detstomСтоматология детского возраста и профилактикаPediatric dentistry and dental prophylaxis1683-30311726-7218RPA10.33925/1683-3031-2023-598detstom-598Research ArticleОБЗОРREVIEWЭффективность местного применения фторидов: систематический обзорTopical fluoride treatment effectiveness: a systematic reviewhttps://orcid.org/0000-0002-5089-0828БрусницынаЕ. В.BrusnitsynaE. V.

Брусницына Елена Викторовна, кандидат медицинских наук, доцент кафедры стоматологии детского возраста и ортодонтии

Екатеринбург

Elena V. Brusnitsyna, DMD, PhD, Associate Professor, Department of Pediatric Dentistry and Orthodontics

Ekaterinburg

lb1@mail.ruhttps://orcid.org/0000-0003-0806-1177ГинкельД. А.GinkelD. A.

Гинкель Дарья Андреевна, врач-ординатор кафедры стоматологии детского возраста и ортодонтии

Екатеринбург

Daria A. Ginkel, DMD, Resident, Department of Pediatric Dentistry and Orthodontics

Ekaterinburg

iliagavrilov18@yandex.ruhttps://orcid.org/0000-0002-6201-9773ПриходкинА. С.PrihodkinA. S.

Приходкин Артем Сергеевич, врач-ординатор кафедры хирургической стоматологии, оториноларингологии и челюстно-лицевой хирургии

Екатеринбург

Artem S. Prikhodkin, DMD, Resident, Department of Oral Surgery, Otorhinolaryngology and Maxillofacial Surgery

Ekaterinburg

a.prihodkin@mail.ruhttps://orcid.org/0000-0002-3591-0608ЗакировТ. В.ZakirovT. V.

Закиров Тарас Валерьевич, кандидат медицинских наук, доцент кафедры стоматологии детского возраста и ортодонтии

Екатеринбург

Taras V. Zakirov, DMD, PhD, Associate Professor, Department of Pediatric Dentistry and Orthodontics

Ekaterinburg

sekir-zakirov@mail.ruhttps://orcid.org/0000-0002-2470-4614ИощенкоЕ. С.IoshchenkoE. S.

Иощенко Евгений Сергеевич, кандидат медицинских наук, доцент кафедры стоматологии детского возраста и ортодонтии

Екатеринбург

Evgeniy S. Ioschenko, DMD, PhD, Associate Professor, Department of Pediatric Dentistry and Orthodontics

Ekaterinburg

ioshenko@yandex.ruhttps://orcid.org/0000-0001-8641-9088ШишмареваА. С.ShishmarevaA. S.

Шишмарева Анастасия Сергеевна, кандидат медицинских наук, доцент кафедры стоматологии детского возраста и ортодонтии

Екатеринбург

Anastasia S. Shishmareva, DMD, PhD, Associate Professor, Department of Pediatric Dentistry and Orthodontics

Ekaterinburg

dolphy2007@yandex.ruУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation2023300320232317082Copyright © Брусницына Е.В., Гинкель Д.А., Приходкин А.С., Закиров Т.В., Иощенко Е.С., Шишмарева А.С., 20232023Брусницына Е.В., Гинкель Д.А., Приходкин А.С., Закиров Т.В., Иощенко Е.С., Шишмарева А.С.Brusnitsyna E.V., Ginkel D.A., Prihodkin A.S., Zakirov T.V., Ioshchenko E.S., Shishmareva A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.detstom.ru/jour/article/view/598Актуальность

Актуальность. Цель систематического обзора – оценка эффективности местного применения фторидов у детей на основе анализа данных современных рандомизированных клинических исследований (РКИ).

Материалы и методы

Материалы и методы. Обзор был выполнен с использованием чек-листа PRISMA (Тhe Preferred Reporting Items for Systematic Reviews and Meta-Analyses) для систематических обзоров и метаанализов. Предлагаемые критерии применялись для определения качества исследований, подлежащих включению в обзор, а затем при обобщении результатов. Предварительный поиск проведен среди статей, опубликованных в период с 2013 по 2023 год, где были использованы в качестве одного из профилактических средств фтористые лаки. Поиск проводился с использованием терминов MeSH, ключевых слов fluorides, fluorine varnish, caries prevention, remineralisation, children и других свободных терминов на английском и русском языке. Предварительный поиск выдал 346 исследований. После исключения дублирующих и нерелевантных исследований девять РКИ были проанализированы двумя независимыми рецензентами на основе критериев PRISMA.

Результаты

Результаты. Из девяти включенных в обзор РКИ по использованию фтористых лаков в пяти представленных исследованиях участвовали дети в возрасте от 8 месяцев до 5 лет, в четырех исследованиях – подростки 14-20 лет. Длительность исследований составила от 2 месяцев до 3,5 лет. Шесть работ описывают применение фтористого лака у детей, три исследования – применение кальций-фосфатных гелей с фторидами в сравнении с фтористым лаком. Состояние эмали определялось различными способами: визуальный метод, фотографирование с цифровой обработкой, анализ рентгенограмм, QLF (метод количественной световой флюоресценции), метод лазерного флуоресцентного анализа (Diagnodent). Распространенность и интенсивность кариеса оценивалась по индексам dmft, ICDAS, приросту показателей кариеса, WSL (индекс очаговой деминерализации), оценке динамики площади поражения зубов. В контрольных группах в большинстве работ применялись по обычной схеме пасты с содержанием фторид-иона от 1000 до 1500 ppm. Ни в одном из представленных исследований статистически не доказана дополнительная профилактическая эффективность применения фтористых лаков.

Заключение

Заключение. При анализе РКИ не выявлено явных преимуществ применения фтористых лаков для профилактики кариеса у детей и подростков по сравнению со стандартными процедурами гигиены полости рта с использованием фторсодержащих паст.

Relevance

Relevance. The systematic review aimed to evaluate the effectiveness of topical fluoride in children based on the analysis of modern randomized clinical trial (RCT) data.

Materials and methods

Materials and methods. This review was carried out using the PRISMA checklist (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The proposed criteria determined the quality of the studies for inclusion in the review and then during the result summary. A preliminary search was conducted among articles published between 2013 and 2023 where fluoride varnishes were one of the preventive products. The search included MeSH terms, the keywords "fluorides", "fluorine varnish", "caries prevention", "remineralisation", and "children". A preliminary search found 346 studies. After excluding duplicates and irrelevant studies, two independent reviewers analysed nine RCTs based on the PRISMA criteria.

Results

Results. Children aged eight months to five years old participated in five out of nine RCTs on the fluoride varnish application included in the review, and four studies included adolescents aged 14–20 y.o. The duration of the studies ranged from 2 months to 3.5 years. Six studies described the use of fluoride varnish in children, and three studies reported on the application of calcium phosphate gels with fluoride versus fluoride varnish. Various ways determined enamel condition, namely, visual method, digitally processed photography, analysis of radiographs, QLF (quantitative light fluorescence method), and laser fluorescence analysis method (Diagnodent). The dmft, ICDAS indices, caries increment, the WSL (white spot lesion) index, and the assessment of changes in the tooth damage area evaluated the prevalence and intensity of caries. In the control groups, most studies used 1000 to 1500 ppm fluoride toothpastes according to the usual scheme. None of the studies statistically proved the additional preventive effectiveness of the fluoride varnishes.

Conclusions

Conclusions. The analysis of RCTs did not reveal the advantages of fluoride varnishes for caries prevention in children and adolescents compared to standard oral hygiene procedures using fluoride toothpastes.

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The authors declare that there are no conflicts of interest present.