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Cited by 1,022Dental Health and Care UtilizationDental Erosion and TreatmentOral microbiology and periodontitis research

Fluoride varnishes for preventing dental caries in children and adolescents

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Marinho, Valeria CC, Worthington, Helen V, Walsh, Tanya, Clarkson, Jan E·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002279.pub2PMC PMC10758998
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Abstract

BACKGROUND: Topically-applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over three decades. This review updates the first Cochrane review of fluoride varnishes for preventing dental caries in children and adolescents, which was first published in 2002. OBJECTIVES: To determine the effectiveness and safety of fluoride varnishes in preventing dental caries in children and adolescents, and to examine factors potentially modifying their effect. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 13 May 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4), MEDLINE via OVID (1946 to 13 May 2013), EMBASE via OVID (1980 to 13 May 2013), CINAHL via EBSCO (1980 to 13 May 2013), LILACS and BBO via the BIREME Virtual Health Library (1980 to 13 May 2013), ProQuest Dissertations and Theses (1861 to 13 May 2013), and Web of Science Conference Proceedings (1945 to 13 May 2013). A search for ongoing trials was undertaken on ClinicalTrials.gov on 13 May 2013. There were no restrictions on language or date of publication in the search of the electronic databases. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials with blind outcome assessment used or indicated, comparing topically-applied fluoride varnish with placebo or no treatment in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent (D(M)FS) and primary (d(e/m)fs) teeth. DATA COLLECTION AND ANALYSIS: At least two review authors assessed all search results, extracted data and undertook risk of bias independently. Study authors were contacted for additional information. The primary measure of effect was the prevented fraction, that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. The caries increments nearest to three years were used from each included study. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects meta-regression analyses. Adverse effects information was collected from the included trials. MAIN RESULTS: Twenty-two trials with 12,455 participants randomised (9595 used in analyses) were included. For the 13 that contributed data for the permanent tooth surfaces meta-analysis, the pooled D(M)FS prevented fraction estimate comparing fluoride varnish with placebo or no treatment was 43% (95% confidence interval (CI) 30% to 57%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001; I(2) = 75%), however this body of evidence was assessed as of moderate quality. The pooled d(e/m)fs prevented fraction estimate was 37% (95% CI 24% to 51%; P < 0.0001) for the 10 trials that contributed data for the primary tooth surfaces meta-analysis, also with some heterogeneity (P = 0.009; I(2) = 59%). Once again this body of evidence was assessed as of moderate quality. No significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the pre-specified factors of baseline caries severity, background exposure to fluorides, application features such as prior prophylaxis, concentration of fluoride, frequency of application were found. There was also no significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the post hoc factors: whether a placebo or no treatment control was used, length of follow-up, or whether individual or cluster randomisation was used, in the meta-regression models. A funnel plot of the trials in the main meta-analyses indicated no clear relationship between prevented fraction and study precision. In both methods, power is limited when few trials are included. There was little information concerning possible adverse effects or acceptability of treatment. AUTHORS' CONCLUSIONS: The conclusions of this updated review remain the same as those when it was first published. The review suggests a substantial caries-inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate, as it included mainly high risk of bias studies, with considerable heterogeneity.

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  • Regular application of fluoride varnish two to four times per year lowers the incidence of dental caries, reducing carious surfaces by 43% in permanent teeth and 37% in primary teeth.

    “Regular application of fluoride varnish, administered two to four times per year, has been shown to effectively lower the incidence of dental caries, reducing carious surfaces by 43% in permanent teeth and 37% in primary teeth [10].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [10]

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  1. [4]4. Borutta 2006 {published and unpublished data} Borutta A, Hufnagl S, Möbius S, Reuscher G. Caries inhibition of fluoride varnishes among pre-school children: results a er one- year. Oralprophylaxe 2006;28(1):8-14.
  2. [10]10. Bravo M, Montero J. Effectiveness of visible light fissure sealant (Delton) versus fluoride varnish (Duraphat): a 9-year clinical trial. Journal of Dental Research 2002;81(Spec Iss A):A-185 (Abs No 1347).
  3. [43]43. Carvalho DM, Salazar M, Oliveira BH, Coutinho ES. Fluoride varnishes and decrease in caries incidence in preschool children: a systematic review. Revista Brasileira de Epidemiologia 2010;13(1):139-49.
  4. [45]45. Chaves SC, Vieira-da-Silva LM. Anticaries effectiveness of fluoride toothpaste: a meta-analysis. Revista de Saúde Pública 2002;36(5):598-606.
  5. [63]63. Glass RL. The first international conference on the declining prevalence of dental caries. Journal of Dental Research 1982;61:1301-83.
  6. [87]87. Murray 1991a Murray JJ, Rugg-Gunn AJ, Jenkins GN (editors). Fluoride toothpastes and dental caries. Fluorides in Caries Prevention. Oxford: Wright, 1991:127-60.
  7. [114]114. 3 and 10 The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of theCochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011] (Higgins 2011).

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Authors
Marinho, V. C., Worthington, H. V., Walsh, T., & Clarkson, J. E.
Affiliations
  • Queen Mary University of London; Clinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry; Turner Street Whitechapel London UK E1 2AD
  • University of Manchester (GB)
  • University of Dundee (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-07-11
Volume
2014
Issue
2
Pages
CD002279-CD002279
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002279.pub2
PMC
PMC10758998
OpenAlex
W1901133259
Cited by
1,022
References
154
Citations by year
2026: 32 · 2025: 53 · 2024: 57 · 2023: 46 · 2022: 73 · 2021: 83 · 2020: 103 · 2019: 60 · 2018: 64 · 2017: 72 · 2016: 56 · 2015: 52 · 2014: 35 · 2013: 30 · 2012: 37
FWCI
8.49
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
Topics
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Health Sciences › Dentistry › Orthodontics › Dental Erosion and Treatment
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
Keywords
fluoride varnish, dental caries prevention, topical fluoride, children, adolescents, caries increment, primary teeth, permanent teeth, caries risk factors, caries risk assessment
MeSH terms
Adolescent, Child, Dental Caries, Fluorides, Topical, Humans, Mouth, Edentulous, Tooth, Deciduous, Randomized Controlled Trials as Topic, Dentition, Permanent

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