Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

78 questions · 99 findings · 18 reviews

No studies found 8 · 8.1%GRADE not reported 80 · 80.8%Very low 3 · 3%Low 6 · 6.1%Moderate 2 · 2%High 0 · 0%

Fluoride varnish vs Non-fluoride (placebo) varnish

Number of participants with new demineralised lesions (DLs) · Orthodontic patients of any age with fixed braces (new DLs assessed at debond)

Professionally-applied fluoride varnish (7700 or 10,000 ppm F),… showed no clear difference in number of participants with new demineralised lesions (DLs) compared with non-fluoride (placebo) varnish (low certainty).

1 finding from 1 review

Fluoride varnish vs Non-fluoride (placebo) varnish

Adverse effects · Orthodontic patients of any age with fixed braces (new DLs assessed at debond)
1 finding from 1 review

Fluoride varnish vs Non-fluoride (placebo) varnish

Number of participants with more severe DLs (score 3 or 4 versus 1 or 2) · Orthodontic patients of any age with fixed braces (new DLs assessed at debond)

Professionally-applied fluoride varnish (7700 ppm F ammonium… may leads to lower number of participants with more severe DLs (score 3 or 4 versus 1… compared with non-fluoride (placebo) varnish (low certainty).

1 finding from 1 review

Fluoride varnish vs Fissure sealant (resin-based or glass ionomer)

Caries incidence of first permanent molars (FPMs) · Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel…

After excluding the high-risk-of-bias study (Bravo 1996), fluoride varnish and fissure sealant did not differ in caries incidence of FPMs and heterogeneity fell to 0% (RR 1.05, 95% CI 0.91 to 1.22; 5 RCTs; ungraded).

3 findings from 1 review

Fluoride varnish vs Fissure sealant (resin-based or glass ionomer)

Caries incidence (proportion of enrolled children developing dentin caries, ICDAS 4-6) · Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel…

Fluoride varnish and fissure sealant did not differ significantly in the proportion of children developing caries at 2 to 3 years (RR 1.12, 95% CI 0.60 to 2.09; 2 RCTs; ungraded).

1 finding from 1 review

Fluoride varnish vs Fissure sealant (resin-based or glass ionomer)

Caries incidence of occlusal surfaces of first permanent molars · Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel…

After excluding Bravo 1996, occlusal caries incidence slightly favored fluoride varnish but was not significant, with heterogeneity falling to 0% (RR 0.98, 95% CI 0.82 to 1.16; 3 RCTs; ungraded).

2 findings from 1 review

Fluoride varnish vs Fissure sealant (resin-based or glass ionomer)

Increment of occlusal DMFS (decayed, missing, filled surfaces) of FPMs · Generally healthy children aged 6 to 9 years with at least one fully erupted first permanent molar with deep fissures or early enamel…

Fluoride varnish and fissure sealant did not differ significantly in occlusal DMFS increment of FPMs (MD 0.13, 95% CI -0.09 to 0.34; 3 RCTs; ungraded).

2 findings from 1 review

Fluoride varnish vs Placebo varnish, resin sealant, or standard care (oral hygiene instructions)

Prevalence of white spot lesions (WSL) at debonding, subject level · Healthy adolescents and adults undergoing orthodontic treatment with fixed multi-bracket appliances

Fluoride varnish applied regularly during fixed orthodontic treatment may reduce the prevalence of white spot lesions at debonding (pooled RR 0.64, 95% CI 0.42 to 0.98), but the certainty of evidence is very low.

1 finding from 1 review

Fluoride varnish vs Placebo varnish, resin sealant, or standard care (oral hygiene instructions)

White spot lesion clinical score (mean values), subject level · Healthy adolescents and adults undergoing orthodontic treatment with fixed multi-bracket appliances

In a pooled analysis of two placebo-controlled trials, fluoride varnish also reduced white spot lesion clinical scores (pooled SMD -0.44, 95% CI -0.64 to -0.24); this secondary outcome was not separately GRADE-rated.

1 finding from 1 review

P11-4 + fluoride varnish vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

P11-4 plus fluoride varnish was significantly better than CPP-ACP (SMD -0.78, 95% CI -1.33 to -0.24; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

P11-4 + fluoride varnish vs CPP-ACP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · People or specimens with white spot lesions or early caries lesions

The NMA estimated an SMD of -0.78 for P11-4 + fluoride varnish versus CPP-ACP (95% CI -1.33 to -0.28).

1 finding from 1 review

P11-4 + fluoride varnish vs Placebo or no active treatment

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

Combined self-assembling peptide P11-4 plus fluoride varnish significantly improved white spot lesion remineralization versus control (SMD -0.96, 95% CI -1.44 to -0.48) and ranked highest of seven therapies by SUCRA (89.7%); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

P11-4 + fluoride varnish vs CPP-ACFP

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

P11-4 plus fluoride varnish did not differ significantly from CPP-ACFP (SMD -0.54, 95% CI -1.15 to 0.08; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

P11-4 + fluoride varnish vs Self-assembling peptide P11-4

Remineralization / reduction in lesion severity (change in QLF, laser fluorescence, or lesion area) · Patients with white spot lesions / early caries lesions (WSLs/ECLs), including orthodontic and non-orthodontic lesions, active caries…

P11-4 plus fluoride varnish did not differ significantly from P11-4 alone (SMD -0.40, 95% CI -0.97 to 0.17; indirect evidence only); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

6% sodium fluoride with 6% calcium fluoride varnish vs no treatment

Remineralisation of early enamel caries · Children with early enamel caries (permanent dentition)

One trial found 6% sodium fluoride plus 6% calcium fluoride varnish significantly reversed early enamel caries versus no treatment; ungraded and not meta-analysed.

1 finding from 1 review

Fluoride varnish vs Fluoride in dentifrice

Caries increment, surface index D(M)FS · Children or adolescents

The illustrative network meta-regression estimated an SMD for caries increment for fluoride in varnish versus fluoride in dentifrice across randomization year; the review did not state whether the difference was significant and certainty was not graded.

1 finding from 1 review

Fluoride varnish vs Fluoride gel

Caries increment, surface index D(M)FS · Children or adolescents

The illustrative network meta-regression estimated an SMD for caries increment for fluoride in varnish versus fluoride in gel across randomization year; the review did not state whether the difference was significant and certainty was not graded.

1 finding from 1 review

Fluoride varnish vs Fluoride in rinse

Caries increment, surface index D(M)FS · Children or adolescents

The illustrative network meta-regression estimated an SMD for caries increment for fluoride in varnish versus fluoride in rinse across randomization year; the review did not state whether the difference was significant and certainty was not graded.

1 finding from 1 review

Fluoride varnish vs no treatment

Caries increment, surface index D(M)FS · Children or adolescents

In the illustrative network meta-regression the SMD for caries increment differed between fluoride in varnish and no treatment at randomization years 1954 to 1990; certainty was not graded.

1 finding from 1 review