The efficacy of fluoride and others in caries prevention
A systematic review
Keywords:
Dental caries, fluoride, caries prevention, fluoride varnish, water fluoridation, antimicrobial agents, sealantsAbstract
Background: Dental caries remains a significant public health issue, manifesting in various forms such as early childhood caries (ECC), primary caries, and root surface caries. It results from bacterial metabolism of dietary sugars leading to tooth enamel demineralization. While various preventive interventions, including fluoride and non-fluoride agents, have been employed, their efficacy varies and remains a subject of extensive research. Aim: This systematic review aims to evaluate the effectiveness of fluoride and other preventive measures in reducing dental caries and improving oral health outcomes across different populations and age groups. Methods: The review synthesizes evidence from clinical trials, observational studies, and public health reports on the effectiveness of fluoride varnishes, supplements, community fluoridation, sugar substitutes, sealants, and antimicrobial agents in caries prevention. Key variables include intervention types, dosage, application methods, and demographic variables. Results: Fluoride-based interventions, such as varnishes and water fluoridation, have demonstrated varying levels of effectiveness. Water fluoridation shows a 35% reduction in carious lesions in primary dentition and 26% in permanent teeth. Fluoride varnishes and supplements provide modest benefits, with fluoride toothpaste achieving a 24% reduction in caries. Antimicrobial agents and sealants also contribute to caries control, although their effectiveness is often context-dependent.
Downloads
References
Kearns, C. E., Glantz, S. A., & Schmidt, L. A. (2015). Sugar industry influence on the scientific agenda of the National Institute of Dental Research’s 1971 National Caries Program: A historical analysis of internal documents. PLoS Medicine, 12(3), e1001798. https://doi.org/10.1371/journal.pmed.1001798
Colchero, M. A., Rivera-Dommarco, J., Popkin, B. M., et al. (2017). In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Affairs, 36(3), 564–571. https://doi.org/10.1377/hlthaff.2016.1231
Sheiham, A. (2006). Dental caries affects body weight, growth and quality of life in preschool children. British Dental Journal, 201(10), 625–626. https://doi.org/10.1038/sj.bdj.4814188
Nelson, S., Mandelaris, J., Ferretti, G., et al. (2012). School screening and parental reminders in increasing dental care for children in need: A retrospective cohort study. Journal of Public Health Dentistry, 72(1), 45–52. https://doi.org/10.1111/j.1752-7325.2011.00291.x
Köhler, B., & Andréen, I. (1994). Influence of caries-preventive measures in mothers on cariogenic bacteria and caries experience in their children. Archives of Oral Biology, 39(10), 907–911. https://doi.org/10.1016/0003-9969(94)90070-5
Thorild, I., Lindau, B., & Twetman, S. (2006). Caries in 4-year-old children after maternal chewing of gums containing combinations of xylitol, sorbitol, chlorhexidine, and fluoride. European Archives of Paediatric Dentistry, 7(4), 241–245. https://doi.org/10.1007/BF03321769
Alamoudi, N. M., Hanno, A. G., Almushayt, A. S., et al. (2014). Early prevention of childhood caries with maternal xylitol consumption. Saudi Medical Journal, 35(6), 592–597. https://doi.org/10.15537/smj.2014.6.8553
Isokangas, P., Söderling, E., Pienihaikkinen, K., et al. (2000). Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. Journal of Dental Research, 79(11), 1885–1889. https://doi.org/10.1177/00220345000790111301
Milgrom, P., Riedy, C. A., Weinstein, P., et al. (2000). Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6- to 36-month-old children. Community Dentistry and Oral Epidemiology, 28(4), 295–306. https://doi.org/10.1034/j.1600-0528.2000.028004295.x
Carlos, J. P., & Gittelsohn, A. M. (1965). Longitudinal studies of the natural history of caries—II. Archives of Oral Biology, 10(5), 739–751. https://doi.org/10.1016/0003-9969(65)90035-8
Li, Y., & Wang, W. (2002). Predicting caries in permanent teeth from caries in primary teeth: An eight-year cohort study. Journal of Dental Research, 81(8), 561–566. https://doi.org/10.1177/002203450208100803
Heller, K. E., Eklund, S. A., Pittman, J., et al. (2000). Associations between dental treatment in the primary and permanent dentitions using insurance claims data. Pediatric Dentistry, 22(6), 469–474.
