Summary of findings 2. Fluoride toothpaste with higher versus lower concentration of fluoride for preventing caries in children and adolescents (immature permanent dentition) ‐ NMA estimates.
| The effects of fluoride toothpaste with higher versus lower concentration of fluoride for preventing caries in children and adolescents ‐ NMA estimates | ||||||
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Population: children and adolescents between 5 and 15 years of age at the start of the study Setting: home, school Intervention: toothbrushing with higher fluoride concentration toothpaste Comparison: toothbrushing with lower fluoride concentration toothpaste Outcomes: immature permanent dentition: D(M)FS, D(M)FT (all follow‐ups: closest to 36 months) | ||||||
| Comparison | Relative effect SMD (NMA estimate) (95% CI) | Studies* | Certainty of evidence (GRADE) | Relative effect SMD (NMA estimate) (95% CI) | Studies* | Certainty of evidence (GRADE) |
| Caries increment (surface index D3(M)FS) | Caries increment (tooth index D3(M)FT) | |||||
| 250 versus 0 ppm F | ‐0.15 (‐0.25 to ‐0.05) |
3 | lowa, b, c | ‐0.11 (‐0.27 to 0.05) |
1 | lowa, b, c |
| 440 to 550 versus 0 ppm F | ‐0.12 (‐0.31 to 0.07) |
2 | lowa, c, d | ‐0.18 (‐0.41 to 0.04) |
2 | lowa, c |
| 1000 to 1250 versus 0 ppm F | ‐0.28 (‐0.32 to ‐0.25) |
55 | higha, d | ‐0.26 (‐0.31 to ‐0.21) |
41 | higha |
| 1450 to 1500 versus 0 ppm F | ‐0.36 (‐0.43 to ‐0.29) |
4 | moderatea, d | ‐0.39 (‐0.49 to ‐0.28) |
4 | moderatea |
| 1700 to 2200 versus 0 ppm F | ‐0.32 (‐0.41 to ‐0.22) |
‐ | lowa, d | ‐0.33 (‐0.56 to ‐0.11) |
‐ | lowd, e |
| 2400 to 2800 versus 0 ppm F | ‐0.41 (‐0.49 to ‐0.33) |
3 | lowa, b, c | ‐0.39 (‐0.52 to ‐0.25) |
2 | lowa, c, d |
| 440 to 550 versus 250 ppm F | 0.03 (‐0.17 to 0.23) |
1 | lowa, b, c | ‐0.08 (‐0.32 to 0.17) |
1 | lowa, c, d |
| 1000 to 1250 versus 250 ppm F | ‐0.14 (‐0.24 to ‐0.04) |
7 | lowa, b, c | ‐0.15 (‐0.31 to 0) |
3 | lowa, c, d |
| 1450 to 1500 versus 250 ppm F | ‐0.21 (‐0.33 to ‐0.10) |
‐ | lowa, d | ‐0.28 (‐0.47 to ‐0.09) |
‐ | lowa, d |
| 1700 to 2200 versus 250 ppm F | ‐0.17 (‐0.30 to ‐0.04) |
‐ | lowa, d | ‐0.23 (‐0.50 to 0.05) |
‐ | lowd, e |
| 2400 to 2800 versus 250 ppm F | ‐0.26 (‐0.38 to ‐0.14) |
‐ | lowa, d | ‐0.28 (‐0.48 to ‐0.08) |
‐ | lowa, d |
| 1000 to 1250 versus 440 to 550 ppm F | ‐0.16 (‐0.35 to 0.03) |
1 | lowa, d | ‐0.08 (‐0.30 to 0.15) |
1 | lowa, c, d |
| 1450 to 1500 versus 440 to 550 ppm F | ‐0.24 (‐0.44 to ‐0.04) |
‐ | lowa, d | ‐0.20 (‐0.45 to 0.04) |
‐ | lowa, d |
| 1700 to 2200 versus 440 to 550 ppm F | ‐0.20 (‐0.41 to 0.01) |
‐ | lowa, d | ‐0.15 (‐0.46 to 0.16) |
‐ | lowa, d |
| 2400 to 2800 versus 440 to 550 ppm F | ‐0.29 (‐0.49 to ‐0.08) |
‐ | lowa, d | ‐0.20 (‐0.46 to 0.05) |
‐ | lowa, d |
| 1450 to 1500 versus 1000 to 1250 ppm F | ‐0.08 (‐0.14 to ‐0.01) |
10 | moderatea | ‐0.13 (‐0.23 to ‐0.02) |
4 | lowa, b |
| 1700 to 2200 versus 1000 to 1250 ppm F | ‐0.03 (‐0.12 to 0.06) |
5 | lowc, e | ‐0.07 (‐0.30 to 0.15) |
1 | very lowc, d, e |
| 2400 to 2800 versus 1000 to 1250 ppm F | ‐0.12 (‐0.20 to ‐0.05) |
6 | lowa, b, c | ‐0.12 (‐0.25 to 0.01) |
3 | very lowb, c, e |
| 1700 to 2200 versus 1450 to 1500 ppm F | 0.04 (‐0.07 to 0.15) |
‐ | moderatea | 0.05 (‐0.19 to 0.30) |
‐ | lowa, b, d |
| 2400 to 2800 versus 1450 to 1500 ppm F | ‐0.05 (‐0.14 to 0.05) |
2 | moderatea | 0 (‐0.16 to 0.17) |
‐ | lowa, f |
| 2400 to 2800 versus 1700 to 2200 ppm F | ‐0.09 (‐0.20 to 0.02) |
1 | lowa, e | ‐0.05 (‐0.27 to 0.17) |
‐ | very lowb, e, g |
| *Indirect evidence only is indicated by ‐ CI: confidence interval; D(M)FS: decayed, missing, filled surfaces (permanent dentition); D(M)FT: decayed, missing, filled teeth (permanent dentition); D3: dentinal/cavitated caries lesions level; F: fluoride; NMA: network meta‐analysis; ppm: parts per million; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: 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 certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded (some concerns) for within‐study bias. bDowngraded (some concerns) for heterogeneity: prediction interval extends into clinically important or unimportant effects. cDowngraded (some concerns) for incoherence: lack of agreement of the direct and indirect estimates relative to the clinically important value (0.30 SMD). dDowngraded (some concerns) for imprecision: 95% CI extends into clinically important effects (0.30 SMD). eDowngraded (major concerns) for within‐study bias. fDowngraded (major concerns) for heterogeneity: prediction interval extends into clinically important or unimportant effects. gDowngrade (major concerns) for incoherence: lack of agreement of the direct and indirect estimates relative to the clinically important value (0.30 SMD).