Clinical success with different intensive fluoridation methods
Professor Klaus Pieper
Head of the Department of Pedodontics and Community Dentistry, Philipps-University Marburg, GER
Fluorides are applied as low concentrated toothpastes and mouthrinses or as higher concentrated varnishes and gels. A brief review of meta-analyses and Cochrane Reviews illustrates the effects that can be achieved with these measures. In addition, we report our own results out of two studies focusing on the effectiveness of a children?s toothpaste (with 500 ppm fluoride) and a fluoride varnish.
Study 1: Two- to four-year-old children attending kindergartens were randomly allocated to two groups. Children in the test group participated in daily supervised toothbrushing with 500 ppm fluoride toothpaste. Children in the control group received instruction on toothbrushing three to four times a year. After 30 months, the caries increment of the test group (¢ dmf-s=1.55) was 24% lower than that of the control group (¢ dmf-s=2.02, p=0.043). The results of this study show that a 500 ppm fluoride toothpaste is effective when applied on a daily basis.
Study 2: Selective intensified prevention (SIP) including fluoride varnish applications four times per year was introduced at individual schools in underprivileged areas in Marburg County in 1995. The effectiveness of this program was evaluated in sixth graders (mean age: 12.06) in comparison with a control region. Caries was recorded using the ICDAS II. Combining ICDAS scores 3 to 6, children from the control region (mean D3-6MFT: 1.73) showed roughly double the caries seen in the test group (mean D3-6MFT: 0.88, p < 0.005).
The results indicate a clear effect of frequent fluoride varnish applications in underprivileged children.
Key messages from the lecture
- Dental health of children in Germany improved considerably from 1994 to 2009 (caries reduction around 70% in 12 year old children)
- This decline was a result of several factors, topical fluoride application being a major factor
- Many systematic reviews showed a strong caries preventive activity for fluoride containing toothpastes (f.e. Walsh et al. 2010)
- High fluoridation by fluoride gels or varnishes was shown to give further reduction in caries experience (Marinho et al. 2003)
- Fluoride containing toothpaste and gels are excellent preventative measures for low to medium risk patients
- Fluoride varnishes are extremely beneficial also in high risk patients and were shown to reduce caries experience in low risk patients almost to zero
- Intensified prevention programs (health education, oral hygiene instructions and fluoride varnish application) in schools with high risk children can improve oral health considerably
- Questionnaires showed that brushing behaviour and disease knowledge was not increased, suggesting that the positive effect was mainly due to the varnish application
- Scientific study have also shown that caries experience of the kid is closely related to the parents? social level and education
- A similar prevention program with 500ppm fluoride children?s toothpaste in kindergartens showed that daily tooth brushing under guidance results in a reduction of 23% in caries increment
- Fluoride plays a key role in caries prevention
- Adequate formulations should be chosen according to the setting and the degree of professional support
- Fluoride varnishes are most effective but require professional application
- Fluoride gels are less effective but can be applied by laymen
- Toothpastes with low fluoride content need frequent application at least once better twice a day
