Arresting dental caries in preschool children by topical fluorides - 30-month results

Abstract

OBJECTIVES: This study aimed to compare the effectiveness of three topical fluoride application protocols in arresting dental caries in primary teeth of preschool children. METHODS: A total of 371 children aged 3-4 years who had at least one active caries lesion in their primary teeth were randomly allocated into three intervention groups: Group 1 - annual application of 30% silver diammine fluoride (SDF) solution; Group 2 - three applications of 30% SDF solution at weekly intervals; and Group 3 - three applications of 5% sodium fluoride (NaF) varnish at weekly intervals. Follow-up examinations every 6 months were carried out by the same masked examiner to assess whether the treated caries lesions had become arrested. RESULTS: After 30 months, 309 children (83%) with 1877 caries lesions remained in the study. For cavitated lesions (ICDAS codes 5 and 6), caries arrest rates of Groups 1, 2 and 3 were 48%, 33% and 34%, respectively (p<0.001). Moreover, the results of multi-level survival analysis showed that the arrest times of cavitated dentin caries in both SDF solution groups were significantly shorter than that of the NaF varnish group. For established caries lesions (ICDAS codes 3 and 4), the caries arrest rates were 45%, 44% and 51% in Groups 1, 2 and 3, respectively (p>0.05). Presence of plaque on lesion surface, tooth type and tooth surface had significant effects on caries arrest rates. CONCLUSIONS: Based on the 30-month results, annual application of SDF is more effective in arresting active cavitated dentin caries lesions than 3 weekly applications of NaF and SDF at baseline. For established caries lesions, there are no significant differences among the effectiveness of the three fluoride application protocols in controlling dental caries.