Slow-release fluoride devices for the control of dental decay

Bonner BC, Clarkson JE, Dobbyn L, Khanna S

Published Online:

October 8, 2008

Slowly dissolving fluoride-releasing glass beads may help reduce dental decay if retained in the mouth over time, but retention of the beads is a problem.
This review concludes that slow-release fluoride devices have the potential to protect against tooth decay if they can be kept in place, in the mouth, for 2 years. The evidence, so far, is considered to be weak and unreliable. In a single study a reduction of 0.72 in mean caries increment (assessed as decayed, filled, or missing teeth) compared to control was reported (caries increment in the intervention group was 0.19 versus 0.91 in the control group). However, this analysis excluded 52% of available participants, whose beads had become dislodged.

Abstract (click to read)

Background:

Slow-release fluoride devices have been investigated as a potentially cost-effective method of reducing dental caries in those with high risk of disease.

Objectives:

To evaluate the effectiveness of different types of slow-release fluoride devices on preventing, arresting, or reversing the progression of carious lesions on all surface types of deciduous and permanent teeth.

Search strategy:

We searched (up until February 2005) multiple electronic databases (Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE), bibliographic references of identified randomised controlled trials (RCTs), textbooks, review articles, and meta-analyses. Letters were sent to authors of identified RCTs asking for clarifications and unpublished or ongoing research. Relevant journals were handsearched for more recent reports than those obtained from databases.

Selection criteria:

Randomised or quasi-randomised controlled trials (RCTs) comparing slow-release fluoride devices with an alternative fluoride treatment, placebo, or no intervention in all age groups. The main outcomes measures sought were changes in numbers of decayed, missing, and filled teeth or surfaces (DMFT/DMFS in permanent teeth or dmft/dmfs in primary teeth) and progression of carious lesions through enamel and into dentine.

Data collection and analysis:

Abstracts of all reports identified were considered independently by two review authors and full reports obtained of any potentially relevant articles to allow further assessment for relevance and validity. Data extraction and quality assessment were conducted independently by two and three review authors respectively, with arbitration by the fourth. Where uncertainty existed, authors were contacted for additional information.

Main results:

Only one trial involving 174 children fully met the criteria for inclusion in this review. Although 132 children were still included in the trial at the 2-year completion point, examination and statistical analysis was performed on only the 63 children who had retained the beads. Thirty-one of these were in the intervention group and 32 in the control group.
Amongst these 63 children, caries increment was reported to be statistically significantly lower in the intervention group than in the placebo group (mean difference: -0.72 DMFT, 95% confidence interval -1.23 to -0.21 and -1.52 DMFS, 95% confidence interval -2.68 to -0.36)

Authors' conclusions:

There is some evidence of a caries-inhibiting effect of slow-release fluoride glass beads. This evidence is regarded as weak and unreliable because the results were from participants selected on the basis of bead retention rather than an intention-to-treat analysis.

This record should be cited as:

Bonner BC, Clarkson JE, Dobbyn L, Khanna S. Slow-release fluoride devices for the control of dental decay. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005101. DOI: 10.1002/14651858.CD005101.pub2

Assessed as up to date:

August 9, 2006

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Dental caries > Prevention

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Slow-release fluoride devices for the control of dental decay

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