Fluoride varnishes for preventing dental caries in children and adolescents

  • Review
  • Intervention




Topically applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over 2 decades.


To determine the effectiveness and safety of fluoride varnishes in the prevention of dental caries in children and to examine factors potentially modifying their effect.

Search methods

Multiple electronic database searches, reference lists of articles, journal handsearch, selected authors and manufacturers.

Selection criteria

Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride varnish with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).

Data collection and analysis

Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Study authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF), that is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects metaregression analyses.

Main results

Nine studies were included, involving 2709 children. For the seven that contributed data for the main meta-analysis, the D(M)FS pooled prevented fraction estimate was 46% (95% CI, 30% to 63%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001). The pooled d(e/m)fs prevented fraction estimate was 33% (95% CI, 19% to 48%; P < 0.0001). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity or background exposure to fluorides was found in metaregression, and a funnel plot of the seven studies indicated no relationship between prevented fraction and study precision. In both methods, power is limited when only a few trials are included.

Authors' conclusions

The review suggests a substantial caries-inhibiting effect of fluoride varnish in both the permanent and the deciduous dentitions based largely on trials with no treatment controls. There is little information concerning acceptability of treatment or possible side effects in the included trials. Given the relatively poor quality of most of the included studies and the wide confidence intervals around the estimates of effect, there remains a need for further trials. It is important that these trials should be of high quality and include assessment of potential adverse effects.










隨機化或半隨機化的對照試驗並採取盲性的結果評估,將氟漆與安慰劑或不治療分別實驗在十六歲以下的小朋友身上,做試驗至少一年.主要的結果是測量齲齒在齲齒牙,喪失牙和被填補的牙表面(D (M) FS)的增加量。




9個試驗包含了2709個小朋友,其中7個研究的數據作整合分析, D(M)FS的PF為46% (95%信賴區間(CI)為30%到63%; p < 0.0001)。統計上已證實關聯性是真實的(p<0.0001)。合併d(e/m)fs之PF估記為 33% (95%信賴區間(CI),19%到48%; p < 0.0001)。由整合迴歸分析顯示,估計的D(M)FS預防分數(PF)與原本齲齒嚴重程度或氟暴露無統計相關.而7個研究的funnel plot顯示PF與研究之精密度無關。這兩種方法,如果包含不夠多的試驗則結果不夠有力.





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Fluoride varnishes for preventing dental caries in children and adolescents

Fluoride varnishes applied professionally two to four times a year would substantially reduce tooth decay in children.
Fluoride is a mineral that prevents tooth decay (dental caries). Since widespread use of fluoride toothpastes and water fluoridation, the value of additional fluoride has been questioned. Fluoride varnishes can be professionally applied at a frequency from two to four times a year. The review of trials found that fluoride varnish can substantially reduce tooth decay in both milk teeth and permanent teeth. However, more high quality research is needed to be sure of how big a difference the treatment makes, and to study acceptability and adverse effects