ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Prescription Dentifrices Are More Effective At Preventing Caries In Adolescents Than Over-The-Counter Dentifrices
Clinical Question For caries control in adolescents, is the use of a prescription fluoride toothpaste better than the over-the-counter toothpastes?
Clinical Bottom Line Prescription dentifrices containing 5000ppm fluoride are significantly more effective at preventing dental caries in adolescents than the over-the-counter dentifrices with fluoride levels in the of 1100-1450 ppm.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20606431Nordström/2010211 adolescents randomly assigned a high fluoride or a regular toothpasteRandomized Controlled Trial
Key resultsAdolescents using the 5,000ppm F toothpaste had a much slower progression of caries compared to those using 1450ppm F toothpaste In both compliance groups(A: p<0.01, B: p<0.001), with a prevention fraction of 40%. Also noted was that adolescents using 5000ppm F toothpaste with lower compliance had lower caries incidence compared to those using 1450ppm F toothpaste (p<0.05); with prevention of fraction 42%, which may indicate that 5000ppm F toothpaste has a bigger effect on those with lower compliance.
#2) 20091655Walsh/201075 RCT trialsSystematic review of randomized trials
Key results“The caries preventative effect of fluoride toothpaste increased significantly with higher fluoride concentrations.” Prevention fraction was measured at 26% (confidence interval of 11-41%) with toothpaste concentrations of 2400-2800 ppm F when using a 250ppm F toothpaste as the baseline. Also noted was that only toothpastes with >1000 ppm F were significantly different from a placebo toothpaste containing 0ppm F, with a prevention fraction of 23% and confidence interval of 19-26%.
#3) 24177407Weyant/201371 trialsClinical Guidelines
Key resultsThe updated recommendations from the ADA regarding the use of professionally applied, prescription-strength, and home-use topical fluoride agents for caries prevention in children.
Evidence Search ("fluorides"[MeSH Terms] OR "fluorides"[All Fields] OR "fluoride"[All Fields]) AND ("toothpastes"[MeSH Terms] OR "toothpastes"[All Fields] OR "toothpaste"[All Fields]) AND ("attention"[MeSH Terms] OR "attention"[All Fields] OR "concentration"[All Fields]) AND ("adolescent"[MeSH Terms] OR "adolescent"[All Fields] OR "adolescents"[All Fields])
Comments on
The Evidence
Validity: There were two studies in the review; both a simple single-blind randomized control trial as well as a Cochrane Systemic review. Each study compared the results of different F concentrations in toothpastes. In the randomized control trial, subjects were unsupervised, such that they were asked at the end of the study to evaluate their compliance. Two groups were formed in the 5000ppm F and the 1450ppm F, those that used it regularly and those that were not regular in their use. These compliance groups were then compared to each other. In the Cochrane Systemic Review, randomized controlled trials and cluster randomized controlled trials with at least a 1-year follow up were selected. From 535 studies, 75 were found to fit the criteria needed. A Meta analysis was completed for 66 of the studies to present the review findings. Perspective: Both studies provide valid results both in the type of study (RCT and Cochrane Systemic Review) as well as in the blinding and selection process for the subjects.
Applicability Preventing caries development and retarding the progression of caries lesions is vital to protecting permanent dentition in adolescent years. Choosing the right product and counseling the patient on the right protocol are essential for the achievement of this purpose. Products’ effectiveness supported by strong research evidence would offer the right benefit to the patients. The result of the above Nordström (2010) study indicates that 5,000 ppm F toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day (high caries risk). Thus, 5,000 ppm F toothpaste appears to be an important vehicle for caries prevention and treatment of adolescents with a high caries risk.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Fluoride, Toothpaste, Prescription, Caries Prevention
ID# 3075
Date of submission: 04/21/2016spacer
E-mail theurer@livemail.uthscsa.edu
Author Brad Theurer
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett Amaechi, BDS, MS, PhD
Faculty mentor/Co-author e-mail amaechi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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