Grembowski, D., & Milgrom, P. M. (2000). Increasing access to dental care for Medicaid preschool children: The Access to Baby and Child Dentistry (ABCD) program. Public Health Reports, 115(5), 448–459. https://doi.org/10.1016/S0033-3549(04)50051-1
Anusavice, K. J. (2005). Present and future approaches for the control of caries. Journal of Dental Education, 69(5), 538–554. https://doi.org/10.1002/j.0022-0337.2005.69.5.tb03914.x
Twetman, S., & Dhar, V. (2015). Evidence of effectiveness of current therapies to prevent and treat early childhood caries. Pediatric Dentistry, 37(3), 246–253.
Gustafsson, B. E., Quensel, C. E., Lanke, L. S., et al. (1954). The Vipeholm Dental Caries Study: The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontologica Scandinavica, 11(3–4), 232–264. https://doi.org/10.3109/00016355409029807
Weiss, R. L., & Trithart, A. H. (1960). Between-meal eating habits and dental caries experience in preschool children. American Journal of Public Health and the Nations Health, 50(8), 1097–1104. https://doi.org/10.2105/AJPH.50.8.1097
Newbrun, E., Hoover, C., Mettraux, G., et al. (1980). Comparison of dietary habits and dental health of subjects with hereditary fructose intolerance and control subjects. Journal of the American Dental Association, 101(4), 619–626. https://doi.org/10.14219/jada.archive.1980.0271
van Houte, J., & Duchin, S. (1975). Streptococcus mutans in the mouths of children with congenital sucrase deficiency. Archives of Oral Biology, 20(11), 771–773. https://doi.org/10.1016/0003-9969(75)90051-4
Paglia, L. (2015). Does breastfeeding increase risk of early childhood caries? European Journal of Paediatric Dentistry, 16(3), 173. https://doi.org/10.23804/ejpd.2015.16.03.08
Axelsson, P., Kristoffersson, K., Karlsson, R., et al. (1987). A 30-month longitudinal study of the effects of some oral hygiene measures on Streptococcus mutans and proximal dental caries. Journal of Dental Research, 66(3), 761–765. https://doi.org/10.1177/00220345870660031801
Marinho, V. C. C., Worthington, H. V., Walsh, T., et al. (2013). Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, 7, CD002279. https://doi.org/10.1002/14651858.CD002279.pub2
Milgrom, P., Taves, D. M., Kim, A. S., et al. (2014). Pharmacokinetics of fluoride in toddlers after application of 5% sodium fluoride dental varnish. Pediatrics, 134(3), e870–e874. https://doi.org/10.1542/peds.2014-0074
Jiang, E. M., Lo, E. C.-M., Chu, C.-H., et al. (2014). Prevention of early childhood caries (ECC) through parental toothbrushing training and fluoride varnish application: A 24-month randomized controlled trial. Journal of Dentistry, 42(12), 1543–1550. https://doi.org/10.1016/j.jdent.2014.09.008
Agouropoulos, A., Twetman, S., Pandis, N., et al. (2014). Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: A double-blind randomized controlled trial. Journal of Dentistry, 42(10), 1277–1283. https://doi.org/10.1016/j.jdent.2014.07.008
Oliveira, B. H., Salazar, M., Carvalho, D. M., et al. (2014). Biannual fluoride varnish applications and caries incidence in preschoolers: A 24-month follow-up randomized placebo-controlled clinical trial. Caries Research, 48(3), 228–236. https://doi.org/10.1159/000358284
