While fluoride varnish has become a popular anti-cavity treatment for children, researchers at the University of Washington Dental School question its cost-effectiveness for preschool children and call the anti-cavity effects “moderate and uncertain” in this age group.
Researchers reviewed 20 clinical trials on the use of fluoride varnish alone or as part of an oral health program in 13 countries. They also tested the effects of using fluoride varnish versus a placebo, usual care, or no treatment.
“As much as we want fluoride varnish to be effective, the current evidence does not support a huge benefit for its use in young children,” said researcher Joana Cunha-Cruz, DDS, MPH, PhD, associate professor of oral health. science at school.
The researchers noted that fluoride varnish applications are specifically aimed at children at high risk of tooth decay. It is not considered a primary form of treatment but rather a supplement to other fluoride treatments such as fluoride toothpaste.
However, the researchers reported that more recent clinical trials in both low-risk and high-risk groups failed to show a protective effect of fluoride varnish applications. Cost-effectiveness analyses, they said, are needed to assess whether fluoride varnish should be adopted or abandoned by dental services.
Fluoride varnish is considered easy to apply, with dentists, dental hygienists and even pediatricians able to apply it. It goes on with a brush and dries in a few hours. There is little risk of children swallowing it the way they might swallow other topical treatments such as gels. And, it only costs about $25 to $55 per treatment.
The researchers did not claim that fluoride varnish does not work. Their analysis showed that the risk of developing new cavities was reduced by 12% among children who received fluoride varnish compared to those who did not.
Fluoride varnish could still be a cost-effective alternative in some cases, the researchers added, but further noted that it was a rather modest benefit as many of the children developed new legions of tooth decay regardless of fluoride varnish use.
Fluoride concentrations can also vary between different polishes, Cunha-Cruz said, noting that there are still highly effective alternative topical treatments.
For example, he said, sealants do a good job of protecting teeth, especially those in the back of the mouth. Even better are glass ionomer sealants, which release fluoride, as opposed to resin-based sealants, which don’t, he explained.
Sealants are more difficult to apply than varnish, but remain effective for two to three years, Cunha-Cruz said. Silver diamine fluoride (SDF) has also grown in popularity and is effective in stopping decay, he said, but more research is needed into its preventive effects. Additionally, SDF can discolor teeth, but this is not a concern for preschoolers who still have their primary teeth.
“Evidence continues to support the use of fluoride toothpaste, which is easy and low-cost. The value of toothpaste is how it creates a daily presence of fluoride in the mouth,” Cunha-Cruz said, adding that fluoride rinses are also effective in this way.
The researchers then call for more studies on the cost-effectiveness of fluoride varnish among different populations and application settings. Additionally, Cunha-Cruz suggests another approach to fighting tooth decay.
“Reducing your sugar intake is an even more cost-effective strategy,” he says.
The study, “Fluoride varnish and caries in preschool children: a systematic review and meta-analysis”, posted by Dental caries research.
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