小児および青年の定期的なフッ化物洗口液の使用と齲蝕減少の関連性

Regular supervised fluoride mouthrinse use by children and adolescents associated with caries reduction.

抄録

データソースCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS, BBO, Proquest Dissertations and Theses, Web of Science Conference Proceedings, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform.研究選択盲検アウトカム評価が明記または指示されたランダム化または準ランダム化対照試験で、16歳までの小児を対象にフッ化物洗口液とプラセボまたは無治療を比較し、期間は12カ月以上とした。データ抽出と統合少なくとも2名の審査員が独立して研究を選択、データを抽出、偏りのリスクを評価した結果、15,813名の児童および青年を含む37の試験が対象とされた。すべての試験で、学校での監視下での洗口がテストされた。28の試験はバイアスのリスクが高く、9の試験はリスクが不明確であった。35の試験（15,305人）が永久歯表面のデータをメタ分析に提供し、D（M）FS = 27%（95%CI 23% to 30%; I = 42%）の防止率を発見した（中程度の質の証拠）。メタ回帰分析では，D(M)FS の推定値とベースラインう蝕重症度，フッ化物への背景暴露，洗口頻度，フッ化物濃度との間に有意な関連はみられなかった．13 件の研究から得られた D(M)FT の予防割合のプール推定値は 23% (95%CI, 18% to 29%; I = 54%) であった。結論このレビューにより，小児および青年によるフッ化物洗口の指導付き定期使用は，永久歯におけるう蝕増生の大きな減少に関連していることがわかった．その効果の大きさは中程度であった．ほとんどのエビデンスは，学校での指導下でのフッ化物洗口液の使用を評価しているが，この知見は，他の環境でも指導下または非指導下で洗口する子どもたちに適用できるかもしれないが，う蝕予防効果の大きさはあまり明らかではない．フッ化物洗口液に関する今後の研究では，異なるフッ化物洗口液の特徴や他の予防戦略に対するフッ化物洗口液の比較に焦点を当て，有害作用や受容性を評価することが必要である．

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS, BBO, Proquest Dissertations and Theses, Web of Science Conference Proceedings, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform.Study selectionRandomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years of age with a duration of at least 12 months.Data extraction and synthesisA least two reviewers independently selected studies, abstracted data and assessed risk of bias.ResultsThirty-seven trials involving 15,813 children and adolescents were included. Supervised rinsing in schools was tested in all trials. Twenty-eight studies were at high risk of bias, nine at unclear risk. Thirty-five trials (15,305 participants) contributed data on permanent tooth surface for meta-analysis and found a prevented fraction for D(M)FS = 27%(95%CI 23% to 30%; I = 42%) (moderate quality evidence). Meta-regression showed no significant association between estimates of D(M)FS with baseline caries severity, background exposure to fluorides, rinsing frequency or fluoride concentration. The pooled estimate of prevented fraction from 13 studies for D(M)FT = 23% (95%CI, 18% to 29%; I = 54%).There was limited information on possible adverse effects or acceptability of the treatment regimen in the included trials.ConclusionsThis review found that supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth. We are moderately certain of the size of the effect. Most of the evidence evaluated use of fluoride mouthrinse supervised in a school setting, but the findings may be applicable to children in other settings with supervised or unsupervised rinsing, although the size of the caries-preventive effect is less clear. Any future research on fluoride mouthrinses should focus on head-to-head comparisons between different fluoride rinse features or fluoride rinses against other preventive strategies, and should evaluate adverse effects and acceptability.