Memarpour, M., Fakhraei, E., Dadaein, S., et al. (2015). Efficacy of fluoride varnish and casein phosphopeptide-amorphous calcium phosphate for remineralization of primary teeth: A randomized clinical trial. Medical Principles and Practice, 24(3), 231–237. https://doi.org/10.1159/000377658
Lawrence, H. P., Binguis, D., Douglas, J., et al. (2008). A 2-year community-randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal children. Community Dentistry and Oral Epidemiology, 36(6), 503–516. https://doi.org/10.1111/j.1600-0528.2008.00453.x
Anderson, M., Dahllöf, G., Twetman, S., et al. (2016). Effectiveness of early preventive intervention with semiannual fluoride varnish application in toddlers living in high-risk areas: A stratified cluster-randomized controlled trial. Caries Research, 50(1), 17–23. https://doi.org/10.1159/000443371
Ramos-Gomez, F. J., Gansky, S. A., Featherstone, J. D. B., et al. (2012). Mother and youth access (MAYA) maternal chlorhexidine, counseling, and pediatric fluoride varnish randomized clinical trial to prevent early childhood caries. International Journal of Paediatric Dentistry, 22(3), 169–179. https://doi.org/10.1111/j.1365-263X.2011.01167.x
Tickle, M., O’Neill, C., Donaldson, M., et al. (2016). A randomized controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: The Northern Ireland Caries Prevention In Practice (NIC-PIP) trial. Health Technology Assessment, 20(71), 1–96. https://doi.org/10.3310/hta20710
Slade, G. D., Bailie, R. S., Roberts-Thomson, K., et al. (2011). Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: Results from a community-randomized controlled trial. Community Dentistry and Oral Epidemiology, 39(1), 29–43. https://doi.org/10.1111/j.1600-0528.2010.00562.x
Dehailan, A. L., Lippert, F., González-Cabezas, C., et al. (2017). Fluoride concentration in saliva and biofilm fluid following the application of three fluoride varnishes. Journal of Dentistry, 60, 87–93. https://doi.org/10.1016/j.jdent.2017.03.001
Lopez, L., Berkowitz, R., Spiekerman, C., et al. (2002). Topical antimicrobial therapy in the prevention of early childhood caries: A follow-up report. Pediatric Dentistry, 24(3), 204–206.
Milgrom, P. M., Tut, O. K., & Mancl, L. A. (2011). Topical iodine and fluoride varnish effectiveness in the primary dentition: A quasi-experimental study. Journal of Dental Child (Chic), 78(3), 143–147.
Tubert-Jeannin, S., Auclair, C., Amsallem, E., et al. (2011). Fluoride supplements (tablets, drops, lozenges, or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews, (12), CD007592. https://doi.org/10.1002/14651858.CD007592.pub2
Harding, M. A., & O’Mullane, D. M. (2013). Water fluoridation and oral health. Acta Medica Academica, 42(2), 131–139. https://doi.org/10.5633/ama.2013.0218
Iheozor-Ejiofor, Z., Worthington, H. V., Walsh, T., et al. (2015). Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews, (6), CD010856. https://doi.org/10.1002/14651858.CD010856.pub2
Marthaler, T. M. (2013). Salt fluoridation and oral health. Acta Medica Academica, 42(2), 140–155. https://doi.org/10.5633/ama.2013.0219
Bánóczy, J., Rugg-Gunn, A., & Woodward, M. (2013). Milk fluoridation for the prevention of dental caries. Acta Medica Academica, 42(2), 156–167. https://doi.org/10.5633/ama.2013.0220
