Topical fluoride-antibacterial agent combined therapy versus topical fluoride monotherapy in preventing dental caries: a systematic review and meta-analysis

Purpose: To compare the effectiveness of topical fluoride-antibacterial agent combined therapy versus topical fluoride monotherapy in preventing dental caries among 1- to 16-year-old children.

Methods: PubMed, EbscoHost, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were searched for randomised controlled trials. The trials should have assessed the caries-preventive effectiveness of topical fluoride-antibacterial agent (Povidone Iodine/Chlorhexidine/Xylitol/Triclosan/Cetylpyridinium Chloride) combined therapy versus topical fluoride monotherapy among children. Out of 3475 records that were screened, full text of 41 articles was assessed for potential inclusion. Sixteen trials that fulfilled the eligibility criteria were subjected to qualitative synthesis. The risk of bias was assessed using the Cochrane Collaboration's tool. Continuous data from nine trials were pooled using Inverse Variance test in meta-analysis function of Review Manager (version 5.4). GRADE approach was used to analyse the certainty of evidence. Statistical heterogeneity was quantified using the I² statistic. A p-value of < 0.05 was considered as statistically significant.

Results: With respect to the caries increment, combined therapy showed superior caries-preventive effectiveness than topical fluoride monotherapy [SMD - 0.12, 95% CI (- 0.2 to - 0.04), p = 0.004; (I² = 20%, p = 0.29)]. No significant difference was noted between the two groups for the post-intervention salivary S mutans count [SMD - 0.11, 95% CI (- 0.33 to 0.1), p = 0.3; (I² = 0%, p = 0.77)].

Conclusion: The pooled analysis indicates towards an added benefit of topical fluoride-antibacterial agent combined therapy over topical fluoride monotherapy in preventing dental caries incidence among children. However, the results may be interpreted with caution since the evidence generated is of low certainty and is driven by two studies on Xylitol, thus it demands further good quality trials.

Keywords: Antibacterial agent; Dental caries; Streptococcus mutans; Topical fluoride.