Fluoride in root caries prevention: review with network meta-analysis

Abstract

Objectives: The aim of this systematic review and network meta-analysis was to summarize the direct and indirect clinical evidence on the effectiveness of professional applied and self-applied topical fluorides in preventing dental root caries. Methods: Randomized clinical trials with any follow-up duration were included. MEDLINE, PubMed, Embase, Scopus and Cochrane Library were searched. Two reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments and assessment of the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Fixed effects model and frequentist approach were used in the network meta-analyses. Results: Nine clinical trials involving 4,030 participants were included. Five professional applied and seven self-applied topical fluoride agents or combinations were included in the meta-analyses. Compared to no additional fluoride, three professional applied agents, 38% silver diamine fluoride solution, 5% sodium fluoride varnish and 1.2% acidulated phosphate fluoride reduced root caries increment after 2 years (ranged from 0.59 to 0.85 DF-root). Fluoride mouth rinse and fluoride toothpaste, used alone or in combination reduced root caries increment after 1 year (ranged from 0.29 to 1.90 DF-root). Conclusions: Among the professional applied topical fluoride reviewed, annually applied 38% silver diamine fluoride solution combined with oral health education is the most effective. Among the reviewed self-applied topical fluoride methods, 0.2% NaF mouth rinse, 1100-1500 ppm fluoride toothpaste followed by 0.05% NaF mouth rinse, and 1100-1500 ppm fluoride toothpaste, are effective in preventing dental root caries.