 |
| Title |
Application of Topical Fluoride Varnish and Placement of Glass Ionomer Sealants are Clinically Similar in Reducing the Incidence of Caries in Children |
| Clinical Question |
In pediatric patients, does the application of fluoride varnish compared to the placement of glass-ionomer sealant result in a greater reduction in the incidence of caries? |
| Clinical Bottom Line |
Glass-ionomer sealants and fluoride varnish demonstrate comparable effectiveness in reducing the incidence of caries in children. This is supported by multiple large randomized controlled trials in which glass-ionomer sealants were similarly effective as fluoride varnish in reducing caries incidence. These findings support the clinical use of either intervention for caries prevention in children. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 39357618 | Lam/2024 | 736 Children | Randomized Controlled Trial | | Key results | No significant differences exist between the fluoride varnish applied quarterly and the single placement of glass-ionomer sealant in preventing dentinal caries of primary second molars. 17.1% of primary second molars in the glass-ionomer sealant group developed dentinal caries, while 17.0% of primary second molars in the fluoride varnish group developed dentinal caries. No statistically significant differences were found between the two groups. | | #2) 34284374 | Lam/2021 | 323 Children | Randomized Controlled Trial | | Key results | Quarterly applying fluoride varnish versus a single placement of glass-ionomer sealant on primary second molars resulted in similar efficacy in preventing caries development or progression. The incidence of dentinal caries was 7.8% of the fluoride varnish group and 8.0% in the glass-ionomer sealant group (p = 0.913), indicating both interventions are equally effective. | | #3) 23153006 | de Oliveira/2013 | 80 Children | Randomized Controlled Trial | | Key results | In a split-mouth study of 80 children, fluoride varnish and glass-ionomer sealants showed similar effectiveness at preventing caries on newly erupted first permanent molars over an 18-month period. Of 299 treated teeth, 91% showed no caries, while 9% developed caries lesions after 18 months. Of the glass-ionomer sealant treated group, 15 of the 138 teeth developed caries, whereas the fluoride varnish treated group experienced caries in 13 of the 161 teeth (10.9% vs 8.1%, respectively; p > 0.05). | |
| Evidence Search |
(pediatric OR children OR "primary teeth") AND ("fluoride varnish") AND ("glass ionomer" OR "glass ionomer sealant") AND ("dental caries" OR "tooth decay") AND (prevention OR incidence OR reduction)
|
Comments on
The Evidence |
The study by Lam, published in 2024, included 736 children from 18 kindergartens. The study followed proper randomization, accounted for all participants, and followed an intention-to-treat analysis. A limitation of this study was the high attrition rate, which increased over time, reaching 34.9% by 24 months, which could have impacted the long-term findings. Blinding was a notable challenge due to the visible differences between interventions. Similarly, the earlier randomized controlled trial by Lam (2021) faced difficulty with maintaining blinding, especially due to the pink coloration of the glass-ionomer sealant compared to fluoride varnish. The study was also subject to potential selection bias as parents who consented were likely more health-conscious, potentially limiting generalizability. In contrast, the study by de Oliveira demonstrated balanced baseline characteristics between groups and used appropriate randomization with low attrition and clear outcome reporting over an 18-month period. In all three studies, blinding was limited due to the visibility of the intervention. All three trials found the fluoride varnish and glass-ionomer sealants to be similarly effective in reducing caries incidence in primary molars, supporting their use in pediatric dental practice. |
| Applicability |
These findings are highly applicable to pediatric care as the children studied in these randomized controlled trials represent the typical pediatric patients in real-world environments and these studies compared interventions that are commonly used in practice. Although the studies had some limitations, the results were consistent among the randomized controlled trials. Both interventions demonstrated similar caries-preventive effects supporting the use of both in pediatric dental practice. |
| Specialty/Discipline |
(General Dentistry) (Pediatric Dentistry) |
| Keywords |
Fluoride varnish; Glass-ionomer sealants; Pediatric; Children; Primary caries; Prevention
|
| ID# |
3579 |
| Date of submission: |
06/24/2025 |
| E-mail |
josephlai21@yahoo.com |
| Author |
Joseph Lai |
| Co-author(s) |
Johanna Lindquist |
| Co-author(s) e-mail |
JGL0399@gmail.com |
| Faculty mentor/Co-author |
Kelly Lemke, DDS, MS |
| Faculty mentor/Co-author e-mail |
lemkek@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
