Fluoride varnish in primary dentition positively affects caries prevention

Permanent teeth may be affected by caries at an early stage in the case of caries-affected primary teeth, as the enamel has not yet fully hardened. Because oral hygiene and caries prevention can be challenging in young children, the use of fluoride varnish can be beneficial.

For this reason, the IQWiG researchers investigated whether the application of fluoride varnish to primary dentition has advantages in comparison with standard care without fluoride application by comparing the findings of 15 randomised controlled trials. In these, a total of 5,002 children were treated with fluoride varnish, and 4,705 children received no such treatment, being the control group. Children aged up to 6 years with or without caries of their primary teeth were included in the research.

In several of the studies, further measures for caries prevention in addition to the application of fluoride varnish were offered. These included training on oral hygiene, instruction on the correct toothbrushing technique, and the provision of toothbrushes and fluoridated toothpaste. The follow-up observation period was mostly two years.

The development of caries was investigated in all 15 studies; side-effects were investigated in nearly all of the studies. However, owing to a lack of conclusive data, it is unclear whether fluoride application also has advantages regarding further patient-relevant outcomes, such as tooth preservation, toothache or dental abscesses. There was no data on oral health-related quality of life.

A clear advantage of fluoride varnish was determined despite the very heterogeneous study results. After the application of fluoride varnish, caries in primary teeth was less frequent. More precisely, the fluoride treatment could completely prevent caries in approximately every tenth child and would at least reduce progression of caries in further children. Apparently, whether the children already had caries or whether their teeth were completely intact made no difference regarding the benefit of fluoride varnish application.

The report, titled “Assessment of the application of fluoride varnish on milk teeth to prevent the development and progression of initial caries or new carious lesions”, was published online by IQWiG on 26 April 2018.

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