Skip to main content
SpringerLink
Log in

Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries

  • Published:
European Archives of Paediatric Dentistry Aims and scope Submit manuscript

Abstract

AIM: o present the evidence summarized in the Cochrane fluoride reviews. STUDY DESIGN: An overview of the results of selected systematic reviews. METHODS: Relevant systematic reviews published in the Cochrane Database of Systematic Reviews (CDSR) were identified by searching ‘The Cochrane Library issue 4, 2008’, using the terms ‘Fluoride’ and ‘Caries’. Complete Cochrane reviews assessing the effectiveness of any fluoride-based intervention for preventing caries were selected, and their main features and findings were reviewed. RESULTS: 14 papers were identified of which 11 were relevant full-text reviews. The results were assessed of 7 reviews published from 2002 to 2004 concerning the relative effectiveness of 4 topical fluoride treatments (toothpastes, gels, varnishes and mouthrinses) in preventing caries in children and adolescents. Comparisons in these reviews were made against non-fluoride controls, against each other, and against different combinations. Findings from 4 reviews published between 2004 and 2006, assessing other fluoride modalities (slow release devices, milk), specific comparison/site (fluoride varnishes versus sealants in occlusal surfaces), and particular population and caries outcome (fluorides for white spot lesions in orthodontic patients) were also assessed. The 7 reviews confirm a clear and similar effectiveness of topical fluoride toothpastes, mouthrinses, gels and varnishes for preventing caries, and show that additional caries reduction can be expected when another topical fluoride is combined with fluoride toothpaste. Evidence is insufficient to confirm the effectiveness of slow release fluoride devices and fluoridated milk. The comparative effectiveness of other modes of delivering fluoride, such as to orthodontic patients is also as yet unclear. Fissure sealants appear more effective than fluoride varnish for preventing occlusal caries but the size of the difference is unclear. CONCLUSIONS: The benefits of topical fluorides are firmly established based on a sizeable body of evidence from randomized controlled trials. The size of the reductions in caries increment in both the permanent and the primary dentitions emphasizes the importance of including topical fluoride delivered through toothpastes, rinses, gels or varnishes in any caries preventive program. However, trials to discern potential adverse effects are required, and data on acceptability. Better quality research is needed to reach clearer conclusions on the effects of slow release fluoride devices, milk fluoridation, sealants in comparison with fluoride varnishes, and of different modes of delivering fluoride to orthodontic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ammari AB, Bloch-Zupan A, Ashley PF. Systematic review of studies comparing the anti-caries efficacy of children’s toothpaste containing 600 ppm of fluoride or less with high fluoride toothpastes with 1,000 ppm or above. Caries Res 2003;37:85–92.

    Article  PubMed  Google Scholar 

  • Autio-Gold JT, Courts F. Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition. J Am Dent Assoc 2001;132(9):1247–53.

    PubMed  Google Scholar 

  • Bartizek RD, Gerlach RW, Faller RV, et al. Reduction in dental caries with four concentrations of sodium fluoride in a dentifrice: a meta-analysis evaluation. J Clin Dent 2001; 12:57–62.

    PubMed  Google Scholar 

  • Benson PE, Parkin N, Millett DT, et al. Fluorides for the prevention of white spots on teeth during fixed brace treatment. Cochrane Database of Systematic Reviews 2004; 3:CD003809.

    Google Scholar 

  • Bonner BC, Clarkson JE, Dobbyn L, Khanna S. Slow-release fluoride devices for the control of dental decay. Cochrane Database of Systematic Reviews 2006; 4:CD005101.

    Google Scholar 

  • Chaves SC, Vieira-da-Silva LM. Anticaries effectiveness of fluoride toothpaste: a meta-analysis. Rev Saude Publica 2002 Oct;36(5):598–606.

    Article  PubMed  Google Scholar 

  • Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res 2002;81(11):767–70.

    Article  PubMed  Google Scholar 

  • Clarke M. Interpreting the results of systematic reviews. Semin Hematol 2008 Jul;45(3):176–80.

    Article  PubMed  Google Scholar 

  • Glenny A M, Esposito M, Coulthard P, Worthington H V. The assessment of systematic reviews in dentistry. Eur J Oral Sci 2003; 111: 85–92.

    Article  PubMed  Google Scholar 

  • Hardman MC, Davies GM, Duxbury JT, Davies RM. A cluster randomised controlled trial to evaluate the effectiveness of fluoride varnish as a public health measure to reduce caries in children. Caries Res 2007;41(5):371–6.

