Fluoride supplements for pregnant women to prevent caries in their children

Pregnancy is a major life changing event for all women, but this study shows that women who are depressed during pregnancy are also at risk of reduced breastfeeding initiation and premature delivery

A number of reviews have demonstrated the benefits of topical fluoride in caries prevention.  Placenta transfer of fluoride is possible although the mechanism is subject to controversy. Consequently, there is the possibility that fluoride could be incorporated into teeth developing in utero, so fluoride supplements taken during pregnancy could prevent caries in their children.

The aim of this Cochrane review was to evaluate the effects of women taking fluoride supplements (tablets, drops, lozenges or chewing gum) compared with no fluoride supplementation during pregnancy to prevent caries in the primary teeth of their children.

Methods

Searches were conducted in the Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) Medline, Embase, LILACS BIREME Virtual Health Library CINAHL US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform databases with no restrictions on language or date.

Randomised controlled trials (RCTs) of fluoride supplements (tablets, drops, lozenges or chewing gum) given to women during pregnancy with the aim of preventing caries in the primary teeth of their children were considered.  Two reviewers independently screened the studies, extracted data and assessed risk of bias. Overall study quality was assessed using the GRADE approach.

Results

  • Only 1 RCT at a high risk of bias was included.
  • 1175 children were born to participants, at 3 years 938 children were followed up (464 in fluoride group, 484 in placebo group). 798 children were followed up at 5 years (398 fluoride, 400 placebo).
  • There was no statistical difference in decayed or filled primary tooth surfaces(dfs) or % of children with caries at 3 years or 5 years.
  •  3 years, risk ratio (RR) = 1.46, (95%CI; 0.75 to 2.85)
  • 5 years, RR = 0.84, (95%CI; 0.53 to 1.33)
  • Incidence of fluorosis at 5 years was similar between the groups

Conclusions

The authors concluded: –

There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.

Comments

As the authors note, the theoretical weakness of mechanisms surrounding placental transfer of fluoride and concerns related to exposure during pregnancy taken together with a lack of recent studies and improved knowledge regarding topical fluoride raise important questions as to whether research on this topic should be given any priority.

Links

Primary paper

Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E.
 Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children.
Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD011850.
DOI: 10.1002/14651858.CD011850.pub2.

Other references

Cochrane Oral Health Group Blog – No evidence that fluoride supplements taken by pregnant women prevent tooth decay in their babies

 

 

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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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