The Effectiveness of Fluoride Varnish and Fissure Sealant in Elementary School Children: A Systematic Review and Meta-Analysis
-
Dariush Jafarzadeh
,
Ramin Rezapour
,
Teimour Abbasi
,
Jafar Sadegh Tabrizi
,
Maryam Zeinolabedini
,
Assef Khalili
,
Mahmood Yousefi
Abstract
Background: Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related studies on the effects of fluoride varnish and fissure sealant on dental caries in 6-12 children.
Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and Scopus databases using Fluoride Varnish, Fissure Sealant, Caries, and Oral Health keywords. The timeframe selected to search for articles is from 2000 to Dec 2020. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. The intervention groups in this study were fluoride varnish and fissure sealants, each of them compared to the control groups.
Results: We included nine studies. In the intervention group 84,380 and control group 11,254 individuals were studied. Eight of the studies were Randomized Clinical Trial (RCT) and Field RCT, and two was non-RCT. In the overall Fluoride Varnish efficacy study, 4 were fully effective, 1 was ineffective, and all 4 were completely effective for Fissure Sealant. There was a significant difference between decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices in both interventions and comparison groups. Moreover, the mean difference of DMFT for Fluoride Varnish and Fissure Sealant in the intervention and control groups were -0.55 and -0.29, respectively (P=0.00).
Conclusion: Due to the efficacy of fissure sealant and fluoride varnish in preventing dental caries in children aged 6-12 yr, these interventions can be considered as health priorities of societies and health systems interventions in countries.
1. Bajomo A, Rudolph M, Ogunbodede E(2004). Dental caries in six, 12 and 15 year old Venda children in South Africa. East Afr Med J, 81(5):236-43.
2. Nurelhuda NM, Trovik TA, Ali RW, Ahmed MF(2009). Oral health status of 12-year-old school children in Khartoum state, the Sudan; a school-based survey. BMC Oral Health, 9:15.
3. Hopcraft M, Morgan M, Satur J, Wright F(2008). Dental service provision in Victorian residential aged care facilities. Aust Dent J, 53(3):239-45.
4. Carvalho JC, Van Nieuwenhuysen JP, D'Hoore W(2001). The decline in dental caries among Belgian children between 1983 and 1998. Community Dent Oral Epidemiol, 29(1):55-61.
5. Locker D(2000). Deprivation and oral health: a review. Community Dent Oral Epidemiol, 28(3):161-9.
6. Aligne CA, Moss ME, Auinger P, Weitzman M(2003). Association of pediatric dental caries with passive smoking. JAMA, 289(10):1258-64.
7. Shafer WG(1983). A text book of oral pathology. Cherubism, 699-702.
8. Almasi A, Rahimiforoushani A, Eshraghian MR, et al.(2016). Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10–12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach. Iran J Public Health, 45(3):353-61.
9. Haghighati F, Mofidi F (2006). An Evaluation of High School Female Student’s Knowledge and Behaviour Regarding Oral Hygiene. Iran J Public Health, 35(1):82-87.
10. Tohidast Akrad Z, Beitollahi JM, Khajetorab AA (2006). DMFT (Decayed, Missing, Filled, Teeth) Oral Health Index in Sweets and Cable Industry Workers. Iran J Public Health, 35(2):64-68.
11. T Malek Mohammadi EK, C Wright (2005). Effect of Dental Caries on Children Growth. Iran J Public Health, 34(Supple 1):36-37.
12. El-Housseiny A, Sharaf A(2005). Evaluation of fissure sealant applied to topical fluoride treated teeth. J Clin Pediatr Dent, 29(3):215-9.
13. Shaw L (2000). Modern thoughts on fissure sealants. Dent Update, 27(8):370-4.
14. McDonald R, Avery D, Dean J(2011). Dentistry for the child and adolescent 9th ed. St Louis: Mosby co. 28-43.
15. Mellberg JR, Ripa LW. Fluoride in preventive dentistry: theory and clinical applications: Quintessence Pub Co; 1983.
16. Ten Cate J(2013). Contemporary perspective on the use of fluoride products in caries prevention. Br Dent J, 214(4):161-7.
