Fluoride Varnish in Nursery Schools: A Randomised Controlled Trial – Protecting Teeth @3

Abstract

Studies suggest that fluoride varnish (FV) application can reduce dental caries in child populations. The multiple-component national child oral health improvement programme in Scotland (Childsmile) includes nursery-based universal supervised toothbrushing and deprivation-targeted FV applications, together with community and dental practice prevention interventions. This trial, a double-blind, two-arm randomised control trial, aimed to assess the effectiveness and cost-effectiveness of the nursery-based FV applications plus treatment-as-usual (TAU) Childsmile programme interventions, compared to TAU Childsmile interventions alone, in children not targeted to receive nursery FV as part of the programme. Participating children in the first year of nursery (aged three), with or without existing caries, were randomised to either FV or TAU and followed up for 24 months until the first year of primary school. Treatments were administered at six-monthly intervals. The primary endpoint was “worsening of d3mft” from baseline to 24 months. Secondary endpoints were worsening of d3mfs, d3t, mt, and ft. Individual record-linkage captured wider programme activities and tertiary endpoints. A total of 1,284 children were randomised, leading to 1,150 evaluable children (<i>n</i> = 577 FV, <i>n</i> = 573 TAU, 10% dropouts). Mean age was 3.5 years, 50% were female (<i>n</i> = 576), 17% had caries at baseline (<i>n</i> = 195), all balanced between the groups. Most children received three/four treatments. Overall, 26.9% (<i>n</i> = 155) had worsened d3mft in the FV group, and 31.6% (<i>n</i> = 181) in the TAU group, with an odds ratio (OR) of 0.80 (0.62–1.03), <i>p</i> = 0.078. The results for worsening of the secondary endpoints were: d3mfs 0.79 (0.61–1.01) <i>p</i> = 0.063, d3t 0.75 (0.57–0.99) <i>p</i> = 0.043, mt 1.34 (0.75–2.39) <i>p</i> = 0.319, and ft 0.77 (0.53–1.14) <i>p</i> = 0.191. We calculated a number needed to treat of 21 and a cost of GBP 686 to prevent a single worsening of d3mft. There was a modest non-significant reduction in the worsening of d3mft in the nursery FV group compared to TAU, suggesting that this intervention is unlikely to represent an effective or cost-effective addition to the population oral health improvement programme.

Evaluation of a community‐based early childhood caries (ECC) intervention in Cambodia

“…5 The findings of the present study are more favourable than other recent fluoride varnish studies 10 ; some of which were underpowered, 11,12 and others conducted in populations with an ECC prevalence in 2-year-olds below 40%. [12][13][14][15][16][17][18] In some studies, only participants who had already reached 2 to 3 years of age with no clinical signs of dental caries were recruited. [17][18][19] Recent studies on fluoride varnish for prevention of ECC are centred on populations which do not match the characteristics of the Cambodian environment.…”

“…[12][13][14][15][16][17][18] In some studies, only participants who had already reached 2 to 3 years of age with no clinical signs of dental caries were recruited. [17][18][19] Recent studies on fluoride varnish for prevention of ECC are centred on populations which do not match the characteristics of the Cambodian environment. The explanation for the effectiveness of fluoride varnish therapy in the present study may include that it was placed: (a) at a time when the caries process was underway but the lesions were initial and non-cavitated; and/or (b) in the context of a population with universally high caries risk and low exposure to fluoride from other sources.…”

In vitro study of the preventive activity of fluoride varnish by X-ray diffraction

“…In our country, the knowledge of pediatric dentists about the new treatment concepts is still insufficiently thorough in terms of diagnosis and choice of treatment method. There are few developments for the selection of non-invasive methods in the application of mineralizing varnishes [23]- [25]. There are predominant publications about their prophylactic and therapeutic effect, mainly in permanent dentition.…”

Private Interests and the Start of Fluoride-Supplemented High-Carbohydrate Nutritional Guidelines

“…The effectiveness of some fluoride treatments in preventing dental caries remain overestimated. For instance, the recommendation by the United States Preventive Services Taskforce (USPSTF) that primary care clinicians apply fluoride varnish to all children 5 years and younger is puzzling as it is an intervention of marginal to no effectiveness [ 149 , 150 , 151 ]. Contrast the USPSTF’s clinical guideline with the 1945 New Hampshire Public Health Statement by the dental profession who felt “obligated to convey to the citizens” that “no baby was ever born crying for candy”, that “the cultivation of artificial appetites for candy should be avoided.” That even though fluoride may prove helpful, “it must be borne in mind that the fundamental cause of dental decay is sugar and starches” [ 152 ].…”