Topical fluoride treatment effectiveness: a systematic review

Relevance. The systematic review aimed to evaluate the effectiveness of topical fluoride in children based on the analysis of modern randomized clinical trial (RCT) data.

Materials and methods. This review was carried out using the PRISMA checklist (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The proposed criteria determined the quality of the studies for inclusion in the review and then during the result summary. A preliminary search was conducted among articles published between 2013 and 2023 where fluoride varnishes were one of the preventive products. The search included MeSH terms, the keywords "fluorides", "fluorine varnish", "caries prevention", "remineralisation", and "children". A preliminary search found 346 studies. After excluding duplicates and irrelevant studies, two independent reviewers analysed nine RCTs based on the PRISMA criteria.

Results. Children aged eight months to five years old participated in five out of nine RCTs on the fluoride varnish application included in the review, and four studies included adolescents aged 14–20 y.o. The duration of the studies ranged from 2 months to 3.5 years. Six studies described the use of fluoride varnish in children, and three studies reported on the application of calcium phosphate gels with fluoride versus fluoride varnish. Various ways determined enamel condition, namely, visual method, digitally processed photography, analysis of radiographs, QLF (quantitative light fluorescence method), and laser fluorescence analysis method (Diagnodent). The dmft, ICDAS indices, caries increment, the WSL (white spot lesion) index, and the assessment of changes in the tooth damage area evaluated the prevalence and intensity of caries. In the control groups, most studies used 1000 to 1500 ppm fluoride toothpastes according to the usual scheme. None of the studies statistically proved the additional preventive effectiveness of the fluoride varnishes.

Conclusions. The analysis of RCTs did not reveal the advantages of fluoride varnishes for caries prevention in children and adolescents compared to standard oral hygiene procedures using fluoride toothpastes.

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