Fluorides for management of caries in children: a systematic review

Abstract

OBJECTIVES: To investigate the clinical efficacy of professional fluoride therapy in remineralizing and arresting caries in children.Methods: A systematic search of publications from November, 1977 to April, 2014 in PubMed by using the key words (fluoride) AND (remineralisation OR remineralization OR arresting) AND (children caries or early childhood caries) was conducted. Title and abstract of initially identified publications were screened. Laboratory studies, case reports, reviews, non-English articles and irrelevant studies were excluded. The remaining papers were retrieved with full texts. Manual screening was conducted on the bibliographies of remaining papers to identify relevant articles. RESULTS: The search indentified 142 papers at beginning and 109 were excluded after initial screening. Two additional articles were identified from the bibliographies of the remaining 33 papers. After retrieving the full texts, 9 randomized clinical trials met the inclusion criteria. For these 9 studies on fluoride treatment, four investigated remineralising effect on enamel caries by using sodium fluoride (NaF) and five studied arresting effect on dentine caries with silver diamine fluoride (SDF). Meta-analysis was performed on studies of NaF and SDF separately. The overall percentage of dimension reduction for enamel caries after NaF therapy was 40.5% (95% CI: 34.5% - 46.4%; p<0.001); and the overall proportion of arrested dentine caries after SDF treatment was 72.6% (95% CI: 53.4% - 91.7%; p<0.001).CONCLUSIONS: NaF therapy can remineralise enamel caries and SDF is effective in arresting dentine caries.