17. Chestnutt IG, Playle R, Hutchings S, et al (2017). Fissure seal or fluoride varnish? A randomized trial of relative effectiveness. J Dent Res, 96(7):754-61.
18. Ahovuo‐Saloranta A, Forss H, Hiiri A, et al (2016). Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Sys Rev, 2016(1):CD003067.
19. Khan K, Kunz R, Kleijnen J, Antes G. Systematic reviews to support evidence-based medicine. Crc press; 2011.
20. Autorino R, Borges C, White MA, et al(2010). Randomized clinical trials presented at the World Congress of Endourology: how is the quality of reporting? J Endourol, 24(12):2067-73.
21. Des Jarlais DC, Lyles C, Crepaz N, Group T(2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health, 94(3):361-6.
22. Armstrong R, Waters E, Moore L, et al (2008). Improving the reporting of public health intervention research: advancing TREND and CONSORT. J Public Health (Oxf), 30(1):103-9.
23. Ogilvie D FD, Petticrew M, Sowden A, et al (2008). The harvest plot: a method for synthesising evidence about the differential effects of interventions. BMC Med Res Methodol, 8:8.
24. Keshvari-Shad F, Hajebrahimi S, Pilar Laguna Pes M, et al (2020). A Systematic Review of Screening Tests for Chronic Kidney Disease: An Accuracy Analysis. Galen Med J, 9: e1573.
25. Tricco AC, Lillie E, Zarin W, et al (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med, 169(7):467-73.
26. Moher D, Liberati A, Tetzlaff J, et al (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097.
27. Khalili F, Najafi B, Mansour-Ghanaei F, et al (2020). Cost-Effectiveness Analysis of Colorectal Cancer Screening: A Systematic Review. Risk Manag Healthc Policy, 13:1499-1512.
28. Xhemnica L, Sulo D, Rroço R, Hysi D (2008). Fluoride varnish application: a new prophylactic method in Albania. Effect on enamel carious lesions in permanent dentition. Eur J Paediatr Dent, 9(2):93-6.
29. Patil SK, Fatangare M, Jadhav RG, et al (2017). Caries Preventive Effect of Sodium Fluoride Varnish on Deciduous Dentition: A Clinical Trial. J Contemp Dent Pract, 18(12):1190-93.
30. Samara SA, Haidar Z(2011). Two-year sealant survival in a high caries cohort at a graduate pedodontic clinic. J Clin Exp Dent, 3(4):e289-96.
31. Oliveira FSd, da Silva S, Machado M, et al (2008). Resin-modified glass ionomer cement and a resin-based material as occlusal sealants: a longitudinal clinical performance. J Dent Child (Chic), 75(2):134-43.
32. Liu BY, Lo E, Chu C, Lin H (2012). Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res, 91(8):753-8.
33. Reddy VR, Chowdhary N, Mukunda K, et al (2015). Retention of resin-based filled and unfilled pit and fissure sealants: A comparative clinical study. Contemp Clin Dent, 6(Suppl 1):S18-23.
34. Ercan E, Dülgergil ÇT, Dalli M, et al (2009). Anticaries effect of atraumatic restorative treatment with fissure sealants in suburban districts of Turkey. J Dent Sci, 4(2):55-60.
35. Chen X, Du M, Fan M, et al (2012). Effectiveness of two new types of sealants: retention after 2 years. Clin Oral Investig, 16(5):1443-50.
36. Al-Sabri FA, El-Marakby AM, Mourshed BD, et al (2017). Efficiency of fissure sealants in dental caries prevention among young school children. A comparative evaluation. Int J Med Dent, 7(4):271-8.
37. Hilgert L, Leal S, Mulder J, et al (2015). Caries-preventive effect of supervised toothbrushing and sealants. J Dent Res, 94(9):1218-24.
