Fluoride supplements have a preventive effect on caries in permanent teeth

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In the past 30 years most developed countries have seen a decrease in the prevalence and severity of dental caries in children, with most disease now found in children often characterised by a low socioeconomic status. The aim of this Cochrane review was to evaluate the efficacy of fluoride supplements for preventing dental caries in children.

Detailed searches of a range of databases ( Cochrane Oral Health Group’s Trials Register), the Cochrane Central Register of Controlled Trials [CENTRAL] , Medline , Embase, WHOLIS/PAHO/MEDCARIB/LILACS/BBO and Current Controlled Trials)  were conducted. Reference lists were searched and selected authors contacted.  Randomised or quasi-randomised controlled trials that compared fluoride supplements (tablets, drops, lozenges) with no fluoride supplement or with other preventive measures such as topical fluorides in children less than 16 years of age with a minimum or two-year follow-up were included.  Caries increment measured by the change in decayed, missing and filled tooth surfaces (DMFS) was the main outcome.

They included eleven studies  ( 7196 Children) and found:-

  •  Comparing fluoride supplements were compared with no fluoride supplement
    •  In permanent teeth, fluoride supplements were associated with a 24% (95% CI; 16 to 33%) reduction in decayed, missing and filled surfaces(D(M)FS).
    • In deciduous or primary teeth the effect was unclear.  ( One study showed no effect,  the other a substantial reduction in caries increment).
  •  When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth.
  •  The review found limited information on the adverse effects associated with the use of fluoride supplements.

They concluded:-

This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.

Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, Schulte AG, Koch MJ, Rège-Walther M, Ismail A. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD007592. DOI: 10.1002/14651858.CD007592.pub2.

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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