Fluoride varnish application
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Fluoride Varnish Application: Efficacy, Cost-Effectiveness, and Implementation
Efficacy of Fluoride Varnish in Caries Prevention
Fluoride Varnish in Preschoolers
Fluoride varnish (FV) has been extensively studied for its role in preventing dental caries in preschool children. A systematic review of economic evaluations found mixed results regarding the cost-effectiveness of FV in this age group. While some studies reported FV as a cost-effective measure, others indicated a significant increase in costs with low cost-effectiveness. Another systematic review and meta-analysis concluded that FV has modest effectiveness in reducing the incidence of dentinal caries in preschoolers.
Fluoride Varnish in School-Aged Children
In a randomized controlled trial conducted in rural Brazil, the application of 5% sodium fluoride (NaF) varnish significantly reduced caries increments in the permanent dentition of school children over 12 months. The study reported a preventive fraction (PF) of 40%, indicating a substantial reduction in caries incidence among children who received FV compared to those who received a placebo.
Fluoride Varnish During Orthodontic Treatment
For adolescents undergoing orthodontic treatment with fixed appliances, regular applications of a 1.5% ammonium fluoride varnish were found to reduce the prevalence of advanced white spot lesions (WSLs). The study highlighted a significant reduction in severe lesions in the test group compared to the placebo group, demonstrating the efficacy of FV in this context.
Comparative Efficacy with Other Treatments
A study comparing fluoride-releasing sealants and FV for managing initial proximal caries found no significant difference in caries progression between the two treatments over a 12-month period. Both treatments were effective in controlling caries progression, suggesting that FV is as effective as fluoride-releasing sealants for this purpose.
Cost-Effectiveness and Economic Evaluations
Economic Evaluations in Preschoolers
The economic evaluations of FV application in preschoolers revealed a lack of convincing evidence for its cost-effectiveness. While some studies suggested that FV is a cost-effective measure, others reported increased costs and limited generalizability of results due to data constraints. This indicates a need for more comprehensive and standardized economic evaluations to determine the true cost-effectiveness of FV in this population.
Implementation Challenges and Recommendations
Barriers to Implementation
Despite the acknowledged efficacy of FV in clinical practice guidelines globally, several barriers hinder its widespread implementation. These include insufficient time to integrate oral health services into well-child visits, lack of skills and training among healthcare providers, and resistance from colleagues and staff. Additionally, obtaining parental consent for FV application in children under 16 can be challenging, especially when children attend dental appointments with guardians other than their parents .
Facilitators for Successful Implementation
Factors that may facilitate the successful implementation of FV include Medicaid eligibility, strong relationships with dentists and community centers, and effective communication between physicians and support staff. Encouraging clinicians' motivation to perform FV applications and addressing professional and parental concerns about potential negative consequences can also enhance implementation efforts.
Conclusion
Fluoride varnish is an effective measure for preventing dental caries across various age groups and clinical settings. However, its cost-effectiveness, particularly in preschoolers, remains inconclusive. Addressing implementation barriers and leveraging facilitators can improve the uptake of FV applications, ultimately contributing to better oral health outcomes. Further research is needed to standardize economic evaluations and explore the long-term benefits and cost-effectiveness of FV in routine dental care.
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