Which of the preventive agents perform best for prevention of early childhood caries?

Abstract

A comprehensive search strategy was planned a priori and accordingly three electronic databases including Medline, Embase, and Cochrane CENTRAL with no language and time restrictions were searched for finding the relevant literature. Hand searching of the relevant articles was also done to retrieve other possible studies. Both parallel and split-mouth RCTs with a minimum follow-up period of 2 years were included. Non-randomised studies were also selected. Data about study characteristics, demographic and clinical parameters, assessed outcome, outcome assessment methods etc. were retrieved by two independent authors. Network meta-analysis (NMA) was carried for two different outcomes viz caries increment and caries incidence. For the purpose of NMA, standardized mean difference (SMD) was calculated for analysing the continuous outcome (caries increment) while Odds ratio was used for dichotomous outcome (caries incidence at individual level). A total of 3807 publication were retrieved and after sifting 33 RCTs and other quasi-randomised/ non-randomized studies were selected for this NMA. Network diagrams were created and two NMAs were carried; one for caries increment and another for caries incidence. A total of 18 preventive agents were explored for caries increment and amongst these, only Fluoride-foam and Fluoride-salt exhibited significant better prevention than the control; with SMD and confidence interval values of 0.69 (0.32-1.06) and 0.66 (0.13-1.20) respectively. While for caries incidence outcome 11 preventive agents could be included out of which, Probiotic-milk + LowF toothpaste, Fluoride-foam, Fluoride-Varnish, and FV + HFTP exhibited significant higher odds of caries prevention; and the odds ratio with 95% confidence intervals were 0.34 (CI = 0.15-0.77), 0.48 (CI = 0.37-0.63), 0.63 (CI = 0.48-0.81), and 0.73 (CI = 0.57-0.93) respectively. SUCRA rankings were also obtained for both the outcomes. Fluoride preparations, namely Fluoride-Foam (FF), Fluoride-Salt(FS) and Probiotic Milk+ Low-F toothpaste(PMLFTP), Fluoride-varnish(FV) and Fluoride-varnish+ High-F toothpaste (FVHFTP) were found to be effective in preventing early childhood caries.