Background considerations
GRADES of evidence quality | Interpretation |
---|---|
HIGH | We are very confident that the true effect lies close to that of the estimate of the effect |
MODERATE | We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different |
LOW | Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect |
VERY LOW | We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect |
Strong recommendation | Conditional recommendation | |
---|---|---|
For patients | Most people would want the recommended course of action and only a small proportion would not | Most people would want the recommended course of action, but many would not |
For clinicians | Most patients should receive the recommended course of action | Different choices will be appropriate for different patients and each patient should be advised for a management decision consistent with her/his values and preferences |
For policy makers | The recommendation can be adopted as a policy in most situations | Policy making will require substantial debate and involvement of stakeholders |
Introduction
0–4 years
4–6 years
6 years and above
Use of silver diamine fluoride
Guidelines
Fluoride toothpastes
Clinical effectiveness
Intervention | Control | PF % (95% CI) |
---|---|---|
Fluoride toothpaste | Placebo | 24 (21–28) |
Supervised brushing | Non-supervised | 11 (4–18) |
Brushing twice per day | Once per day | 14 (6–22) |
1450–1500 ppm F | 1000–1100 ppm F | 8 (1–16) |
Fluoride toothpaste + other sources* | Fluoride toothpaste | 10 (2–17) |
Potential harm
Evidence-based statements
Statement | GRADE of evidence quality | GRADE of recommendation strength |
---|---|---|
Daily brushing with fluoride toothpaste prevents caries | High | Strong |
Toothpastes containing higher concentrations of fluoride are more effective than those with lower concentration in preventing caries | High | Strong |
Supervised tooth brushing is more effective than non-supervised | High | Strong |
There is inconclusive evidence that the use of fluoridated toothpaste in young children is associated with an increased risk of fluorosis | Low | Conditional |
Good practice points on brushing behaviour
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Tooth brushing should be conducted so each tooth surface is reached and brushing should exceed 1 min, also in preschool children.
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Children should avoid rinsing with a lot of water afterwards.
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Children’s teeth should be brushed using either a soft manual or power toothbrush.
High fluoride toothpaste
Clinical recommendations
Age (years) | (ppm F) | Frequency | Amount (g) | Size |
---|---|---|---|---|
First tooth—up to 2 years | 1000 | Twice daily | 0.125 | Grain of rice |
2–6 years | 1000* | Twice daily | 0.25 | Pea |
Over 6 years | 1450 | Twice daily | 0.5–1.0 | Up to full length of brush |
Knowledge gaps
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The appropriate amount and concentration of fluoride in toothpastes for preschool children related to the risk of fluorosis.
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The effect of toothpaste introduction age, optimal brushing time and post-brushing behaviour on caries development.
Fluoride gels, rinses and varnishes
Clinical recommendations
Modality | Grade of evidence quality and recommendation strength | Good practice points and clinical advice |
---|---|---|
Gels (professional use; 5000–12,300 ppm F) | Primary teeth Evidence/recommendation: none | Do not use in children < 6 years of age, as risk/benefit ratio is in favour of risk due to danger of swallowing the gel |
Permanent teeth Evidence: moderate recommendation: conditional. | Use 2–4 times per year In dental practice, remove obvious deposits of dental plaque and choose appropriate size trays. Patient should sit in upright position and not swallow; use suction devices during treatment and after tray removal to minimise swallowing In schools, it can be brushed on according to needs and for home use brushed on weekly Instruct child not to eat or drink for 20–30 min after application | |
Rinses (home or use at schools); (a) daily: 0.05% NaF (225 ppm F), (b) weekly: 0.2% NaF (900 ppm F) | Primary teeth Evidence/recommendation: none | Do not use in children < 6 yrs of age, as risk/benefit ratio is in favour of risk, due to danger of swallowing the rinse |
Permanent teeth Evidence: moderate recommendation: conditional | Supervised use (by parents or at school) more efficacious than unsupervised 10 ml of the solution is swished around the mouth for 1 min Instruct child not to eat or drink for 20–30 min after application | |
Varnishes (professional use; typically, 22,600 ppm F) | Evidence: moderate recommendation: conditional (Efficacious in preventing caries in both primary and permanent teeth Marinho et al. 2013) | Should be used for prevention of caries in both primary and permanent teeth Varnish is the only high fluoride topical agent that can be used in preschool Use 2–4 times per year Obvious deposits of dental plaque should be removed prior to application In order not to exceed the PTD, clinicians should use a thin film using a minimal amount on caries predilection sites, initial caries lesions and defects according to manufacturer’s instructions. Instruct child not to eat or drink for 20–30 min |