Caries development after substitution of supervised fluoride rinses and tooth brushings by unsupervised use of fluoride toothpaste

Abstract

In a nonfluoridated community of Finland, where fortnightly fluoride rinsing with 0.2% sodium fluoride has been used for nearly two decades, a total of 313 children 7-8 yr old were recruited and randomly divided into two groups. 206 children completed the 3-yr trial. The control group (n = 94) participated in the rinsing program which included supervised toothbrushings, while the test group (n = 112) received a new fluoride toothpaste tube (0.15% F) for home use every second month. Annual dental recordings, treatment plannings and the treatment itself were all carried out by one clinician. At the end of the study the number of caries-free children of the toothpaste group was lower (P < 0.01) and the caries increment higher (P < 0.05) than that of the mouthrinse group. Out of the mean of four dental visits per child and year some 1.5 were prophylactic by nature. No differences were found between the number of treatment visits, time or prophylactic care of the two groups. Unsupervised use of fluoride toothpaste may not be a sufficient substitute for the school-based fortnightly fluoride rinses and supervised toothbrushings in caries prevention of children with erupting permanent teeth.

Statistical Aspects of Design and Analysis of Clinical Trials for the Prevention of Caries

“…The author has been contacted and confirmed that the trial was randomized. The trial by Karjalainen et al [1994] was excluded because the intervention included a nonfluoride component.…”

“…The first [Bravo et al, 1996] did not report when consent took place, but did state that there were different consent rates in the three groups, ranging from 75% in the varnish group to 87% in the sealant group. The other two trials [Chikte et al, 1996;Karjalainen et al, 1994] did not report whether the random allocation of schools took place prior to the consent process.…”

Treatment practices in caries prevention for 6-year-olds in Finland

“…This requires arresting the progression of caries at the time of eruption of FPMs at the latest. For erupting FPMs, several preventive treatment strategies have been reported to be effective (11)(12)(13); however, there are no data on the cost-effectiveness of these treatment strategies. Professional plaque removal and oral hygiene instruction combined with selective application of topical fluorides provided at intervals no longer than 6 months seems to be effective in preventing caries in erupting FPMs (11), whereas no statistically significant difference has been reported between such a protocol provided at intervals of 6-12 months and a selective sealing treatment combined with topical application of fluorides (22).…”

“…This risk persists throughout adolescence (7), even among previously cariesfree children but especially among children with 338 caries experience in their primary dentition (8)(9)(10). Caries-preventive interventions can, however, keep FPMs healthy during tooth eruption and the intraoral late maturation stages (11)(12)(13). Our aim was to evaluate dentists' caries-preventive treatment practices in public oral health service in Finland, particularly in relation to eruption of the first permanent molars among 6-year-olds with high caries occurrence and among those remaining cavity free.…”

Mouthrinses and dental caries

“…The effectiveness seems to show some tendencies to differ according to the mode of rinsing frequency but not concerning the fluoride concentration in the rinsing solutions and the rinsing time. The effectiveness of FMR is favoured either on a combination of high frequency rinsing (once a day), with low fluoride concentration (0.025 per cent -0.05 per cent NaF solution) or a combination with low rinsing frequency (once a week or twice a month) with high fluoride concentration (0.2 per cent NaF solution)": Karjalainen et al 58 have however suggested that unsupervised use of fluoride toothpaste may not be a sufficient substitute for the school based fortnightly fluoride rinses (0.2 per cent NaF) and supervised toothbrushing in caries prevention of children with erupting permanent teeth. Twice daily rinsing with a remineralising solution, although combined with a NaP gel, was inferior to everyday brushing with 0.4 per cent SnF 2 gel in patients receiving radiation.…”