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Article: Topical fluoride as a cause of dental fluorosis in children

TitleTopical fluoride as a cause of dental fluorosis in children
Authors
Issue Date2009
PublisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html
Citation
Cochrane Database Of Systematic Reviews, 2009 n. 2 How to Cite?
AbstractBACKGROUND: For many years, topical use of fluorides has gained greater popularity than systemic use of fluorides. A possible adverse effect associated with the use of topical fluoride is the development of dental fluorosis due to the ingestion of excessive fluoride by young children with developing teeth. OBJECTIVES: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis. SEARCH STRATEGY: Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, EMBASE, BIOSIS, Dissertation Abstracts and LILACS/BBO. Reference lists from relevant articles were searched. Date of the most recent searches: 9th March 09. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies and cross-sectional surveys, in which fluoride toothpastes, mouthrinses, gels, foams, paint-on solutions, and varnishes were compared to an alternative fluoride treatment, placebo or no intervention group. Children under the age of 6 years at the time topical fluorides were used. DATA COLLECTION AND ANALYSIS: Data from all included studies were extracted by two review authors. Risk ratios for controlled, prospective studies and odds ratios for case-control studies or cross-sectional surveys were extracted or calculated. Where both adjusted and unadjusted risk ratios or odds ratios were presented, the adjusted value was included in the meta-analysis. MAIN RESULTS: 25 studies were included: 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias. Studies were included in four intervention/exposure comparisons. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months odds ratio 0.70 (random-effects: 95% confidence interval 0.57 to 0.88) (data from observational studies). Inconsistent statistically significant associations were found between starting using fluoride toothpaste/toothbrushing before or after the age of 24 months and fluorosis (data from observational studies). From the RCTs, use of higher level of fluoride was associated with an increased risk of fluorosis. No significant association between the frequency of toothbrushing or the amount of fluoride toothpaste used and fluorosis was found. AUTHORS' CONCLUSIONS: There should be a balanced consideration between the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis. The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm).More evidence with low risk of bias is needed. Future trials assessing the effectiveness of different types of topical fluorides (including toothpastes, gels, varnishes and mouthrinses) or different concentrations or both should ensure that they include an adequate follow-up period in order to collect data on potential fluorosis. As it is unethical to propose RCTs to assess fluorosis itself, it is acknowledged that further observational studies will be undertaken in this area. However, attention needs to be given to the choice of study design, bearing in mind that prospective, controlled studies will be less susceptible to bias than retrospective and/or uncontrolled studies.
Persistent Identifierhttp://hdl.handle.net/10722/66028
ISSN
2014 Impact Factor: 6.035
2015 SCImago Journal Rankings: 2.366
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, MCMen_HK
dc.contributor.authorGlenny, AMen_HK
dc.contributor.authorTsang, BWKen_HK
dc.contributor.authorLo, ECMen_HK
dc.contributor.authorWorthington, HVen_HK
dc.contributor.authorMarinho, VCCen_HK
dc.date.accessioned2010-09-06T05:42:59Z-
dc.date.available2010-09-06T05:42:59Z-
dc.date.issued2009en_HK
dc.identifier.citationCochrane Database Of Systematic Reviews, 2009 n. 2en_HK
dc.identifier.issn1469-493Xen_HK
dc.identifier.urihttp://hdl.handle.net/10722/66028-
dc.description.abstractBACKGROUND: For many years, topical use of fluorides has gained greater popularity than systemic use of fluorides. A possible adverse effect associated with the use of topical fluoride is the development of dental fluorosis due to the ingestion of excessive fluoride by young children with developing teeth. OBJECTIVES: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis. SEARCH STRATEGY: Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, EMBASE, BIOSIS, Dissertation Abstracts and LILACS/BBO. Reference lists from relevant articles were searched. Date of the most recent searches: 9th March 09. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies and cross-sectional surveys, in which fluoride toothpastes, mouthrinses, gels, foams, paint-on solutions, and varnishes were compared to an alternative fluoride treatment, placebo or no intervention group. Children under the age of 6 years at the time topical fluorides were used. DATA COLLECTION AND ANALYSIS: Data from all included studies were extracted by two review authors. Risk ratios for controlled, prospective studies and odds ratios for case-control studies or cross-sectional surveys were extracted or calculated. Where both adjusted and unadjusted risk ratios or odds ratios were presented, the adjusted value was included in the meta-analysis. MAIN RESULTS: 25 studies were included: 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias. Studies were included in four intervention/exposure comparisons. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months odds ratio 0.70 (random-effects: 95% confidence interval 0.57 to 0.88) (data from observational studies). Inconsistent statistically significant associations were found between starting using fluoride toothpaste/toothbrushing before or after the age of 24 months and fluorosis (data from observational studies). From the RCTs, use of higher level of fluoride was associated with an increased risk of fluorosis. No significant association between the frequency of toothbrushing or the amount of fluoride toothpaste used and fluorosis was found. AUTHORS' CONCLUSIONS: There should be a balanced consideration between the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis. The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm).More evidence with low risk of bias is needed. Future trials assessing the effectiveness of different types of topical fluorides (including toothpastes, gels, varnishes and mouthrinses) or different concentrations or both should ensure that they include an adequate follow-up period in order to collect data on potential fluorosis. As it is unethical to propose RCTs to assess fluorosis itself, it is acknowledged that further observational studies will be undertaken in this area. However, attention needs to be given to the choice of study design, bearing in mind that prospective, controlled studies will be less susceptible to bias than retrospective and/or uncontrolled studies.-
dc.languageengen_HK
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.htmlen_HK
dc.relation.ispartofCochrane Database of Systematic Reviewsen_HK
dc.rightsThis review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2010, Issue 1. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshCariostatic Agents - adverse effects-
dc.subject.meshChild, Preschool-
dc.subject.meshFluorides - adverse effects-
dc.subject.meshFluorosis, Dental - etiology-
dc.subject.meshToothpastes - adverse effects-
dc.titleTopical fluoride as a cause of dental fluorosis in childrenen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1469-493X&volume=issue 1, article no. CD007693&spage=1&epage=49&date=2010&atitle=Topical+fluoride+as+a+cause+of+dental+fluorosis+in+childrenen_HK
dc.identifier.emailWong, MCM:mcmwong@hkucc.hku.hken_HK
dc.identifier.emailLo, ECM:hrdplcm@hkucc.hku.hken_HK
dc.identifier.authorityWong, MCM=rp00024en_HK
dc.identifier.authorityLo, ECM=rp00015en_HK
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1002/14651858.CD007693.pub2en_HK
dc.identifier.pmid20091645-
dc.identifier.scopuseid_2-s2.0-70049109196en_HK
dc.identifier.hkuros168821en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-70049109196&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volumeissue 1, article no. CD007693-
dc.identifier.issue2en_HK
dc.identifier.spage1-
dc.identifier.epage49-
dc.identifier.eissn1469-493X-
dc.identifier.isiWOS:000274653900038-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridWong, MCM=26029250900en_HK
dc.identifier.scopusauthoridGlenny, AM=7004684536en_HK
dc.identifier.scopusauthoridTsang, BWK=35114041400en_HK
dc.identifier.scopusauthoridLo, ECM=7101705982en_HK
dc.identifier.scopusauthoridWorthington, HV=7102322448en_HK
dc.identifier.scopusauthoridMarinho, VCC=7004346070en_HK

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