relevant clinical findings were evaluated and categorized with the use of the evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination. Recommendations were developed for each method of caries prevention, with reduced incidence of dental caries and improved prevalence of caries-free teeth given high values.
BENEFITS, HARMS AND COSTS: The potential benefits of these measures in the long-term are a lower incidence of tooth decay, longer retention of teeth and prevention of fluorosis. The cost saving can be considerable for patients and insurers; however, implementation of some recommendations will be difficult, since the traditional preventive practices of dentists and dental hygienists are not easily changed.
There is good evidence that the following manoeuvres are effective in preventing dental caries: use of dentifrices containing fluoride, fluoridation of drinking water, fluoride supplements for patients in areas where there is a low level (0.3 ppm or less) of fluoride in the drinking water, professionally applied topical fluoride and the use of fluoride mouth rinses for patients with very active decay or at a high risk of dental caries and selective use of professionally applied fissure sealants on permanent molar teeth. There is poor evidence that the following manoeuvres are effective in preventing dental caries: professionally applied topical fluoride and the use of fluoride mouth rinses for patients with a low risk of caries, toothbrushing (without a dentifrice containing fluoride) and flossing, cleaning of teeth by a dentist or dental hygienist before topical application of fluoride or at a dental visit and dietary counselling for the general population. There is good evidence to recommend against the use of over-the-counter fluoride mouth rinses by the general population.
These guidelines are compatible with those of the US Preventive Services Task Force.
These guidelines were developed and endorsed by the task force, which is funded by Health Canada. Major funding was provided by the Faculty of Dentistry of the University of Toronto, Toronto and the Faculty of Dentistry of Dalhousie University, Halifax.
基于现有证据，为执业医师和牙医就患者龋齿预防干预措施提出建议。
全身用氟、专业应用氟化物、使用含氟漱口水、窝沟封闭、口腔卫生措施、饮食习惯、确定龋齿高危人群以及早期诊断与治疗。
降低龋齿和氟斑牙患病率，延长牙齿保留时间，降低治疗成本。
对1980年1月至1992年12月发表的文章进行了多次MEDLINE检索，包括相关综述文章。
运用加拿大定期健康检查特别工作组基于证据的方法和价值观对相关临床研究结果进行评估和分类。针对每种龋齿预防方法制定了建议，将降低龋齿发病率和提高无龋牙齿患病率视为高价值目标。
益处、危害和成本：这些措施长期的潜在益处是降低龋齿发病率、延长牙齿保留时间以及预防氟斑牙。对患者和保险公司而言，成本节约可能相当可观；然而，一些建议的实施将很困难，因为牙医和口腔卫生员的传统预防措施不易改变。
有充分证据表明以下措施在预防龋齿方面有效：使用含氟牙膏、饮用水氟化、为饮用水中氟含量低（0.3 ppm或更低）地区的患者补充氟化物、专业应用局部用氟化物以及为龋齿活动非常频繁或龋齿高危患者使用含氟漱口水，以及对恒牙磨牙选择性地专业应用窝沟封闭。证据不足表明以下措施在预防龋齿方面有效：为龋齿低风险患者专业应用局部用氟化物和使用含氟漱口水、刷牙（不使用含氟牙膏）和使用牙线、在局部用氟化物之前或就诊时由牙医或口腔卫生员清洁牙齿以及对普通人群进行饮食咨询。有充分证据建议普通人群不要使用非处方含氟漱口水。
这些指南与美国预防服务特别工作组的指南一致。
这些指南由特别工作组制定并认可，该工作组由加拿大卫生部资助。主要资金由多伦多大学牙科学院和哈利法克斯达尔豪西大学牙科学院提供。
