Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial

Muñoz-Millán, Patricia; Zaror, Carlos; Espinoza-Espinoza, Gerardo; Vergara-González, Carolina; Muñoz, Sergio; Atala-Acevedo, Claudia; Martinez‐Zapata, Maria José

doi:10.1111/cdoe.12330

Cited by 31 publications

(39 citation statements)

References 21 publications

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“…6 Some additional studies concerning this topic have been published since undertaking the modelling. 8,11 These report that there was no evidence of the effect of FV on caries-free populations. Undoubtedly, more studies are required to determine the effect on caries-free populations.…”

Section: Discussionmentioning

confidence: 99%

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Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

Palacio

Shen

Vale

et al. 2019

Comm Dent Oral Epid

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Objectives This study illustrates the use of a decision analytic model (DAM) to evaluate whether fluoride varnish application (FV) increases the proportion of caries‐free children in the Chilean preschool population, at an acceptable cost. Methods Different FV interventions were compared with an oral health counselling‐only intervention. The FV interventions were tested (with and without screening) every 6 months over 2 years, in either a preschool setting or during a well‐child programme appointment in a primary care setting. A Markov model was developed to simulate the FV performance. The model was populated with data obtained from Chilean epidemiologic studies, a systematic review and a costing study. The counselling‐only intervention was compared with FV interventions to estimate the incremental cost per child. As there was uncertainty in terms of precise parameter values both probabilistic and deterministic sensitivity analyses were performed. Results Delivery of FV in a primary care setting without screening was the most effective and the least costly intervention. Compared with counselling‐only intervention, this intervention increased the prevalence of caries‐free children in the population by 3.7%, with an extra cost (in March 2015) of £3 per caries‐free child. The results were sensitive to the starting age of FV application; increasing age would reduce the cost‐effectiveness of the FV intervention. Furthermore, cost‐effectiveness improves if some equipment such as an oral hygiene kit was not used and if less costly but qualified staff applied FV rather than dentists. Conclusions This analysis allowed the comparison of the performance of FV in realistic scenarios incorporating important aspects of health and education policies. The application of FV in a primary care setting was the most cost‐effective strategy. The work demonstrated that both the methodology and results are useful for decision‐makers.

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Section: Discussionmentioning

confidence: 99%

“…The limited number of studies about the effect of FV on caries‐free populations meant that the model was reliant on data drawn from a single study . Some additional studies concerning this topic have been published since undertaking the modelling . These report that there was no evidence of the effect of FV on caries‐free populations.…”

Section: Discussionmentioning

confidence: 99%

Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

Palacio

Shen

Vale

et al. 2019

Comm Dent Oral Epid

View full text Add to dashboard Cite

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“…A recent publication conducted in a rural non-fluoridated community in Chile found that bi-annual fluoride application was not effective in preschool children. 25 A community-randomised controlled trial in Australian Aboriginal children however showed that fluoride varnish was efficacious in preventing dental caries. 26 In this trial the caries reduction ranged from 2.3 to 3.5 surfaces per child with a preventive fraction of 24 to 36% (that is, similar to our findings).…”

Section: Discussionmentioning

confidence: 99%

Impact of a caries preventive intervention in remote Indigenous Australian children

Lalloo

Tadakamadla

Kroon

et al. 2019

Preprint

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IMPORTANCE: The burden of dental caries in remote Indigenous communities in Australia is unacceptably high. OBJECTIVES: We tested the impact of an annual caries preventive intervention, delivered by a fly-in/fly-out professional team, on Indigenous children residing in a remote Australian community, involving selective fissure sealants, topical povidone iodine and fluoride varnish application. The outcome was caries increment at 12- and 24-month follow-up. DESIGN, SETTING, PARTICIPANTS: Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of which 408 had caregiver consent provided. Of these, 196 consented to both the study and the treatment arm and comprised the experimental group. Two hundred and twelve consented to the epidemiological examination only, and constituted the comparison group. INTERVENTION: The Big Bang intervention, which occurred annually, comprised placement of fissure sealants, and application of povidone-iodine and fluoride varnish, following completion of each childs dental treatment plan. Standard diet and oral hygiene advice was provided. MAIN OUTCOMES AND MEASURES: Caries increment (number of tooth surfaces with new dental caries) in both primary and permanent dentitions at 12- and 24-month follow-up. RESULTS: At 12-month follow-up, children in the experimental group had, on average, 5.05 (5.47) new carious lesions compared to 7.49 (6.94) in the comparison group (p=0.001). The preventive fraction was 33%. At 24-month follow-up, children in the experimental group had, on average, 6.47 (6.07) new carious lesions compared to 8.43 (5.83) in the comparison group (p=0.002). The preventive fraction was 23%. CONCLUSIONS AND RELEVANCE: Indigenous children exposed to the Big Bang caries intervention had significantly less increment in dental disease than those not exposed to the intervention. Benefits were demonstrated at both 12- and 24-month follow-ups, suggesting that the intervention is likely to be sustained if delivered across a childs life. The cost-effectiveness of this approach is being evaluated.

