Preventing caries in children: Treatment in the chair

OK, so stuff we can say. What about stuff we can do? And the big one is probably fluoride varnish and I’m using a Cochrane review here, just to show how high quality the evidence is. I think if you’re looking for evidence we start with the Cochrane review or a well done systematic review and then work your way down. This Cochrane review showed that there was more evidence to show a substantial carie’s debiting effect. So we know fluoride varnish works. Usually 2.26%. Apply topically two to four times a year. Safe at any age. So there’s evidence using it in one-year-olds and up.

No reported cases that I’m aware of fluorosis and no reported cases for sure of any kind of systemic toxicity. So fluoride varnish is your first go-to with regards to stuff you can do. What about fluoride mouth rinses? Again, another Cochrane review. Again, good evidence to show that they work. Usually we tend to say, or people tend to use them at bedtime. And certainly if you use a fluoride mouth rinse right after tooth brushing you will still get some extra benefit. But if you talk to people teaching this field a lot of us believe that it would be nice if the fluoride mouth rinse could be done at a different time, maybe at lunchtime.

May not be practical but something to consider. Do remember though, fluoride mouth rinse is only suitable if the child could rinse and spit. And so as a sort of guideline we tend to say 7 and below is the age where we shouldn’t be using fluoride mouth rinses. And finally, sealants. Yeah and again, another Cochrane review showing that there is moderate quality evidence for resin-based sealants, not glass ionomer sealants, resin-based sealants. That they will prevent carries on the occlusal surfaces. Clearly the more decay you have, the more prevention you’ll get. But quoted figures are between 11 and 51% over a two-year period. So we know that they work if they’re applied properly.

OK, before we finish let’s just touch on silver diamine fluoride. Certainly here in the UK it’s less commonly used than in other parts of the world, it’s used a little bit more frequently. 38% fluoride with good emerging evidence to show that not only will it prevent dental decay but it seems to arrest it as well. Any downside being this black stain that you get. You can see some evidence of that on the photo on the slide. But this is an up and comer, appears to be an effective intervention. And I have a Cochrane review here. I think there is one planned.

I have got a systematic review in caries research and they’re showing that on the whole there a high quality studies and a really big reduction of caries when SDF is used. So I think this is one that’s going to be coming through and used more and more frequently. My summary. Firstly, there are lots of well evidence therapies to choose from. So there’s no real excuse to be going off piste in terms of prevention. A lot of good stuff out there and we know that it works. Fluoride therapies is still the most effective. Fluoride varnish is probably the most effective of these. So I think you should be building these into your preventive regime. Don’t forget sealants.

They certainly have a role with preventing caries on the occlusal surfaces. Thank you very much.