Insufficient evidence that slow-release fluoride devices reduce caries

Area of Science:

• Dental Public Health
• Caries Prevention
• Fluoride Therapy

Background:

• Dental caries remains a significant global health issue, particularly in children.
• Slow-release fluoride devices are explored as an alternative or adjunct to traditional fluoride applications.
• Assessing the efficacy of novel caries prevention methods is crucial for public health strategies.

Purpose of the Study:

• To systematically evaluate the effectiveness of slow-release fluoride devices in preventing dental caries.
• To synthesize evidence from randomized controlled trials (RCTs) on the caries-inhibiting effects of these devices.
• To determine the quality of evidence and clinical applicability of slow-release fluoride for caries prevention.

Main Methods:

• A comprehensive literature search was conducted across multiple databases, including Cochrane Oral Health Group's Trials Register, CENTRAL, Medline, and Embase.
• Parallel randomized controlled trials (RCTs) of any slow-release fluoride device were included, regardless of publication status, language, or blinding.
• Standard Cochrane methods were employed, with independent data extraction and synthesis by at least two reviewers.

Main Results:

• One trial, deemed at high risk of bias, was included, involving 174 children.
• Statistical analysis focused on 63 children who retained the beads (47.7% retention rate at two years).
• A statistically significant reduction in caries increment (DMFT and DMFS) was observed in the intervention group, but this finding is based on very low-quality evidence and only applies to children who retained the device.

Conclusions:

• There is insufficient evidence to support the caries-inhibiting effect of slow-release fluoride glass beads due to very low-quality evidence.
• The potential overestimation of benefits for the average child is a concern, as over 50% of participants did not retain the devices.
• The applicability to the wider population is unclear, given the specific characteristics of the study population (deprived area, low fluoride water) and the high rate of device loss.