3. Findings of the assessment 1: Evidence Mapping Table for Designed to Smile Study Details Study design Outcome measures Main findings Results Evidence Grading Include? Reason for exclusion Marinho, VCC et al, 2009 Fluoride toothpastes for preventing dental caries Children and Adolescents Systematic Review and Meta-analysis The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established. together, the trials are of relatively high quality, and provide clear evidence that fluoride toothpastes are efficacious in preventing caries 74 studies were included, 70 that contributed data for meta-analysis (involving 42,300 children) the D(M)FS pooled PF was 24% (95% confidence interval (CI), 21 to 28%; P < 0.0001). In populations with caries increment of 2.6 D(M)FS per year, 1.6 children need to brush with a fluoride toothpaste (rather than a toothpaste) to prevent one D(M)FS. ++ Exclude Provides evidence for use of fluoride toothpaste, limited information on supervised brushing as in Trial
Supervised Children Age 5 years at outset one control class, 595 pupils randomised into intervention (279) and control (255). subsequently. Intervention group received supervised toothbrushing once a day at school with 1,000 ppm fluoride toothpaste and a home support package encouraging twice-daily toothbrushing. The control group did not brush at significant long-term benefit in the dental health of children 4.5 years after the cessation of a supervised toothbrushing programme using a 1,000 ppm fluoride toothpaste. Further follow-up at an age when the second molars and premolars have all erupted will help determine whether this benefit is due to a long-term behavioural change or a prolonged biological effect Of the 428 children who were examined at the end of the 329 (77%) were examined 54 months later when the children were aged 12 years on average. The intervention group still had less caries (D 3 FS caries increment 1.62) than the nonintervention children (D 3 FS caries increment 2.65, p<0.05). Prolonged benefits have been found for intervention children principally in less caries in first permanent molars.
school or receive the home support package. Aged 5 years at baseline and were examined every 6 months during the trial, then at 6, 18, 30 and 54 months after the end of the trial. Jackson, RJ et al, 2005 Supervised Children aged 5 – 6 years Randomised controlled in high caries (5 year old mean dmft 2.83, 45.9% caries free) prevalence area in London. 517 5 year old children recruited and Caries increment All were by visual only. All teeth present were This study suggests that a programme of daily toothbrushing with fluoride toothpaste can be effectively targeted into socially deprived communities and a significant reduction in dental caries can For children in the intervention group, the overall caries increment (2.60) was significantly less (10.9%; p < 0.001) than for children in the non intervention group (2.92). Among different tooth surfaces, the difference in caries increment between the + study with significant weaknesses Sponsored by commercial interests e.g. Sugar Bureau
randomised into control (258) and intervention (259) classes. Children in intervention undertook supervised toothbrushing daily (at school) for 21 month study period. assessed using the BASCD criteria thereby be achieved especially among children intervention group (0.78) and the group (1.03) was greatest for the proximal surfaces (21.4%; p < 0.01 Children older than in DTS Rong, WS et al, 2003 Oral Health Programme including Supervised Pre-school 10 kindergartens randomised into intervention and control groups. Intervention, twice daily supervised toothbrushing; 3 monthly oral health education Caries increment; This oral health education program was effective in establishing good oral health habits among preschool children and in increasing oral health knowledge of their parents, in conjunction with daily supervised Caries increment in intervention group 2.47 and control 3.56, (P=0.009) Statistically significant differences in knowledge and attitudes among parents and in + Exclude Relevance of rural Chinese population to UK – Brushing 2x per day
to teachers and semi-annually to parents, children provided with toothbrush/ toothpaste in both intervention and control groups, control group toothbrushing with fluoride toothpaste which could reduce the development of new dental caries in children in China toothbrushing behaviour in children at two year evaluation. Curnow,MM et al, 2002 Supervised Children aged 5 years Randomised Control Exclude – Earlier paper for study above Pine et al, 2007 Marinho VCC et al, 2009 Systematic Review and Meta-analysis Prevented fraction % The review suggests a substantial effect of fluoride varnish in both Nine studies were included, involving 2709 children. For the seven that contributed +/- Include
seven studies indicated no relationship between prevented fraction and study precision. In both methods, power is limited when only a few trials are included Petersson , LG et al, 2004 Professional fluoride varnish Systematic review randomised and controlled clinical trials of professional fluoride varnish treatments. 24/302 papers included Preventive fraction expressed as percentage The results displayed limited evidence for the caries preventive effect of topical applications of fluoride varnishes in permanent The review reinforces the need for future clinical research of high quality Average prevented fraction 30% (0-60%) when compared with untreated controls, limited poor quality studies. Three trials in high risk groups did not demonstrate significant caries reduction. Inconclusive evidence was found for fluoride varnish in primary dentition or in adults +/- Include Marinho,VCC et al, 2009 Systematic Review and Meta-analysis Prevented Fraction % Topical fluorides (mouthrinses, gels, or varnishes) used in 11/12 included studies contributed +/- Include
of topical fluoride gels, varnishes) versus single topical fluoride Children and Adolescents addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects could be reached, because data were scarcely reported in the trials. data for the 9 trials for the main meta-analysis on the effect of fluoride mouthrinses, gels or varnishes used in combination with toothpaste (involving 4026 children) the D(M)FS pooled PF was 10% (95% CI, 2% to 17%; P = 0.01) in favour of the combined regimens. Heterogeneity was not substantial in these results (I2 = 32%). The separate of fluoride gel or mouthrinse
gels or varnishes) Children and adolescents. of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce prevented fraction estimate was 26% (95% CI, 24% to 29%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001), but the direction of effect was consistent. The effect of topical fluoride varied according to type of control group used, type of TFT used, mode/setting of TFT use, initial caries levels and intensity of TFT application, but was not influenced by exposure to water ,
Based upon the appraisal strategy above a subjective judgement of the overall balance of economic evidence was made by the economic evidence sub-group and the following traffic light system of grading was used. Green I Green II Amber I Amber II Red I Red II frequency of good quality economic showing as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation frequency of good quality economic showing as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Fair quality economic showing as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Fair quality evidence however, showing mixed evidence of as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation Poor quality evidence showing was not as appraised by Drummond et al’s Checklist for a sound economic evaluation No