Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis

Abstract

Background: The systematic review and network meta-analysis (NMA) summarizes the evidence by comparing directly or indirectly the early childhood caries (ECC) preventive effect of 2 or more types of topical (professional or self-applied) fluorides.

Methods: Randomized controlled clinical trials with a minimum of 1-year follow-up that assessed the caries-preventive effect of topical fluorides among children younger than 6 years of age were included. Eight electronic databases and grey literature were searched. Two independent reviewers performed screening, data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 and assessed certainty of evidence using GRADE approach. Surface under the cumulative ranking command was used for ranking the interventions and NMA was conducted using a frequentist random-effects approach.

Results: Twenty-four trials (27 published articles) were included, among which 17 were assessed to be of “high risk” and the other 7 as “low risk”. Fifteen studies evaluated professionally-applied topical fluorides, and the other 9 used self-applied topical fluorides agents. Ten studies were included in NMA with professionally-applied topical fluorides reporting the net caries increment (dmfs increment) at 2-year follow-up. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish, were effective in preventing ECC compared to control.

Conclusion: Among all reviewed professionally-applied topical fluoride interventions, 0.9% DFS application at 3-monthly intervals was ranked first. Among the included studies on self- applied topical fluorides, due to the variations in follow-up time points and data presentation, the evidence was inconclusive.