Evidence-Based Answer:
Fluoride mouth rinses and fluoride toothpastes used regularly at home reduce the incidence of dental caries about 25%. Professionally applied fluoride varnishes reduce carries by about 50%. (SOR A, based on systematic reviews of randomized controlled trials.) Pit and fissure sealants provide additional protection beyond fluoride varnishes. (SOR B, based on a meta-analysis with a small number of patients.)
A 2003 Cochrane review pooled 34 studies for meta-analysis to investigate the caries-inhibiting effect of fluorinated mouth rinses in 14,600 children over a period of 2 to 3 years. Of the studies selected, 29 were double-blinded, 3 were blinded, and 4 were unclear as to what outcome assessment was used. The mouth rinses were administered under supervision in school programs at a frequency of 3 to 330 times per year. The fluorides used were acidulated phosphate fluoride (APF), sodium fluoride (NaF), amine fluoride (AmF), sodium monofluorophosphate (SMFP), ammonium fluoride (NH4F), and stannous fluoride (SnF2). When rinsing, 16 of the trials used a concentration of 900 ppm fluoride once or twice per week. Across all studies, concentrations of fluoride varied between 100 and 3,000 ppm in volumes of 5 or 10 mL. Rinse times were between 1 and 2 minutes. There was a 26% reduction of caries found on the surfaces of teeth in children who used fluorinated mouth rinse treatments compared with placebo or no treatment (95% confidence interval [CI], 0.23–0.30; P less than .0001).1
A 2003 meta-analysis, in which 70 double-blinded studies were pooled, examined the effect of fluoride toothpastes on 42,300 children over a period of 1 to 7 years. Children brushed their teeth with fluoride or placebo toothpaste once or twice daily. The fluoride compounds used were APF, NaF, AmF, SMFP, and SnF2. Concentrations of fluoride varied between 250 and 2,500 ppm. There was a 24% reduction of caries in children brushing with fluoride toothpaste compared with placebo (95% CI, 0.21–0.28; P less than .0001).2
A 2002 Cochrane review, in which 7 studies were pooled for meta-analysis, evaluated the caries-inhibiting effect of fluoride varnish in 2,790 children over a period of 1 to 4.5 years. Of the studies selected, 3 were double-blinded, 5 blinded, and 1 was unclear as to what outcome assessment was used. Dental professionals applied varnish to the teeth with a small brush, probe, or cotton swab 2 to 4 times per year. The fluoride varnishes studied were sodium fluoride–based (Duraphat®, Lawefluor®, and bifluoride 12) or difluorsilane. Concentrations of fluoride varied between 7,000 ppm (difluorsilane) and 56,300 ppm (sodium fluoride–based varnishes) in a volume of 0.5 mL per child for 1 to 4 minutes. The meta-analysis demonstrated a 46% reduction of caries in children who used fluoride varnish treatments compared with placebo or no treatment (95% CI, 0.30–0.63; P less than .0001).3
A 2002 meta-analysis, including 23 studies, examined the caries-inhibiting effect of topically applied fluoride gels in 7,747 children over a period of 1 to 4 years. Of the studies selected, 14 were double-blinded, 6 were blinded, and 5 were unclear as to what outcome assessment was used. The gel was administered either by tray or brush 1 to 140 times per year. The fluorides used were APF, NaF, AmF, and SnF2. Concentrations of fluoride varied between 2,425 ppm (SnF2) and 12,500 ppm (AmF and NaF) in volumes of 1 to 4 mL. Teeth were exposed to the fluoride gels between 2 and 12 minutes. Fluoride gels demonstrated a 28% reduction of caries compared with placebo or no treatment (95% CI, 0.19–0.37; P less than .0001).4
A 2006 Cochrane review of 4 studies investigated whether pit and fissure sealants or fluoride varnishes were superior for preventing dental caries in 317 people over a period of 1 to 9 years. Of the 4 studies, 2 utilized allocation concealment along with randomization. The remaining 2 studies used randomization with an unclear concealment approach. Three of the studies compared fluoride varnishes with pit and fissure sealants directly using either parallel study groups or a split-mouth design. One study compared a combination of fluoride varnish and pit and fissure sealant with fluoride varnish treatment alone. Three different types of sealants were used and applied to both sound and repaired surfaces of teeth. All studies used Duraphat as the fluoride varnish, which was applied twice yearly. Patients using pit and fissure sealants developed fewer caries compared with fluoride varnish after 24 months (risk ratio [RR]=0.75; 95% CI, 0.58–0.95) and 9 years (RR=0.48; 95% CI, 0.29–0.79). Patients using pit and fissure sealant in combination with fluoride varnish developed fewer caries compared with fluoride varnish alone after 24 months (RR=0.36; 95% CI, 0.21–0.61).5
HelpDesk Answer From EBP,
Micah D. Gaar, BS José E. Rodríguez, MD Elena B. Alexiev
Florida State University Tallahassee, FL
1. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003; (3):CD002284. [LOE 1a]
2. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003; (1):CD002278. [LOE 1a]
3. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents.Cochrane Database Syst Rev. 2002; (3):CD002279. [LOE 1a]
4. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2002; (2):CD002280. [LOE 1a]
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Category: D. Digestive System. Keywords: dental caries, prevention, fluoride, helpdesk answer
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 27 July 2010
