Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries
V. C. C. Marinho
ABSTRACT
AIM: To 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.
Key words: topical fluorides, dental caries, systematic review, randomized controlled trials
Eur Archs Paediatr Dent 2009;10(3):183-191
Dept. of Paediatric Dentistry, Leeds Dental Institute, Leeds, UK.
Postal address: Dr V. Marinho., Queen Mary University of London, Barts and The London School of Medicine and Dentistry,
Institute of Dentistry, Turner Street, London E1 2AD,
UK
Tel: +44 (0)20 7882 8671, Fax: +44 (0)20 7377 7064
Email: v.marinho@qmul.ac.uk
