Evaluating the effectiveness of fluoride varnish in preventing caries amongst Long‐Term Care Facility Residents

Jabir, E; McGrade, Catherine; Quinn, Grainne; McGarry, Joe; Iomhair, Aoife Nic; Kelly, Niamh; Srinivasan, Murali; Watson, Sinead; McKenna, Gerald

doi:10.1111/ger.12563

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…Across all KQs, 16 studies (in 17 publications; total 3300 participants) were included (Figure 3). One randomized clinical trial (RCT) and 7 diagnostic accuracy studies addressed screening, and 4 RCTs and 5 nonrandomized trials addressed preventive interventions. The Table summarizes the evidence reviewed for this report.…”

Section: Resultsmentioning

confidence: 99%

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Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults

Chou,

Selph,

Bougatsos

et al. 2023

JAMA

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ImportanceDental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention.ObjectiveTo systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force.Data SourcesMEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.Study SelectionDiagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms.Data Extraction and SynthesisOne investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model.Main Outcomes and MeasuresDental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy.ResultsFive randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, −0.33 to −1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care–administered preventive interventions.Conclusions and RelevanceScreening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.

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Section: Resultsmentioning

confidence: 99%

“…One fair-quality and 4 poor-quality trials evaluated topical fluorides (varnish or gels/solutions) vs placebo or no topical fluoride for prevention of dental caries in adults (eTables 5 and 6 in the Supplement). In all trials, topical fluorides were applied by dental professionals.…”

Section: Resultsmentioning

confidence: 99%

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults

Chou,

Selph,

Bougatsos

et al. 2023

JAMA

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“…The effectiveness of an intervention with fluoride varnish and topical agents for reduction of RCLs depends on the interval and the frequency of application. For example, sodium fluoride varnish (Duraphat) is recommended to be applied four times per year [ 11 , 12 ]; however, a frequency of twice a year has also been shown to be effective in reducing the number of RCLs in care-dependent older adults [ 50 ]. Tan et al [ 55 ] performed an intervention using SDF only once a year; even at this relatively low rate of application, they were able to report greater effectiveness in reducing new RCLs incidence compared with the other substances (Duraphat or Cervitec) [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review

Morén

Skott

Edman

et al. 2023

JCM

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With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed.

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“…1,19 In addition, fluoride varnish was associated with decreased risk of developing new dental caries (relative risk, 0.25 [95% CI, 0.10-0.63]), translating to a number needed to treat of 3.1 (95% CI, 2.1-7.7). 1,19 A nonrandomized cluster trial 25 (n = 232) of older adults in long-term care facilities found no group differences in dental caries burden (based on DMFT/DFT [Decayed, Missing, and Filled Teeth/Decayed, Filled Teeth] score) at 1 year (adjusted mean difference, −0.04 [95% CI, −0.10 to 0.03]). 1,19 The 3 additional trials of other topical fluoride approaches (sodium fluoride 2% solution, stannous fluoride [30%] paste followed by aqueous solution, and acidulated phosphate fluoride [1.2%] at varied time frames) obtained inconsistent results.…”

Section: Effectiveness Of Preventive Interventionsmentioning

confidence: 99%

Screening and Preventive Interventions for Oral Health in Adults

Barry,

Nicholson,

Silverstein

et al. 2023

JAMA

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ImportanceOral health is fundamental to health and well-being across the life span. Dental caries (cavities) and periodontal disease (gum disease) are common and often untreated oral health conditions that affect eating, speaking, learning, smiling, and employment potential. Untreated oral health conditions can lead to tooth loss, irreversible tooth damage, and other serious adverse health outcomes.ObjectiveThe US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in adults.PopulationAsymptomatic adults 18 years or older.Evidence AssessmentThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults.RecommendationsThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement)

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Evaluating the effectiveness of fluoride varnish in preventing caries amongst Long‐Term Care Facility Residents

Cited by 12 publications

References 11 publications

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults

The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review

Screening and Preventive Interventions for Oral Health in Adults

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