Yeung, C. A., Chong, L. Y., & Glenny, A.-M. (2015). Fluoridated milk for preventing dental caries. Cochrane Database of Systematic Reviews, (9), CD003876. https://doi.org/10.1002/14651858.CD003876.pub3
Walsh, T., Worthington, H. V., Glenny, A.-M., et al. (2010). Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, (1), CD007868. https://doi.org/10.1002/14651858.CD007868.pub2
Ellwood, R. P., Davies, G. M., Worthington, H. V., et al. (2004). Relationship between area deprivation and the anticaries benefit of an oral health programme providing free fluoride toothpaste to young children. Community Dentistry and Oral Epidemiology, 32(3), 159–165. https://doi.org/10.1111/j.1600-0528.2004.00115.x
Wright, J. T., Hanson, N., Ristic, H., et al. (2014). Fluoride toothpaste efficacy and safety in children younger than 6 years: A systematic review. Journal of the American Dental Association, 145(2), 182–189. https://doi.org/10.14219/jada.2014.2
Wong, M. C., Glenny, A.-M., Tsang, B. W., et al. (2010). Topical fluoride as a cause of dental fluorosis in children. Cochrane Database of Systematic Reviews, (1), CD007693. https://doi.org/10.1002/14651858.CD007693.pub2
Aimée, N. R., van Wijk, A. J., Maltz, M., et al. (2017). Dental caries, fluorosis, oral health determinants, and quality of life in adolescents. Clinical Oral Investigations, 21(5), 1811–1820. https://doi.org/10.1007/s00784-016-1940-1
Marinho, V. C. C., Higgins, J. P. T., Logan, S., et al. (2003). Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, (4), CD002782. https://doi.org/10.1002/14651858.CD002782
Marinho, V. C. C., Chong, L. Y., Worthington, H. V., et al. (2016). Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, (7), CD002284. https://doi.org/10.1002/14651858.CD002284.pub3
Marinho, V. C. C., Higgins, J. P. T., Sheiham, A., et al. (2004). One topical fluoride (toothpastes, mouthrinses, gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, (1), CD002780. https://doi.org/10.1002/14651858.CD002780.pub2
Horst, J. A., Ellenikiotis, H., & Milgrom, P. L. (2016). UCSF protocol for caries arrest using silver diamine fluoride: Rationale, indications and consent. Journal of the California Dental Association, 44(1), 16–28. https://doi.org/10.14219/jcad.2016.15
Mei, M. L., Chu, C.-H., & Lo, E. C.-M. (2013). Fluoride and silver concentrations of silver diamine fluoride solutions for dental use. International Journal of Paediatric Dentistry, 23(4), 279–285. https://doi.org/10.1111/ipd.12007
Mei, M. L., Li, Q.-L., Chu, C.-H., et al. (2013). Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries. Annals of Clinical Microbiology and Antimicrobials, 12, 4. https://doi.org/10.1186/1476-0711-12-4
Mei, M. L., Chu, C.-H., Low, K.-H., et al. (2013). Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm. Medicina Oral, Patología Oral y Cirugía Bucal, 18(6), e824–e831. https://doi.org/10.4317/medoral.18451
Knight, G. M., McIntyre, J. M., Craig, G. G., et al. (2009). Inability to form a biofilm of Streptococcus mutans on silver fluoride- and potassium iodide-treated demineralized dentin. Quintessence International, 40(2), 155–161.