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“…It is considered as a physical barrier, so it prevents the direct contact between acids and enamel. In addition, it discharges fluoride in the oral cavity [35] . The varnish is distinguished from other fluoride products as easy to use, safe and effective method.…”

Section: Discussionmentioning

confidence: 99%

Effect of resin infiltrant and fluoride varnish on micro-hardness of de-mineralized enamel submitted to pH challenge

Attia

2018

Egyptian Dental Journal

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The purpose of this study was to evaluate the micro-hardness of artificially induced demineralized enamel after application of resin infiltrant and fluoride varnish and after pH challenge.Material and methods: In the current study; sound bovine incisors were used. A total of 40 sound enamel were then embedded in pre-cut metal cylinders. Two layers of acid-resistant nail varnish were applied to cover most of the enamel surfaces, leaving a window of 4×4 mm for demineralization. Each specimen was immersed in 32 ml of a de-mineralizing solution containing 50 mM acetate buffer solution and 1.28 mM Ca(NO3)2_4H2O, 0.74 mM (NaH2PO4)_2H2O, and 0.03 ppm F at pH 5.0,10 for 24 hours at 37˚C , then microhardness was recorded. The samples then were divided into two groups according to the material used to treat the de-mineralized enamel, each group consisted of 20 samples. Group 1: The samples of de-mineralized enamel were infiltrated with resin infiltration. Then the micro-hardness was recorded for all resin infiltrated samples before pH cycling challenge. The samples were then submitted to a pH cycling model at 37 C over 7 days. The pH cycling consisted of immersing the samples in 35.5 ml of de-mineralizing solution: (2.0 mmol/ L Ca, 2.0 mmol/ L P, 0.075 mol/ L acetate buffer, 2.22 mL/mm 2 of enamel surface) for 6 hours, alternated with immersion in 17.75 mL of re-mineralizing solution: (1.5 mmol/ L Ca, 0.9 mmol/ L P, 0.15 mol/ L KCl, 0.02 mol/ L cacodylate buffer, pH 7.0, 0.25 mL/mm 2 ) for 18 hours for 5 days. Then, specimens were kept for 2 more days in a fresh re-mineralizing solution, completing 7 days of treatment. The samples were washed in de-ionized water for 30 seconds among demineralizing and re-mineralizing cycles. Group 2: Fluoride varnish (Duraphat , Colgate-Palmolive ,NSW, Australia) was applied as a thin layer by a brush and totally dried, then the micro-hardness was recorded. The samples were then subjected to a pH cycling as in group 1. Then after challenge the micro-hardness measurements were performed as formerly described. Results:The difference was highly significant between resin infiltrant and fluoride varnish treated enamel. The comparison among micro-hardness values of initial, de-mineralized enamel, resin-infiltrated enamel and resin infiltrated after pH cycling showed that there was a significant difference. The difference between micro-hardness values was highly significant when comparison was accomplished between initial and de-mineralized enamel, initial and after pH cycling, demineralized enamel and resin infiltrated enamel, de-mineralized enamel and after pH cycling and finally between resin infiltrated enamel and after pH cycling. The difference between microhardness values was not significant regarding initial and resin infiltrated enamel. Conclusion:Within the limitations of this study, it was concluded that the micro-hardness of resin infiltrated enamel was higher than that of de-mineralized enamel treated with fluoride varnish before and after pH cycling.(500) Reham M. Attia E.D.

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Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial

Cited by 31 publications

References 21 publications

Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

Impact of a caries preventive intervention in remote Indigenous Australian children

Effect of resin infiltrant and fluoride varnish on micro-hardness of de-mineralized enamel submitted to pH challenge

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