Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

174 questions · 213 findings · 33 reviews

No studies found 31 · 14.6%GRADE not reported 142 · 66.7%Very low 17 · 8%Low 8 · 3.8%Moderate 15 · 7%High 0 · 0%

Fluoride varnish combined with fluoride toothpaste vs Fluoride toothpaste alone

Unacceptability of treatment (drop-outs / leaving study early) · Children and adolescents aged 16 years or less

Fluoride varnish combined with fluoride toothpaste showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride toothpaste alone; GRADE not reported.

1 finding 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

38% silver diamine fluoride vs Glass ionomer cement (GIC) plus fluoride varnish

Caries prevention (preventive fraction, SDF vs GIC+5% fluoride varnish) · intellectually disabled individuals with caries in permanent posterior teeth

SDF had a 45% preventative fraction versus glass ionomer cement plus fluoride varnish; no pooled estimate or GRADE rating was reported.

1 finding from 1 review

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…

Fluoride varnish did not differ significantly from CPP-ACP (SMD -0.07, 95% CI -0.44 to 0.29); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

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…

Fluoride varnish did not differ significantly from CPP-ACFP (SMD 0.18, 95% CI -0.29 to 0.64); certainty of evidence not assessed (no GRADE).

1 finding from 1 review

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…

Fluoride varnish (gold standard) did not differ significantly from control (SMD -0.25, 95% CI -0.51 to 0.02); certainty of evidence not assessed (no GRADE).

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

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