38. Chestnutt IG, Hutchings S, Playle R, et al (2017). Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technol Assess, 21(21):1-256.
39. Muller‐Bolla M, Lupi‐Pégurier L, Bardakjian H, et al (2013). Effectiveness of school‐based dental sealant programs among children from low‐income backgrounds in F rance: a pragmatic randomized clinical trial. Community Dent Oral Epidemiol, 41(3):232-41.
40. Chen X, Du M, Fan M, et al (2012). Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years. Dent Mater, 28(5):554-60.
41. Ulusoy A, Tunc E, Bayrak Ş (2017). Clinical performance of a glass ionomer sealant protected with two different resin-based agents over a 2-year follow-up period. Eur J Paediatr Dent, 18(1):10-14.
42. Cabral RN, Faber J, Otero SAM, et al (2018). Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial. Clin Oral Investig, 22(9):3171-77.
43. Dohnke‐Hohrmann S, Zimmer S (2004). Change in caries prevalence after implementation of a fluoride varnish program. J Public Health Dent, 64(2):96-100.
44. Truin G, van’t Hof M (2005). Professionally applied fluoride gel in low-caries 10.5-year-olds. J Dent Res, 84(5):418-21.
45. Zimmer S, Bizhang M, Seemann R, et al (2001). The effect of a preventive program, including the application of low-concentration fluoride varnish, on caries control in high-risk children. Clin Oral Investig, 5(1):40-4.
46. Heyduck C, Meller C, Schwahn C, Splieth C(2006). Effectiveness of sealants in adolescents with high and low caries experience. Caries Res, 40(5):375-81.
47. Liu M, Zhao M, Chen W, et al (2020). Caries-Preventive Effect of a Public Health Programme for Pit and Fissure Sealant. Oral Health Prev Dent, 18(3):593-600.
48. Almasi A, Rahimiforoushani A, Eshraghian Mr, et al (2016). Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10-12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach. Iran J Public Health, 45(3):353-361.
49. Nilchian FJIJoPH(2005). The Effectiveness of Fissure Sealant Therapy Placed by Professional Complementary to Dentistry Compared with Dentists. Iran J Public Health, 34(Supple 1):34-35.
50. Azarpazhooh A, Main PA (2008). Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc, 74(1):73-9.
51. Li F, Jiang P, Yu F, et al (2020). Comparison between fissure sealant and fluoride varnish on caries prevention for first permanent molars: a systematic review and meta-analysis. Sci Rep, 10(1): 2578.
2. Nurelhuda NM, Trovik TA, Ali RW, Ahmed MF(2009). Oral health status of 12-year-old school children in Khartoum state, the Sudan; a school-based survey. BMC Oral Health, 9:15.
3. Hopcraft M, Morgan M, Satur J, Wright F(2008). Dental service provision in Victorian residential aged care facilities. Aust Dent J, 53(3):239-45.
4. Carvalho JC, Van Nieuwenhuysen JP, D'Hoore W(2001). The decline in dental caries among Belgian children between 1983 and 1998. Community Dent Oral Epidemiol, 29(1):55-61.
5. Locker D(2000). Deprivation and oral health: a review. Community Dent Oral Epidemiol, 28(3):161-9.
6. Aligne CA, Moss ME, Auinger P, Weitzman M(2003). Association of pediatric dental caries with passive smoking. JAMA, 289(10):1258-64.
7. Shafer WG(1983). A text book of oral pathology. Cherubism, 699-702.
8. Almasi A, Rahimiforoushani A, Eshraghian MR, et al.(2016). Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10–12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach. Iran J Public Health, 45(3):353-61.
9. Haghighati F, Mofidi F (2006). An Evaluation of High School Female Student’s Knowledge and Behaviour Regarding Oral Hygiene. Iran J Public Health, 35(1):82-87.
10. Tohidast Akrad Z, Beitollahi JM, Khajetorab AA (2006). DMFT (Decayed, Missing, Filled, Teeth) Oral Health Index in Sweets and Cable Industry Workers. Iran J Public Health, 35(2):64-68.
