Effectiveness of a New Fluoride Varnish for Caries Prevention In Pre-School Children

Objective: To investigate the effectiveness of a new fluoride varnish (Clinpro White Varnish, 3M Espe, Seefeld, Germany) with regard to the caries incidence within a 2-year period. Study design: A non-randomized sample of 400 children from the Kyffhäuser district (Thuringia, Germany) was divided into a fluoride group (FG, biannual application of fluoride varnish) and control group (CG, no intervention). (Non-)cavitated caries lesions were recorded using World Health Organization (WHO) and Universal Visual Scoring System (UniViSS) criteria. Parents were given questionnaires to gather information about their socio-economic status (SES). Non-parametric methods and binomial logistic regression were used for data analysis. Results: There was a significant increase in caries incidence in both groups. The number of non-cavitated carious lesions was significantly lower in the FG (mean 2.2; sd 2.3) compared with the CG (mean 2.9; sd 1.9). Initial statistical analysis revealed that fluoride varnish might prevent non-cavitated carious lesions. When including SES as a confounder into regression model, potential preventive effect was lost. Conclusions: This study underlines the importance of the multi-factorial etiology of caries and illustrates that the effectiveness of biannual fluoride varnish application was evident in non-cavitated carious lesions only.

Dental caries; prevention; fluoride varnish; preschool child

1. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol; 31 Suppl 1: 3-23. 2003.

2. Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent; 25: 594-600. 2003.

3. Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent; 59: 192-7. 1999.

4. Hirsch C, John M, Waurick M. Pilotstudie zur mundgesundheitsbezogenen Lebensqualität bei Kindern [Pilot study on the oral health-related quality of life in children] (article in German). Oralprophylaxe; 22: 144-9. 2000.

5. Robke F, Buitkamp M. Häufigkeit der Nuckelflaschenkaries bei Vorschulkindern in einer westdeutschen Großstadt [Frequency of baby bottle caries in preschool children in a West german city] (article in German). Oralprophylaxe; 24: 59-65. 2002.

6. Pieper K. Epidemiologische Begleituntersuchungen zur Gruppenprophylaxe 2009 [Epidemiological studies accompanying the group prophylaxis 2009] (article in German). Marburg: Deutsche Arbeitsgemeinschaft für Jugendzahnpflege 2010.

7. Irvine J, Holve S, Krol D, Schroth R. Early childhood caries in Indigenous communities: A joint statement with the American Academy of Pediatrics. Paediatr Child Health; 16: 351-64. 2011.

8. Boeira GF, Correa MB, Peres KG et al. Caries is the main cause for dental pain in childhood: findings from a birth cohort. Caries Res; 46: 488-95. 2012.

9. Scottish Intercollegiate Guidelines Network. SIGN guidelines: Preventing dental caries in children at high caries risk. Edinburgh 2000.

10. Weintraub JA, Ramos-Gomez F, Jue B et al. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res; 85: 172-6. 2006.

11. Ijaz S, Croucher RE, Marinho VC. Systematic reviews of topical fluorides for dental caries: a review of reporting practice. Caries Res; 44: 579-92. 2010.

12 des Jarlais DC, Lyles C, Crepaz N. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health; 94: 361-6. 2004.

13. Arbeitslose und Arbeitslosenquote im Jahresdurschnitt nach Kreisen in Thüringen [Unemployed and unemployment rate on average by circles in Thuringia] (article in German) [Internet] 2008 [cited 2013 Feb 12]. Available from: http://www. statistik.thueringen.de/datenbank/TabAnzeige.asp?tabelle=kr000304%7C%7C.

14. World Health Organization. Oral Health Surveys. Basic methods. 4th ed. Geneva: World Health Organization 1997.

15. Kühnisch J, Bücher K, Henschel V et al. Diagnostic performance of the universal visual scoring system (UniViSS) on occlusal surfaces. Clin Oral Investig; 15: 215-23. 2011.

16. Kühnisch J, Goddon I, Berger S et al. Development, methodology and potential of the new Universal Visual Scoring System (UniViSS) for caries detection and diagnosis. Int J Environ Res Public Health; 6: 2500-9. 2009.

17. Böhm A, Ellsässer G, Lüdecke K. Der Brandenburger Sozialindex: ein Werkzeug für die Gesundheits- und Sozialberichterstattung auf Landesund kommunaler Ebene bei der Analyse von Einscülerdaten [The Brandenburg social index: a tool for health and social reporting at regional and communal levels in the analysis of data of school beginners] (article in German). Gesundheitswesen; 69: 555-9. 2007.

18. Nordström A, Birkhed D. Preventive effect of high-fluoride dentifrice (5,000 ppm) in caries-active adolescents: a 2-year clinical trial. Caries Res; 44: 323-31. 2010.

19. Zhou Y, Yang JY, Lo EC, Lin HC. The contribution of life course determinants to early childhood caries: a 2-year cohort study. Caries Res; 46: 87-94. 2012.

20. Helfenstein U, Steiner M. Fluoride varnishes (Duraphat): a meta-analysis. Community Dent Oral Epidemiol; 22: 1-5. 1994.

21. Petersson LG, Twetman S, Dahlgren H et al. Professional fluoride varnish treatment for caries control: a systematic review of clinical trials. Acta Odontol Scand; 62: 170-6. 2004.

22. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2002: CD002279.

23. Lawrence HP, Binguis D, Douglas J et al. A 2-year community-randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal children. Community Dent Oral Epidemiol; 36: 503-16. 2008.

24. Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res; 81: 767-70. 2002.

25. Pienihäkkinen K, Jokela J. Clinical outcomes of risk-based caries prevention in preschool-aged children. Community Dent Oral Epidemiol; 30: 143-50. 2002.

25. Källestål C. The Effect of Five Years’ Implementation of Caries-Preventive Methods in Swedish High-Risk Adolescents. Caries Res; 39: 20-6. 2005.

27. Moberg Sköld U, Petersson LG, Lith A, Birkhed D. Effect of School-Based Fluoride Varnish Programmes on Approximal Caries in Adolescents from Different Caries Risk Areas. Caries Res; 39: 273-9. 2005.

28. Curnow MM, Pine CM, Burnside G, Nicholson JA, Chesters RK, Huntington E. A randomised controlled trial of the efficacy of supervised toothbrushing in high-caries-risk children. Caries Res; 36: 294-300. 2002.

29. Altenburger MJ, Schirrmeister JF, Lussi A, Klasser M, Hellwig E. In situ fluoride retention and remineralization of incipient carious lesions after the application of different concentrations of fluoride. Eur J Oral Sci; 117: 58-63. 2009.

30. Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2010: CD007868.