Interventions for dental fluorosis: A systematic review

Objective Dental fluorosis has considerable implications on the patients' quality of life. The present study assesses the comparative effectiveness of the various interventions for the treatment of fluorosed enamel. Materials and Methods Nine databases were searched from inception to December 2016 for randomized trials. After duplicate study selection, data extraction, and risk of bias assessment, mean differences (MD) or Relative Risks and the corresponding 95% confidence intervals (CIs) were calculated and assessed with the GRADE approach. Results Six trials with a total of 348 patients (at least 40% male/60% female) with a mean age of 17.7 years treated with bleaching, microabrasion, or resin infiltration were included. Evidence of low quality indicated that microabrasion resulted in smaller esthetic improvement compared to bleaching (MD = -2.9; 95% CI = -3.4 to -2.5). Evidence of moderate quality indicated that compared to bleaching a greater esthetic improvement was seen with resin infiltration (MD = 3.6; 95% CI = 2.7-4.6) or a combination of bleaching with resin infiltration (MD = 3.5; 2.8-3.7). However, all comparisons were supported from single trials and therefore caution is warranted. Conclusions Based on the existing limited evidence, resin infiltration seems to be the most promising treatment for dental fluorosis, followed by bleaching and microabrasion. Clinical Significance For this systematic review, which was registered beforehand in PROSPERO (CRD42016053492), we synthesized evidence from existing randomized clinical trals on humans to see which treatment is most effective for the esthetic rehabilitation of dental fluorosis, the prevalence of which is seeing a worldwide steady increase. We found that resin infiltration seems to be the most effective treatment approach for lesions of mild to moderate severity, followed by bleaching, and finally microabrasion. Our study's strengths are its a priori registration, wide search, quality check according to Cochrane guidelines, and the use of a new robust analytic method to provide valid clinical recommendations according to the principles of evidence-based medicine.