11. T Malek Mohammadi EK, C Wright (2005). Effect of Dental Caries on Children Growth. Iran J Public Health, 34(Supple 1):36-37.
12. El-Housseiny A, Sharaf A(2005). Evaluation of fissure sealant applied to topical fluoride treated teeth. J Clin Pediatr Dent, 29(3):215-9.
13. Shaw L (2000). Modern thoughts on fissure sealants. Dent Update, 27(8):370-4.
14. McDonald R, Avery D, Dean J(2011). Dentistry for the child and adolescent 9th ed. St Louis: Mosby co. 28-43.
15. Mellberg JR, Ripa LW. Fluoride in preventive dentistry: theory and clinical applications: Quintessence Pub Co; 1983.
16. Ten Cate J(2013). Contemporary perspective on the use of fluoride products in caries prevention. Br Dent J, 214(4):161-7.
17. Chestnutt IG, Playle R, Hutchings S, et al (2017). Fissure seal or fluoride varnish? A randomized trial of relative effectiveness. J Dent Res, 96(7):754-61.
18. Ahovuo‐Saloranta A, Forss H, Hiiri A, et al (2016). Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Sys Rev, 2016(1):CD003067.
19. Khan K, Kunz R, Kleijnen J, Antes G. Systematic reviews to support evidence-based medicine. Crc press; 2011.
20. Autorino R, Borges C, White MA, et al(2010). Randomized clinical trials presented at the World Congress of Endourology: how is the quality of reporting? J Endourol, 24(12):2067-73.
21. Des Jarlais DC, Lyles C, Crepaz N, Group T(2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health, 94(3):361-6.
22. Armstrong R, Waters E, Moore L, et al (2008). Improving the reporting of public health intervention research: advancing TREND and CONSORT. J Public Health (Oxf), 30(1):103-9.
23. Ogilvie D FD, Petticrew M, Sowden A, et al (2008). The harvest plot: a method for synthesising evidence about the differential effects of interventions. BMC Med Res Methodol, 8:8.
24. Keshvari-Shad F, Hajebrahimi S, Pilar Laguna Pes M, et al (2020). A Systematic Review of Screening Tests for Chronic Kidney Disease: An Accuracy Analysis. Galen Med J, 9: e1573.
25. Tricco AC, Lillie E, Zarin W, et al (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med, 169(7):467-73.
26. Moher D, Liberati A, Tetzlaff J, et al (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097.
27. Khalili F, Najafi B, Mansour-Ghanaei F, et al (2020). Cost-Effectiveness Analysis of Colorectal Cancer Screening: A Systematic Review. Risk Manag Healthc Policy, 13:1499-1512.
28. Xhemnica L, Sulo D, Rroço R, Hysi D (2008). Fluoride varnish application: a new prophylactic method in Albania. Effect on enamel carious lesions in permanent dentition. Eur J Paediatr Dent, 9(2):93-6.
29. Patil SK, Fatangare M, Jadhav RG, et al (2017). Caries Preventive Effect of Sodium Fluoride Varnish on Deciduous Dentition: A Clinical Trial. J Contemp Dent Pract, 18(12):1190-93.
30. Samara SA, Haidar Z(2011). Two-year sealant survival in a high caries cohort at a graduate pedodontic clinic. J Clin Exp Dent, 3(4):e289-96.
31. Oliveira FSd, da Silva S, Machado M, et al (2008). Resin-modified glass ionomer cement and a resin-based material as occlusal sealants: a longitudinal clinical performance. J Dent Child (Chic), 75(2):134-43.
32. Liu BY, Lo E, Chu C, Lin H (2012). Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res, 91(8):753-8.
33. Reddy VR, Chowdhary N, Mukunda K, et al (2015). Retention of resin-based filled and unfilled pit and fissure sealants: A comparative clinical study. Contemp Clin Dent, 6(Suppl 1):S18-23.
