ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Fluoride Varnish Effective for Caries Prevention
Clinical Question In school-age children with moderate to high caries risk, does the use of professionally applied fluoride varnish to permanent teeth reduce the incidence of caries compared to no treatment, placebo, or other topical fluoride regimen?
Clinical Bottom Line Professionally applied fluoride varnish is effective in preventing caries in permanent teeth in school-age children. There is no statistically significant data that the caries risk of the individual has an outcome on fluoride varnish effectiveness. (See Comments on the CAT below)
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) 12137653Marinho/20022709 children ages 3 to 15Systematic Review
Key results"D(M)FS pooled prevented fraction estimate was 0.46 (95% CI, 0.30 to 0.63; P < 0.0001) compared to a placebo. There was substantial heterogeneity, statistically significant (P < 0.0001)."
#2) 11355442Strohmenger/2001924 school-age children Systematic Review
Key resultsFluoride varnish treatment effect: -1.522 DMFS, CI from -3.168 to 0.12, z = -1.811 and P = 0.070; overall DMFS weighted mean was 4.09 in the fluoride varnish group and 5.07 in the control group (0.2% fluoride rinse).
#3) 15370638Petersson/200412000 school-age childrenSystematic Review
Key resultsMean prevented fraction = 0.30 (0.0-0.69) for professional fluoride varnish treatments in young permanent teeth compared with placebo or untreated controls and 0.178 (0.0-0.52) in comparison to other fluoride regimens. Average number of saved permanent tooth surfaces was 0.4 (0-1.6) per child and year when compared with controls and 0.3 (0-1.6) in favor of other fluoride regimens.
Evidence Search Meta-AnalysisRandomized Controlled Trial "Dental Caries"[Mesh] "Fluorides, Topical"[Mesh]
Comments on
The Evidence
All of the review articles listed above are systematic reviews of randomized controlled trials. All conducted comprehensive, detailed searches for relevant trials. Individual studies in each review were assessed for validity. A meta-analysis was conducted in each of the review articles. There were 9 trials and 2709 patients in the first review article (7 trials were used for the meta-analysis), 3 studies and 924 patients in the second review article, and 24 studies and 12000 patients in the third review. Of the thirteen studies generated from the evidence search the three included in the CAT were the most relevant and offered the strongest evidence to answer the clinical question.
Applicability Fluoride varnish as a preventive means is a feasible treatment in the private practice setting and also in school-based programs.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry)
Keywords
ID# 540
Date of submission: 03/26/2010spacer Revised: 10/27/2011
E-mail tranr@livemail.uthscsa.edu
Author Rosie Tran
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Elaine Neenan, DDS
Faculty mentor/Co-author e-mail NEENAN@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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Shane Juber (San Antonio, TX) on 04/16/2012
A PubMed search performed on April 16, 2012, has shown that the material of this CAT is correct. No new publications were found, making the listed references the most recent and of highest level of evidence.
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