Abstract
BackgroundAs a low-cost and easily operated treatment, the use of professionally applied topical fluoride was approved for preventing dental caries and remineralising early enamel caries or white spot lesions. It is also used to arrest dentine caries. The aim of this study is to investigate the clinical efficacy of professional fluoride therapy in remineralising and arresting caries in children.MethodA systematic search of publications from 1948 to 2014 was conducted using four databases: PubMed, Cochrane Library, ISI Web of Science and Embase. The key words used were (fluoride) AND (remineralisation OR remineralization OR arresting) AND (children caries OR early childhood caries). The title and abstract of initially identified publications were screened. Clinical trials about home-use fluorides, laboratory studies, case reports, reviews, non-English articles and irrelevant studies were excluded. The full texts of the remaining papers were retrieved. Manual screening was conducted on the bibliographies of the remaining papers to identify relevant articles.ResultsA total of 2177 papers were found, and 17 randomised clinical trials were included in this review. Ten studies investigated the remineralising effect on early enamel caries using silicon tetrafluoride, fluoride gel, silver diamine fluoride or sodium fluoride. Seven studies reported an arresting effect on dentine caries using silver diamine fluoride or nano-silver fluoride. Meta-analysis was performed on four papers using 5 % sodium fluoride varnish to remineralise early enamel caries, and the overall percentage of remineralised enamel caries was 63.6 % (95 % CI: 36.0 % - 91.2 %; p < 0.001). Meta-analysis was also performed on five papers using 38 % silver diamine fluoride to arrest dentine caries and the overall proportion of arrested dentine caries was 65.9 % (95 % CI: 41.2 % - 90.7 %; p < 0.001).ConclusionProfessionally applied 5 % sodium fluoride varnish can remineralise early enamel caries and 38 % silver diamine fluoride is effective in arresting dentine caries.
Highlights
As a low-cost and operated treatment, the use of professionally applied topical fluoride was approved for preventing dental caries and remineralising early enamel caries or white spot lesions
Seven studies reported an arresting effect on dentine caries using silver diamine fluoride or nano-silver fluoride
Meta-analysis was performed on four papers using 5 % sodium fluoride varnish to remineralise early enamel caries, and the overall percentage of remineralised enamel caries was 63.6 %
Summary
As a low-cost and operated treatment, the use of professionally applied topical fluoride was approved for preventing dental caries and remineralising early enamel caries or white spot lesions. Alternative treatments for dental caries of children in disadvantaged communities are necessary, and professionally applied fluoride therapy has been proposed for the management of dental caries [7]. Applied fluoride therapy is a relatively low-cost and operated treatment and has been used to arrest active dental caries [7]. The calcium fluoride that is deposited onto a tooth surface after fluoride therapy is not readily soluble and can act as a fluoride reservoir [8] This fluoride can lower the critical pH value of hydroxyapatite crystal dissolution, or the pH value when demineralisation occurs, from approximately 5.5 to 4.5 in the mouth. Alters plaque composition, affects plaque formation and reduces plaque bacteria’s ability to produce a large amount of acid from carbohydrates [8]
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