Fluoride gel applications reduce caries incidence

Abstract

Question: Do fluoride gels reduce dental caries?Objective: To determine the effectiveness and safety of fluoride gels in the prevention of dental caries in children and to determine the relationship to initial caries severity, background exposure to fluoride, and the mode and frequency of gel use.Data Sources: The purpose was to identify all relevant studies from 1965. Electronic searching of the MEDLINE, EMBASE, SCISEARCH, SSCISEARCH, ISTP, BIOSIS, CINAHL, ERIC, Dissertation Abstracts, LILACS/BBO databases and of the Cochrane Controlled Trial and Medline registers has been attempted. Furthermore, all eligible trials, meta-analyses and review articles were scanned for relevant references. In addition 7 journals were hand searched and personal contact with authors and manufacturers was achieved while searching for unpublished data.Study Selection: Exclusively RCTs and quasi-RCTs with blind outcome assessments, comparing groups applying fluoride gel with placebo or no treatment groups consisted of children up to 16 years old at baseline were included in this review. Studies were excluded where the participants were selected on the basis of special health conditions, were carrying orthodontic bands (or other appliances), and/or used additional caries preventive agents (eg chlorhexidine or sealants etc.), as well as studies that provided results only on plaque/ gingivitis, calculus, dentin hypersensitivity or physiological fluoride. Data Extraction and Synthesis:The first reviewer assessed the quality of all included studies. The second reviewer duplicated the process for a random sample of 1/3 of them. In addition, the 2nd reviewer independently assessed any study that could not be classified by the first. A third reviewer was consulted to resolve any disagreement. Attempts were made to contact authors of trials that could not be classified in order to ascertain whether the inclusion criteria were met. Agreement was good for allocation (kappa=0.61) and blinding (kappa=0.73). There was a considerable difference in the quality of the 25 studies in this review. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects meta-regression analyses.Results: Twenty-five studies were included, involving 7747 children. For all the 23 trials, that contributed data for meta-analyses, combined the DMFS pooled prevented fraction estimate was 0.28, suggesting a substantial benefit from the use of fluoride gel. Statistically significant heterogeneity was observed (p50.0001). Univariate meta regression analysis suggested no significant association between estimates of DMFS prevented fractions and length of followup, allocation concealment, blinding of outcome assessment or drop out rate. Populations with a caries incidence of 2.2 DMFS/year had an NNT=2 (95% CI=1 to 3). For populations with a caries incidence of 0.2 DMFS/yr had an NNT=24 (95% CI=18 to 36). A funnel plot suggests a balancing asymmetry with a single large study demonstrating the largest pos...

Feasibility of including APF gel application in a school oral health promotion program as a caries-preventive agent: a community intervention trial

“…The percentage of caries reduction in the experimental group was 76.5% on the occlusal surface, 85.5% on the buccal surface and 83.3% on the lingual surface. The percentage of caries reduction in the present study was higher than in other studies (14)(15)(16)(17)(18) and the results obtained from various reviews and meta-analysis (19)(20)(21). This could be attributed to the fact that in all the above studies and reviews, incipient lesions were not recorded.…”

Caries-Inhibiting Effect of Professional Fluoride Gel Application in Low-Caries Children Initially Aged 4.5–6.5 Years

“…In a meta-analysis on the caries-reducing effect of fluoride gels in children and adolescents, a pooled estimated PF was found of 28% (95% CI: 19-37%) [Marinho et al, 2002]. In a commentary on the latter study, the effectiveness of fluoride gel in addition to fluoride toothpaste and fluoridated water was questioned as well as whether fluoride gel should be provided to all children or selectively applied either based on caries susceptibility of the individual or caries prevalence in the community [Weintraub, 2002]. In the present study several aspects brought forward in the above-mentioned commentaries are included, i.e.…”

Managing Early Childhood Caries for Young Children in China

“…Professionally applied fluoride gels usually contain 2% sodium fluoride or 1.23% acidulated phosphate fluoride. A review suggested that the application of fluoride gels, either professionally or self-applied, is associated with a great reduction in caries increment [ 40 ]. Moreover, the review reported that the effect was independent of other fluoride sources but did depend on application frequency.…”