Tuesday, 5 July 2011

Mouthrinse or not?

A student on clinic recommended mouthrinse for a patient who had caries. I was going to ask him to look up the evidence for this but forgot, so thought I'd do it myself...

By simply typing 'mouthrinse' into the TRIPdatabase and restricting to systematic reviews (I always start with these as they summarise all studies and if there aren't any that address my question begin searching for individual studies) I came up with a couple of relevant Cochrane reviews.

One found an advantage in using fluoridated mouthrinse in children / adolescents, with the benefit increasing as the caries rate increased even when fluoridated toothpaste was used. Fluoride mouthrinses for preventing dental caries in children and adolescents.

However, the other review suggested that whilst fluoridate mouthrinse may be beneficial it wasn't clear whether it was superior to fluoridated toothpaste alone. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents

In the patient we were discussing we were going to prescribe sodium fluoride 5000ppm toothpaste anyway (as opposed to the 1450ppm or so he has in his conventional toothpaste) so perhaps the benefit of adding fluoridated mouthrinse wouldn't be so great in this case.


  1. Hi Dr. Hurst
    My perio tutor suggested that I apply 2.2% duraphat fluoride varnish on my patient's teeth as she suffers from dentine hypersensitivity. I applied it to my patient's teeth and there was a noticeable reduction in hypersensitivity. I searched for the evidence on trip database and i found this one paper (no systemic reviews) http://www.ncbi.nlm.nih.gov/pubmed/16803829. Using this line of thought, I was thinking I could prescribe 5000ppm fluoride using the search "(duraphat fluoride) AND sensitivity" but I could not find anything.
    Can you suggest any other searches I could try?

  2. Hi. If you want to find evidence on the benefit of fluoride for sensitivity then your search is beginning the right way.

    If you revert to the PICO format (see other posts here) then you might structure your clinical problem like this:

    P (patient/problem): dentine (hyper)senstivity
    I (intervention): 1.1% (5000ppm) sodium fluoride toothpaste
    C (comparison) : 1350ppm (normal) sodium fluoride toothpaste
    O (outcome) : reduction in sensitivity (measured in some sort of valid way)

    So you have suggested a search using the P and the I bit, which is fine. Often there's little point in including more than 2 of the 4 concepts.

    So, if you are to search any database you need to think of all the likely words that might be used for the P and the I.

    For P, I might think of: (dentine or dentin) AND (hypersentivity OR sensitivity OR sensitive)

    For the I: fluoride (I would avoid a brand name here) AND (toothpaste OR dentifrice)

    The paper you identified would be good to critically-appraise - see the CASP links in a blog on this blog but there clearly wasn't much difference between the two varnishes.

    The question would be: if they did find a difference, could we extrapolate the results from this higher concentration fluoride varnish to a lower concentration toothpaste? Without a study we would have to make a load of assumptions but may choose to use a high fluoride toothpaste and see. After all the cost to the patient would be relatively low and if it didn't work we wouldn't have done much harm.

    Thanks for the comment - let me know how you get on :-)