Cochrane · intervention · CD002279
Fluoride varnishes for preventing dental caries in children and adolescents
Marinho, VCC, Worthington, HV, Walsh, T, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
7
current version
GRADE rated
2
No studies
0
Included studies
22
as reported
No studies 0 · 0%Ungraded 5 · 71.4%Very low 0 · 0%Low 0 · 0%Moderate 2 · 28.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children or adolescents aged 16 or less at the start of the study (irrespective of initial level of dental caries, background exposure to fluorides, dental treatment level, nationality, setting where intervention is received or time when it started) | Ages at the start of the trials ranged from 1 to 15 years; 14 trials included participants over six years at start and eight trials included children aged one to five (in whom primary teeth were assessed). The total number of children in the 22 included trials (sample analysed) was 9595, ranging from 95 in the smallest to 2604 in the largest trial |
| Intervention | Topical fluoride in the form of varnishes only, using any fluoride agent, at any concentration (ppm F), amount or duration of application, and with any technique of application, prior or post-application; frequency of application at least once a year | Fluoride varnish (n=22) |
| Comparison | Placebo or no treatment | No treatment (n=14); Placebo (n=8) |
| Outcomes | Primary: caries increment measured by change from baseline in decayed, (missing) and filled permanent surfaces / decayed, (extracted/missing) and filled primary surfaces (D(M)FS / d(e/m)fs). Other relevant: coronal dental caries and dental fillings in permanent and primary dentitions, tooth loss, dental pain, specific adverse effects (oral allergic reactions, mucosal irritation, adverse symptoms such as nausea, gagging, vomiting), use of health service resources | D(M)FS increment (n=13); D(M)FT increment (n=5); d(e/m)fs increment (n=10); d(e/m)ft increment (n=2); Proportion developing new caries (n=10) |
| Study designs | Randomised or quasi-randomised controlled trials using or indicating blind outcome assessment, comparing fluoride varnish concurrently to a placebo or no treatment group during at least one year | All included trials used parallel-group designs (split-mouth trials excluded); five were cluster-randomised trials (n=22) |
| Timing | At least one year | Study duration ranged from one to five years among the included trials (12 of these lasted two years) |
Search date: 2013-05-13. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCO; LILACS via BIREME Virtual Health Library; BBO via BIREME Virtual Health Library; ProQuest Dissertations and Theses; Web of Science…
Questions and results
Current version onlyFluoride varnish vs Placebo or no treatment
Population: Children and adolescents aged 16 years or less
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects / specific side effects (oral allergic reactions, mucosal irritation, adverse symptoms such as nausea, gagging, vomiting) At least 1 year | Three trials (Salazar 2008; Skold 2005; Weintraub 2006) provided data reporting no adverse effects. There was little information concerning possible adverse effects; no pooled estimate was possible. | 3 studies | Ungraded |
Caries increment in primary/deciduous teeth: decayed, (extraction indicated/missing) and filled teeth d(e/m)ft (prevented fraction) At least 1 year · Primary/deciduous dentition | PF 0.65 [0.48, 0.82] | 2 studies · 322 participants | Ungraded |
Proportion of children developing one or more new caries (permanent dentition, D(M)FT) At least 1 year | RR 0.75 [0.53, 1.05] | 5 studies · 3253 participants | Ungraded |
Proportion of children developing one or more new caries (primary/deciduous dentition, d(e/m)ft) At least 1 year · Primary/deciduous dentition | RR 0.81 [0.62, 1.06] | 5 studies · 1228 participants | Ungraded |
Caries increment in permanent teeth: decayed, (missing) and filled teeth D(M)FT (prevented fraction) At least 1 year | PF 0.44 [0.11, 0.76] | 5 studies | Ungraded |
Caries increment in permanent teeth: decayed, (missing) and filled tooth surfaces D(M)FS (prevented fraction) At least 1 year | PF 0.43 [0.30, 0.57] Mean caries increment in control group 0.171; 2.37; 7.72 (median 2.37) vs Mean increment in intervention group 0.10… | 13 studies · 6478 participants | Moderate Downgraded: inconsistency |
Caries increment in primary/deciduous teeth: decayed, (extraction indicated/missing) and filled surfaces d(e/m)fs (prevented fraction) At least 1 year · Primary/deciduous dentition | PF 0.37 [0.24, 0.51] Mean caries increment in control group 0.893; 1.65; 13.8 (median 1.65) vs Mean increment in intervention group 0.56… | 10 studies · 3804 participants | Moderate Downgraded: inconsistency |
Fluoride varnish vs Placebo or no treatment
Population: Children and adolescents aged 16 years or less
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment in permanent teeth: decayed, (missing) and filled tooth surfaces D(M)FS (prevented fraction) At least 1 year | PF 0.46 [0.30, 0.63] | 7 studies · 2278 participants | Ungraded |
Adverse effects / specific side effects (fluorosis, tooth staining/discolouration, oral allergic reactions, adverse symptoms such as nausea, vomiting) At least 1 year | No data were reported on adverse effects in the included trials. | 0 studies | No studies |
Unacceptability of treatment (participants leaving study early / drop-outs) At least 1 year | RR 1.78 [0.70, 4.55] | 2 studies · 486 participants | Ungraded |
Caries increment in primary/deciduous teeth: decayed, (extraction indicated/missing) and filled surfaces d(e/m)fs (prevented fraction) At least 1 year · Primary/deciduous dentition | PF 0.33 [0.19, 0.48] | 3 studies · 1107 participants | Ungraded |
Proportion of children developing one or more new caries At least 1 year | RR 0.80 [0.70, 0.92] | 2 studies · 334 participants | Ungraded |
Caries increment in permanent teeth: decayed, (missing) and filled teeth D(M)FT (prevented fraction) At least 1 year | PF 0.53 [0.23, 0.82] | 3 studies | Ungraded |