The additional benefit of professional fluoride application for children as an adjunct to regular fluoride toothpaste: a systematic review and meta-analysis

Yu, Lintong; Yu, Xueqian; Li, Yueyang; Yang, Fengjiao; Hong, Jialan; Qin, Danchen; Song, Gaoyuan; Hua, Fang

doi:10.1007/s00784-021-03909-5

Cited by 9 publications

(7 citation statements)

References 40 publications

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“…The results of our study demonstrated no significant differences in preventing approximal caries development among the 3 groups after controlling for cluster effects and confounding factors based on the 18-month follow-up. The results of the present study support a recent systematic review that concluded that fluoride varnish had a modest and uncertain effect on preventing caries development in children [ 22 , 23 ]. The findings of this study were also consistent with a recent systematic review and network meta-analysis [ 24 ], that for the application of 5% NaF varnish, there may be a higher chance of arresting non-cavitated lesions as compared with no treatment; however, the results were not statistically significant.…”

Section: Discussionsupporting

confidence: 86%

The effectiveness of topical fluoride agents on preventing development of approximal caries in primary teeth: a randomized clinical trial

Sirivichayakul,

Jirarattanasopha,

Phonghanyudh

et al. 2023

BMC Oral Health

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Background This 18-month randomized clinical trial aimed to compare the effectiveness of two topical fluoride applications versus placebo control on preventing development of approximal caries in primary teeth. Methods Preschool children were recruited if they had at least one initial approximal carious lesion at the distal surface of the canines, both approximal surfaces of the first molars, or the mesial surface of the second molars assessed from bitewing radiographs. The participants were randomly allocated into 3 intervention groups: Group 1 (placebo control), Group 2 (5% sodium fluoride [NaF] varnish), and Group 3 (38% silver diamine fluoride [SDF]). All agents were applied semiannually. Two calibrated examiners evaluated the caries development from bitewing radiographs. Caries development was recorded when the baseline sound surface or initial approximal carious lesion surface developed dentin caries (beyond the outer one-third of dentine) at the follow-up examination. The intention-to-treat approach was adopted. The Chi-square test was used to analyze the effectiveness of topical fluoride agents in preventing approximal caries development and the effect of other variables. The multi-level logistic regression analysis was performed to assess the relative effectiveness of topical fluoride agents in preventing approximal caries development at the 18-month follow-up. Results At baseline, 190 participants with 2,685 sound or initial carries at the approximal surfaces were recruited. No differences in participant demographic backgrounds, oral health related habits, or caries experience were observed among the 3 groups (P > 0.05). After 18 months, 155 (82%) participants remained in the study. The rates of developing approximal caries in Groups 1, 2, and 3 were 24.1%, 17.1%, and 27.2%, respectively (P < 0.001, χ2 test). After adjusting for confounding factors and clustering effect, the multilevel logistic regression analysis showed no differences in caries development rates between the 3 groups (P > 0.05). Tooth type and the extent of a carious lesion at baseline were the significant factors for caries development. Conclusion At 18-month follow-up, after adjusting for confounding factors and clustering effect, there were no statistically significant differences in preventing of approximal caries development between the semiannual application of 5%NaF, 38%SDF, or placebo. Trial registration The study was registered in the Thai Clinical Trials Registry under the number TCTR20190315003 on 15/03/2019.

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Section: Discussionsupporting

confidence: 86%

The effectiveness of topical fluoride agents on preventing development of approximal caries in primary teeth: a randomized clinical trial

Sirivichayakul,

Jirarattanasopha,

Phonghanyudh

et al. 2023

BMC Oral Health

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“…18 However, some clinical trials have shown no benefits in using fluoride varnish to reduce the incidence of caries in preschool children regardless of whether they were exposed 9,10,19 to fluoridated water and/or fluoridated toothpaste, or not. 20 T he World Hea lt h Orga n i zat ion (WHO) recommends two to four fluoride applications a year in children at high risk for caries, 1 but this frequency may not be effective in controlling ECC. 21 The contradictory results in the literature 9,10,14,18,20 can be explained by the methodological differences between studies, such as the heterogeneity of patients in presence or absence of caries at baseline and the interval between varnish applications.…”

