Fluoride varnish has changed into a popular anti-cavity treatment for children, and it isn’t hard to see why. It’s relatively easy to utilize, and not only for dentists or dental hygienists. Pediatricians can do it as well, with minimal instruction. The sticky varnish goes up with a comb and then dries in a couple of hours. There’s little threat of children swallowing the fluoride, as they may with other topical treatments such as gels.
Nor can it be extremely expensive, with treatment costs generally ranging from about $25 to $55. That doesn’t seem to be a prohibitive price to pay to shield a kid against tooth decay.
Yet a new study by two University of Washington researchers and their colleagues questions the cost-effectiveness of fluoride varnish for preschoolers and calls its anti-cavity effects “modest and uncertain” in this age group.
Dr. Joana Cunha-Cruz and Dr. Philippe Hujoel of the UW School of Dentistry and four research colleagues came up with their conclusion after reviewing 20 clinical trials of fluoride varnish in 13 countries. They examined trials where fluoride varnish was used by itself or in a oral health program, and also checked the outcomes of using fluoride varnish weighed against placebo, usual care, or no treatment.
“As much as we wish fluoride varnish to be effective, the present evidence doesn’t support an enormous benefit because of its use within young kids,” Dr. Cunha-Cruz said.
In their new study, which was recently published in the journal Caries Research, she and her colleagues noted that fluoride varnish applications are aimed especially at children with a top threat of caries, or tooth decay. It’s not considered a principal type of treatment, but instead a complement to other fluoride treatments such as toothpaste or fluoridated water.
Nonetheless, the researchers reported that more recent clinical trials in both low-risk and high-risk groups “failed to exhibit a protective effect of fluoride varnish applications.”
“Cost-effectiveness analyses are required to assess whether fluoride varnish must be adopted or abandoned by dental services,” they said within their study.
The researchers don’t assert that fluoride varnish doesn’t work. Their analysis revealed that the chance of developing new cavities declined by 12 percent among the kids who received fluoride varnish, weighed against people who did not. And they added that fluoride varnish could still be described as a cost-effective alternative in certain cases. However, in addition they stated, “This is a fairly modest benefit, as a sizable number of the kids developed new dentine caries lesions, regardless of fluoride varnish use.”
Concentrations of fluoride may also vary among different varnishes, Dr. Cunha-Cruz said.
That’s not to say that there aren’t highly effective topical treatment alternatives. Sealants execute a good job of protecting one’s teeth, especially those hard-to-reach ones in the trunk of the mouth, Dr. Cunha-Cruz said. Better still are sealants with glass ionomer, which releases fluoride, in place of resin-based sealants, which don’t have it.
Sealants tend to be more difficult to utilize than varnish, but Dr. Cunha-Cruz said that they remain effective for 2 to 3 years. Silver diamine fluoride has been growing in popularity and is very effective in stopping decay, she said, but more research is required on its preventive effect. It can also discolor teeth, but that isn’t the maximum amount of of a concern for preschoolers who still haven’t lost their primary teeth.
“The evidence still supports the usage of fluoride toothpaste, that will be easy and low-cost,” Dr. Cunha-Cruz said. “The value of toothpaste is based on how it creates an everyday presence of fluoride in the mouth.” Fluoride rinse can also be effective this way, she said.
For the time being, she and her research colleagues are calling for more studies of fluoride varnish’s cost-effectiveness among different populations and application settings.
Meanwhile, aside from using fluoride toothpaste and rinses daily, Dr. Cunha-Cruz suggests another approach: “Reducing sugar intake is a far more cost-effective strategy.”