    Article  PubMed  Google Scholar 

  • Hiiri A, Ahovuo-Saloranta A, Nordblad A,MäkeläM. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents. Cochrane Database of Systematic Reviews 2006; 4:CD003067.

    Google Scholar 

  • Jadad AR, Cook DJ, Jones A, et al. Methodology and reports of systematic reviews and metaanalyses: a comparison of Cochrane reviews with articles published in paper-based journals. JAMA 1998; 280:278–80.

    Article  PubMed  Google Scholar 

  • Jørgensen AW, Maric KL, Tendal B, Faurschou A, Gøtzsche PC. Industry-supported meta-analyses compared with meta-analyses with non-profit or no support: differences in methodological quality and conclusions. BMC Med Res Methodol 2008 Sep; 9(8):60.

    Article  Google Scholar 

  • Lawrence HP, Binguis D, Douglas J, et al. A 2-year community-randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal children. Community Dent Oral Epidemiol 2008;36(6):503–16.

    Article  PubMed  Google Scholar 

  • Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002a;2:CD002280.

  • Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002b;3:CD002279.

  • Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003a;1:CD002278.

  • Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003b;3:CD002284.

  • Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003c;4:CD002782.

  • Marinho VC, Higgins JP, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes)versus another for preventing dental caries in children and adolescents. Cochrane Database Syst Rev2004a;1:CD002780.

  • Marinho VC, Higgins JP, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2004b;1:CD002781.

  • McDonagh MS, Whiting PF, Wilson PM, et al. Systematic review of water fluoridation. BMJ 2000;321:855–859.

    Article  PubMed  Google Scholar 

  • Moberg Sköld U, Petersson LG, Lith A, Birkhed D. Effect of school-based fluoride varnish programmes on approximal caries in adolescents from different caries risk areas. Caries Res 2005;39(4):273–9.

    Article  PubMed  Google Scholar 

  • Petersson LG, Twetman S, Dahlgren H, et al. Professional fluoride varnish treatment for caries control: a systematic review of clinical trials. Acta Odontol Scand 2004;62:170–176.

    Article  PubMed  Google Scholar 

  • Salanti G, Marinho V, Higgins JPT. A case study of multiple-treatments metaanalysis demonstrates that covariates should be considered. J Clin Epi 2009 (Accepted 3 October 2008).

  • Schünemann HJ, Oxman AD, Higgins JPT, et al. Chapter 11: Presenting results and ‘Summary of findings’ tables. In: Higgins JPT, Green S (eds), Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 (updated September 2008). http://www.cochrane-handbook.org/ (accessed November 10, 2008).

  • Steiner M, Helfenstein U, Menghini G. Effect of 1000 ppm relative to 250 ppm fluoride toothpaste: a meta-analysis. Am J Dent 2004;17:85–88.

    PubMed  Google Scholar 

  • Strohmenger L, Brambilla E. The use of fluoride varnishes in the prevention of dental caries: a short review. Oral Dis 2001;7:71–80.

    Article  PubMed  Google Scholar 

  • Twetman S, Axelsson S, Dahlgren H, et al. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand 2003;61:347–355.

    Article  PubMed  Google Scholar 

  • Twetman S, Petersson LG, Axelsson S, et al. Caries-preventive effect of sodium fluoride mouthrinses: A systematic review of controlled clinical trials“, Acta Odontol Scand 2004;62(4):223–230.

    Article  PubMed  Google Scholar 

  • vanRijkom HM, Truin GJ, van ’t Hof MA. A meta-analysis of clinical studies on the caries-inhibiting effect of fluoride gel treatment. Caries Res 1998;32:83–92.

    Article  PubMed  Google Scholar 

  • Weintraub JA, Ramos-Gomez F, Jue B, et al. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res 2006;85(2):172–6.

    Article  PubMed  Google Scholar 

  • World Health Organization. Oral Health. http://www.who.int/oral_health/media/en/index1.html (accessed 08 November 2008).

  • Yeung CA, Hitchings JL, Macfarlane TV, et al., Fluoridated milk for preventing dental caries. The Cochrane Database of Systematic Reviews 2005;3:CD003876.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Barts and The London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, UK

    V. C. C. Marinho

Authors
  1. V. C. C. Marinho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. C. C. Marinho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marinho, V.C.C. Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries. Eur Arch Paediatr Dent 10, 183–191 (2009). https://doi.org/10.1007/BF03262681

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03262681

Keywords

Search

Navigation