Section: Discussionmentioning

confidence: 99%

“…20 T he World Hea lt h Orga n i zat ion (WHO) recommends two to four fluoride applications a year in children at high risk for caries, 1 but this frequency may not be effective in controlling ECC. 21 The contradictory results in the literature 9,10,14,18,20 can be explained by the methodological differences between studies, such as the heterogeneity of patients in presence or absence of caries at baseline and the interval between varnish applications. In the present study, the incidence of caries was higher in children with ECC at baseline than in children without caries, corroborating the findings of another study 9 and consistent with previous experience that caries is an important predictor of the occurrence of new lesions 6 .…”

Section: Discussionmentioning

confidence: 99%

Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial

et al. 2022

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The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d 2 when enamel/dentin were affected and d 3 when dentin affected. Pearson's Chi-square, Fisher's Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d 2 mfs was 1.36 (95% CI = 0.83 -1.89) in the NFG and 1.33 (95% CI = 0.75 -1.89) in FV (p=0.756) groups. Increment of caries in d 3 mfs was 1.60 (95% CI = 0.95 -2.25) in NFG and 1.40 (95% CI = 0.75 -2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.

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“…In countries with community water fluoridation, such as the USA and Australia, fluoride varnish is recommended only for patients with increased caries risk, but in those countries with no water fluoridation or a small concentration of fluoride in drinking water (e.g., England, Scotland) fluoride varnish is indicated for caries prevention in all children and adolescents [52]. Furthermore, a recent systematic review and metaanalysis performed by Yu et al (2021) showed that fluoride varnish did not add significant caries-preventive benefits for children under 8 years old using regular fluoride toothpaste with ≥1000 ppm (low to moderate certainty evidence) [53] Ferreira et al conducted an RCT regarding the therapeutic effect of two fluoride varnishes on white spot lesions, finding a similar effect for both materials after four applications. A preventive fraction of 80% was found, associated with a reduction in the magnitude of WSL [54].…”

Section: Fluoride Varnishesmentioning

confidence: 99%

Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents

et al. 2022

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This review aims to evaluate the effectiveness of professional topical fluoride application on the prevention of dental caries in primary and permanent dentition. A web search was conducted for English papers published from 2000 to 2020, using various digital resources (Pubmed, Google Scholar, Cochrane Library, and ResearchGate). The keywords were “professionally applied fluoride”, “fluoride gel”, “fluoride varnish”, “fluoride foam”, “fluoride mouthrinses”, and “non-cavitated caries lesions”. Inclusion criteria: (a) participants: children and adolescents, treated in a dental care setting; (b) intervention: professionally applied fluorides (gel, varnish, foam, mouthrinse); (c) comparator: no professional treatment or other preventive treatments; (d) outcomes: clinical effectiveness (e.g., caries reduction, tooth remineralization); (e) study design: randomized controlled trials, systematic reviews, meta-analyses; (f) publication period: 1 January 2000–31 December 2021. Clinical studies about home-use fluoride products, discussion papers, in-vitro studies, case reports, non-English articles, and studies with unclear methodology were excluded. Topical fluoride applications are indicated for patients with active smooth surface caries and for patients in high caries risk groups. Both APF gel and fluoride varnish are effective and can be recommended for caries prevention in primary and permanent teeth. For children under the age of 6, only 2.26% fluoride varnish is recommended.

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The additional benefit of professional fluoride application for children as an adjunct to regular fluoride toothpaste: a systematic review and meta-analysis

Cited by 9 publications

References 40 publications

The effectiveness of topical fluoride agents on preventing development of approximal caries in primary teeth: a randomized clinical trial

The effectiveness of topical fluoride agents on preventing development of approximal caries in primary teeth: a randomized clinical trial

Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial

Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents

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