34. Ercan E, Dülgergil ÇT, Dalli M, et al (2009). Anticaries effect of atraumatic restorative treatment with fissure sealants in suburban districts of Turkey. J Dent Sci, 4(2):55-60.
35. Chen X, Du M, Fan M, et al (2012). Effectiveness of two new types of sealants: retention after 2 years. Clin Oral Investig, 16(5):1443-50.
36. Al-Sabri FA, El-Marakby AM, Mourshed BD, et al (2017). Efficiency of fissure sealants in dental caries prevention among young school children. A comparative evaluation. Int J Med Dent, 7(4):271-8.
37. Hilgert L, Leal S, Mulder J, et al (2015). Caries-preventive effect of supervised toothbrushing and sealants. J Dent Res, 94(9):1218-24.
38. Chestnutt IG, Hutchings S, Playle R, et al (2017). Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technol Assess, 21(21):1-256.
39. Muller‐Bolla M, Lupi‐Pégurier L, Bardakjian H, et al (2013). Effectiveness of school‐based dental sealant programs among children from low‐income backgrounds in F rance: a pragmatic randomized clinical trial. Community Dent Oral Epidemiol, 41(3):232-41.
40. Chen X, Du M, Fan M, et al (2012). Caries-preventive effect of sealants produced with altered glass-ionomer materials, after 2 years. Dent Mater, 28(5):554-60.
41. Ulusoy A, Tunc E, Bayrak Ş (2017). Clinical performance of a glass ionomer sealant protected with two different resin-based agents over a 2-year follow-up period. Eur J Paediatr Dent, 18(1):10-14.
42. Cabral RN, Faber J, Otero SAM, et al (2018). Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial. Clin Oral Investig, 22(9):3171-77.
43. Dohnke‐Hohrmann S, Zimmer S (2004). Change in caries prevalence after implementation of a fluoride varnish program. J Public Health Dent, 64(2):96-100.
44. Truin G, van’t Hof M (2005). Professionally applied fluoride gel in low-caries 10.5-year-olds. J Dent Res, 84(5):418-21.
45. Zimmer S, Bizhang M, Seemann R, et al (2001). The effect of a preventive program, including the application of low-concentration fluoride varnish, on caries control in high-risk children. Clin Oral Investig, 5(1):40-4.
46. Heyduck C, Meller C, Schwahn C, Splieth C(2006). Effectiveness of sealants in adolescents with high and low caries experience. Caries Res, 40(5):375-81.
47. Liu M, Zhao M, Chen W, et al (2020). Caries-Preventive Effect of a Public Health Programme for Pit and Fissure Sealant. Oral Health Prev Dent, 18(3):593-600.
48. Almasi A, Rahimiforoushani A, Eshraghian Mr, et al (2016). Effect of Nutritional Habits on Dental Caries in Permanent Dentition among Schoolchildren Aged 10-12 Years: A Zero-Inflated Generalized Poisson Regression Model Approach. Iran J Public Health, 45(3):353-361.
49. Nilchian FJIJoPH(2005). The Effectiveness of Fissure Sealant Therapy Placed by Professional Complementary to Dentistry Compared with Dentists. Iran J Public Health, 34(Supple 1):34-35.
50. Azarpazhooh A, Main PA (2008). Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc, 74(1):73-9.
51. Li F, Jiang P, Yu F, et al (2020). Comparison between fissure sealant and fluoride varnish on caries prevention for first permanent molars: a systematic review and meta-analysis. Sci Rep, 10(1): 2578.
| Files | ||
| Issue | Vol 51 No 2 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i2.8680 | |
| Keywords | ||
| Fluoride varnish Fissure sealant Systematic review Meta-analysis Oral health | ||
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How to Cite
1.
Jafarzadeh D, Rezapour R, Abbasi T, Tabrizi JS, Zeinolabedini M, Khalili A, Yousefi M. The Effectiveness of Fluoride Varnish and Fissure Sealant in Elementary School Children: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(2):266-277.