Llodra, J. C., Rodriguez, A., Ferrer, B., et al. (2005). Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. Journal of Dental Research, 84(8), 721–724. https://doi.org/10.1177/154405910508400808
Zhi, Q. H., Lo, E. C.-M., & Lin, H. C. (2012). Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. Journal of Dentistry, 40(11), 962–967. https://doi.org/10.1016/j.jdent.2012.07.002
Yee, R., Holmgren, C., Mulder, J., et al. (2009). Efficacy of silver diamine fluoride for arresting caries treatment. Journal of Dental Research, 88(7), 644–647. https://doi.org/10.1177/0022034509341343
Fung, M. H. T., Duangthip, D., Wong, M. C. M., et al. (2016). Arresting dentine caries with different concentration and periodicity of silver diamine fluoride. Journal of Dental Research, Clinical & Translational Research, 1(2), 143–152. https://doi.org/10.1177/2380084416667351
Chu, C.-H., Lo, E. C.-M., & Lin, H. C. (2002). Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. Journal of Dental Research, 81(11), 767–770. https://doi.org/10.1177/154405910208101106
Tan, H. P., Lo, E. C.-M., Dyson, J. E., et al. (2010). A randomized trial on root caries prevention in elders. Journal of Dental Research, 89(10), 1086–1090. https://doi.org/10.1177/0022034510375800
Liu, B. Y., Lo, E. C.-M., & Li, C. M. T. (2012). Effect of silver and fluoride ions on enamel demineralization: A quantitative study using micro-computed tomography. Australian Dental Journal, 57(1), 65–70. https://doi.org/10.1111/j.1834-7819.2011.01629.x
Crystal, Y. O., Janal, M. N., Hamilton, D. S., et al. (2017). Parental perceptions and acceptance of silver diamine fluoride staining. Journal of the American Dental Association, 148(7), 510–518.e4. https://doi.org/10.1016/j.adaj.2017.04.014
Chu, C. H., & Lo, E. C.-M. (2008). Microhardness of dentine in primary teeth after topical fluoride applications. Journal of Dentistry, 36(6), 387–391. https://doi.org/10.1016/j.jdent.2008.02.007
Cueto, E. I., & Buonocore, M. G. (1967). Sealing of pits and fissures with an adhesive resin: Its use in caries prevention. Journal of the American Dental Association, 75(1), 121–128. https://doi.org/10.14219/jada.archive.1967.0217
Liu, B. Y., Lo, E. C.-M., Chu, C. H., et al. (2012). Randomized trial on fluorides and sealants for fissure caries prevention. Journal of Dental Research, 91(8), 753–758. https://doi.org/10.1177/0022034512453561
Tagliaferro, E. P. D. S., Pardi, V., Ambrosano, G. M. B., et al. (2011). Occlusal caries prevention in high and low risk schoolchildren: A clinical trial. American Journal of Dentistry, 24(2), 109–114.
Chestnutt, I. G., Hutchings, S., Playle, R., et al. (2017). Seal or varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technology Assessment, 21(21), 1–256. https://doi.org/10.3310/hta21210
Sun, B. C., Chi, D. L., Schwarz, E., et al. (2015). Emergency department visits for nontraumatic dental problems: A mixed-methods study. American Journal of Public Health, 105(5), 947–955. https://doi.org/10.2105/AJPH.2014.302454
Wright, J. T., Crall, J. J., Fontana, M., et al. (2016). Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: A report of the American Dental Association and the American Academy of Pediatric Dentistry. Journal of the American Dental Association, 147(8), 672–682.e12. https://doi.org/10.1016/j.adaj.2016.06.001
Mickenautsch, S., & Yengopal, V. (2016). Caries-preventive effect of high-viscosity glass ionomer and resin-based fissure sealants on permanent teeth: A systematic review of clinical trials. PLoS ONE, 11(1), e0146512. https://doi.org/10.1371/journal.pone.014651
Cagetti, M. G., Carta, G., Cocco, F., et al. (2014). Effect of fluoridated sealants on adjacent tooth surfaces: A 30-month randomized clinical trial. Journal of Dental Research, 93(7 Suppl), 59S–65S. https://doi.org/10.1177/0022034514542745
Trahan, L. (1995). Xylitol: A review of its action on mutans streptococci and dental plaque–its clinical significance. International Dental Journal, 45(1 Suppl 1), 77–92. https://doi.org/10.1111/j.1875-595X.1995.tb00743.x
Horst, J. A., Tanzer, J. M., & Milgrom, P. M. (2018). Fluorides and other preventive strategies for tooth decay. Dental Clinics, 62(2), 207-234.n
Published
How to Cite
Issue
Section
Copyright (c) 2018 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
