| Objective:The efficacy of common fluoride in the treatment of dentin hypersensitivity（DH）was comprehensively and systematically evaluated,compared and ranked by using the method of network meta-analysis（NMA）,providing further scientific basis for the treatment of dentin hypersensitivity.Methods:In this study,we searched 8 medical electronic databases,supplemented by manual searches,to retrieve the clinical randomized controlled trials（RCTs）on fluoride treatment of DH in the databases of China National Knowledge Infrastructure（CNKI）,VIP data,Wanfang data,China Biomedical Literature Database（CBM）,Pubmed,Embase,Web of Science,Cochrane Library.With the search time limit of November 2022.Patients aged 17 years or older with DH and in good health were included.Inclusion and exclusion criteria were established.The quality of the included literatures was assessed using Revman5.41 software according to the Cochrane systematic review"risk assessment of bias"table,and data were extracted and a feature table of the included literatures was developed.Outcome indicators for air stimulation measure method of visual analog scale（VAS）,Schiff air sensitivity（Schiff）.Learning method incorporating the continuity in frequency variable data and calculate the effect of Standardized mean difference（SMD）and 95%Confidence interal（CI）.The network meta-analysis was performed using by stata15 software.Three groups of NMA were performed.The first group was the fluoride toothpaste treatment of DH NMA:Sodium fluoride（NaF）toothpaste,0.454% Stannous fluoride（SnF2）toothpaste,amine toothpaste（AmF）,0.76%Sodium Monofluorophosphate（SMFP）toothpaste and placebo.The second group was fluoride desensitization treatment agent DH NMA:Bifluorid 12,5%or 6%NaF varnish,75%NaF glycerin,Silver diamine fluoride（SDF）compared to placebo,the third group was the fluoride and laser treatment of DH NMA:Fluoride,laser,combined fluoride and laser therapy.Results:1.A total of 1924 relevant literatures were retrieved,and 25 literatures were finally included after screening,involving 3268 patients and about 7403 teeth.2.When evaluating literature quality,2 studies were classified as having low risk of bias,7 studies were classified as having high risk of bias,and 17 studies were classified as having medium risk.3.In terms of effectiveness,at 2 weeks,the effect of AmF toothpaste on DH was higher than that of SMFP toothpaste[SMD=-0.63,95%CI（-1.09,-0.16）],and the effect of AmF toothpaste on DH was higher than that of NaF toothpaste[SMD=-0.44,95%CI（-0.87,-0.02）].The effect of placebo toothpaste on DH was higher than that of SMFP toothpaste[SMD=-0.34,95%CI（-0.68,-0.01）].At 6 weeks,the efficacy of AmF toothpaste for DH was higher than placebo toothpaste[SMD=-1.74,95%CI（-3.43,-0.06）].In subgroup analysis,SnF2toothpaste was more effective than SMFP toothpaste in the treatment of DH [immediately SMD=-0.52,95%CI（-0.69,-0.36）;3day SMD=-1.04,95%CI（-1.2,-0.89）].There was no statistical difference between the other treatment groups.For the longest follow-up time,the efficacy of 5%or 6%NaF varnish for DH was higher than that of placebo,and the difference was statistically significant[SMD=-4.03,95%CI（-7.59,-0.47）].There was no statistically significant difference between the other treatment groups.The DH efficacy of combined fluoride and laser therapy was higher than that of laser therapy[SMD=-1.37,95%CI（-2.65,-0.08）],and the DH efficacy of combined laser therapy was higher than that of fluoride therapy [SMD=-2.64,95%CI（-4.02,-1.27）].The effectiveness of laser treatment for DH was higher than that of fluoride treatment[SMD=-1.28,95%CI（-2.3,-0.25）],and the differences were statistically significant.At 2 weeks,the order of DH effectiveness of fluoride toothpaste may be SnF2toothpaste,AmF toothpaste,placebo,NaF toothpaste,SMFP toothpaste;at 4 weeks,the order of DH effectiveness of fluoride toothpaste may be SnF2toothpaste,AmF toothpaste,SMFP toothpaste,placebo,NaF toothpaste;at 6 weeks,the order of DH effectiveness of fluoride toothpaste may be:AmF toothpaste,SnF2toothpaste,placebo,at 8 weeks,the order of effectiveness of fluoride toothpaste for DH treatment may be:AmF toothpaste,SnF2toothpaste,placebo,SMFP toothpaste,NaF toothpaste,in-clinic medication:5%or 6%NaF varnish,75%NaF glycerin,Bifluorid 12,SDF,placebo,fluoride laser treatment DH:Fluoride+laser,laser,fluoride.Conclusion:The effectiveness of AmF toothpaste in the treatment of DH was better than SMFP toothpaste,NaF toothpaste and placebo toothpaste;the effectiveness of SnF2toothpaste in the treatment of DH was better than SMFP toothpaste;there was no significant difference between SMFP toothpaste,NaF toothpaste and placebo toothpaste.Efficacy of 5%or 6%NaF varnish for DH was superior to placebo,and there was no significant difference between 75%NaF glycerin,Bifluorid 12,SDF,and placebo.The combination of fluoride and laser therapy is more effective than laser therapy or fluoride therapy for DH.In future treatment,AmF toothpaste should be given priority for home application,and 5%or 6%NaF varnish should be given priority for clinic treatment.It is suggested that laser combined with fluoride desensitization agent should be used for DH treatment. |
