Effect of Supervised Toothbrushing on Caries Incidence

Objectives: To assess the effects of supervised toothbrushing on the incidence of caries in children and adolescents.
Methods: Systematic review of clinical trials testing supervised toothbrushing in comparison to a control group that did not receive supervised toothbrushing and appeared to be exposed to a toothpaste with the same fluoride concentration as the test group (CRD42014013879). A search for randomized or quasi-randomized clinical trials was carried out, without idiom restraints, in six electronic databases, registers of ongoing trials, meeting abstracts, dental journals and reference lists of potentially eligible studies. The search yielded 1078 records and 103 full-text articles were independently read by two reviewers. Data regarding characteristics of participants, interventions, outcomes, length of follow-up and potential of bias were independently extracted by the same reviewers. Any disagreement was solved by a third reviewer.
Results: Two trials were included. Both studies had high/unclear potential of bias concerning the following domains: sequence generation, allocation concealment, blinding and incomplete outcome data. One trial compared supervised toothbrushing with 500 ppm fluoride toothpaste (first graders) or 1000 ppm fluoride toothpaste (sixth graders) and oral hygiene instructions to oral hygiene instructions alone. The other trial compared supervised toothbrushing with a non active toothpaste to a group that did not receive supervised toothbrushing. The first trial found that children receiving supervised toothbrushing had a statistically significant lower incidence of decayed, missing and filed teeth when compared to children who received only oral hygine instructions. The second found no difference regarding the incidence of decayed, missing and filled teeth or surfaces among children undergoing daily supervised toothbrushing compared to those who were not supervised. No meta-analysis was perfomed due to the paucity and heterogeneity of the included studies.
Conclusions: There is a lack of reliable evidence regarding the effectiveness of toothbrushing supervision on caries incidence.