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Title Topical Fluorides Are More Effective Than Community Water Fluoridation In Preventing caries
Clinical Question Is topical fluoride more effective in preventing caries than water fluoridation?
Clinical Bottom Line Topical fluoride is more effective in reducing and preventing caries than water fluoridation. Fluoride varnish is the most effective. Water fluoridation is good for poorer populations who do not get regular dental care. (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) 17333303Pizzo/2007Not applicableNarrative Review
Key resultsWater fluoridation is effective in populations with poor oral hygiene and limited access to dental care. It is more effective to use topical fluoride in industrialized and developing countries, and fluoride containing products such as toothpaste need to be expanded. Fluoride toothpaste and mouth rinse reduce caries by 24-26% while water fluoridation only reduces caries by 15%. caries reduced 26-28% for foams and gels and 46% with fluoride varnish.
#2) 14583954Marinho/2003Children from 5-16Systematic Review with Meta-Analysis
Key resultsChildren aged 5 to 16 years who applied fluoride in the form of toothpaste, mouth rinses, gels or varnishes had fewer decayed, missing and filled teeth regardless of whether their drinking water was fluoridated. The prevented fraction estimate was 14% higher (P=.25) in fluoride varnish trials compared to others and 10% lower (P=.003) in trials of unsupervised home use compared to self supervised and operator applied.
Evidence Search ("Fluoridation"[Mesh] OR "Fluorides, Topical"[Mesh]) AND "Dental Caries"[Mesh] AND Meta-Analysis[ptyp] ...view in PubMed
Comments on
The Evidence
The articles used were a critical review and a meta-analysis of randomized controlled trials. The individual studies had to meet specific criteria for validity. Articles from 2001 to 2006 were included in the first review, and 133 trials were included in the second review. It is important to note that none of the articles directly compared fluoride varnish and water fluoridation.
Applicability It is important to use in office topical fluorides such as varnishes and gels and it is important to recommend fluoridated toothpaste and mouth rinse to your patients. Water fluoridation is applicable to poorer populations who do not get routine dental care.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry) (Dental Hygiene)
Keywords caries prevention, fluoride, topical, water fluoridation
ID# 763
Date of submission: 04/12/2011spacer Revised: 01/05/2012
E-mail cadenhead@livemail.uthscsa.edu
Author Amy Cadenhead
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor/Co-author e-mail Amaechi@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
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by Roger Flippen, Scott Fischbuch, Atish Patel (San Antonio, TX) on 01/06/2014
The general information and content remains the same as of today. As far as "effectiveness" the author should have stated whether this is in regards to effectiveness of fluoride reaching the teeth or effectiveness of fluoride reaching the most amount of people. Topical fluoride maximizes the amount of fluoride that reaches the tooth however water fluoridation reaches a large population. Creating a more specific clinical question would help clarify the "effectiveness".

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