Topical fluoride for remineralising and arresting caries

Dental caries remains an important public health problem with almost 30% of toddlers in the USA being affected by caries and 620 million children worldwide having untreated caries.

The aim of this review was to assess the clinical efficacy of professionally applied fluoride therapy in remineralising and arresting dental caries for children.

Methods

Searches were conducted in the Cochrane Library, PubMed, Embase and the ISI Web of Science. Clinical trials conducted in children and published in English where the outcome measures included the remineralisation or arresting effect of caries by professional fluoride treatment were considered. Two authors screed the studies and evaluated risk of bias independently. Random effect meta-analysis was undertaken.

Results

17 RCT studies were included, 10 studies considered remineralisation and 7 studies arresting carious lesions.
Remineralisation – 6 studies involved fluoride varnish, 3 fluoride gels, 1 silicon tetrafluoride and one 10 % silver diamine fluoride
- Meta-analysis for fluoride varnish (4 studies) found the overall percentage of remineralisation of early enamel caries was 63.6 % (95 % CI; 36.0 % – 91.2 %; p<0.001)
Arresting caries – 7 studies all involving silver diamine fluoride solution (SDF) or nano-silver fluoride solution in various concentrations 38%, 30% & 12%.
- Meta-analysis of 5 studies using 38% SDF found the overall proportion of arrested dentine caries after SDF solution treatment was 65.9 % (95 % CI; 41.2 % – 90.7 %; p< 0.001)

Conclusions

The authors concluded

Professionally applied 5 % sodium fluoride varnish shows the capability to remineralise early enamel caries in children. Silver diamine fluoride solution at 38 % is effective in arresting active dentine caries. Because the number of clinical trials that studied the arresting effect of dental caries is limited, more clinical trials should be performed.

Comments

Cochrane reviews have demonstrated the clinical effectiveness of topical fluoride agents, (Varnishes, Gels and toothpastes) in caries prevention. This review has looked specifically at remineralisation and arresting of existing carious lesions. While 4 major databases have been searched only English language studies have been included. While a range of topical fluoride agents were used a majority of the studies focused on two agents, fluoride varnish and silver diamine fluoride. These two agents demonstrated good effectiveness in remineralising and arresting carious lesions respectively.