Comparison of Oral Health Education and Fluoride Varnish to Prevent Early Childhood Caries: A Randomized Clinical Trial

Abstract

Early childhood caries, a serious health problem among young children, can be prevented with effective intervention. The aim of this study was to evaluate the efficacy of oral health education and a fluoride varnish in the prevention of caries in children under the age of 3 years. For this single-blind randomized parallel group 1-year clinical trial in Shiraz, 300 children aged 12-24 months with sound primary teeth were selected and randomly divided into three groups (n = 100): (1) control: no preventive intervention; (2) oral health counseling, and (3) oral health counseling and fluoride varnish at baseline and 6 months later. At baseline and 4, 8 and 12 months after the intervention, caries risk reduction was recorded as the primary outcome. The mothers' knowledge and performance regarding oral health in children was used as a secondary outcome. A total of 260 children (mean age: 20.49 ± 7.33 months) completed the study. Compared to group 1, caries risk reduction in group 2 was 28% (95% CI: -39.05 to -17.45) and 31% in group 3 (95% CI: -41.88 to -21.73). However, there was no significant difference between groups 2 and 3 (95% CI: -8.58 to 1.47). In all groups, mothers' knowledge and performance at baseline were low; however, they increased significantly in follow-up appointments in groups 2 and 3 (p < 0.001). Oral health education increased mothers' knowledge and performance regarding oral health in children. Oral health counseling alone or associated with the use of fluoride varnish reduced the caries incidence in young children.

Industry sponsorship in trials on fluoride varnish or gels for caries prevention

“…The lower efficacy of fluoride varnish and fluoride gels in more recent trials should be born in mind when discussing the application of fluoride varnish and fluoride gels nowadays. In fact, very recent trials (which were not included in the Cochrane reviews and thus not included in the present study), even found no efficacy of fluoride varnishes compared with no or alternative (nonfluoride) interventions, or found this efficacy to be restricted to highly compliant groups …”

“…That is likely due to earlier trials being performed in times of significantly higher caries increment, and fluoride toothpastes not being as with no or alternative (nonfluoride) interventions, or found this efficacy to be restricted to highly compliant groups. [18][19][20] Sponsored trials used fluoride gels instead of fluoride varnishes significantly more often than trials with no or unclear sponsorship status, something which we could not find to impact on synthesized efficacy, but might be explained by fluoride gels having a wider market (as they are oftentimes applied at home) than fluoride varnishes (which are only applied in dental office). Moreover, sponsored trials always employed two or more comparators; that is, were minimum three-armed.…”

Impact of Health Promotion Interventions on Early Childhood Caries Prevention in Children Aged 2–5 Years Receiving Dental Treatment Under General Anesthesia

“…Dental caries is mostly preventable through controlling several factors affecting its onset and progression, such as dietary practices, preventive care, certain drugs (7,10), and improved oral health literacy (11). Oral health preventive strategies for the whole family, such as educational intervention beside childfocused preventive strategies, have shown to be important for pediatric oral health preservation (4,12,13). Oral health education in various aspects such as tooth brushing, dietary and feeding habits, and regular dental visits, together with using fluoride supplementation have been well-documented as useful methods for ECC prevention (12)(13)(14).…”

Cost‐effectiveness of caries‐preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk

“…This “redentistry” has been found to be the relevant driver of costs, as it is usually more complex and expensive than initial treatments . Moreover, the efficacy of the varnish in contemporary populations needs to be considered, with more recent trials finding only very limited or no health benefit from fluoride varnishes …”

“…6,7 Moreover, the efficacy of the varnish in contemporary populations needs to be considered, with more recent trials finding only very limited or no health benefit from fluoride varnishes. [8][9][10][11][12][13] A number of health economic studies have found fluoride varnish applications to be beneficial for health, but costlier than not providing fluoride varnish. [14][15][16][17] None of these studies fully incorporated the full sequence of events following a lesion development or considered the likelihood of differential efficacy of varnishes in populations with different caries risk.…”