Fluoride Varnish in Nursery Schools: A Randomised Controlled Trial - Protecting Teeth @3

Area of Science:

• Public Health
• Pediatric Dentistry
• Health Economics

Background:

• Childsmile is a national program in Scotland aiming to improve child oral health.
• The program includes supervised toothbrushing and targeted fluoride varnish (FV) applications.
• The effectiveness of universal nursery-based FV application as an addition to Childsmile was unknown.

Purpose of the Study:

• To assess the effectiveness and cost-effectiveness of nursery-based FV applications plus treatment-as-usual (TAU) Childsmile interventions.
• To compare this combined approach against TAU Childsmile interventions alone in young children.
• To evaluate the impact on the worsening of decayed, missing, or filled primary teeth (d3mft).

Main Methods:

• A double-blind, two-arm randomized controlled trial involving 1,284 children aged three.
• Children were randomized to receive either FV applications or TAU Childsmile interventions.
• Follow-up was for 24 months, with treatments administered every six months.

Main Results:

• A modest, non-significant reduction in the worsening of d3mft was observed in the FV group (26.9%) compared to the TAU group (31.6%), OR 0.80 (p=0.078).
• A significant reduction was found for the worsening of decayed, missing, or filled surfaces (d3mfs) and decayed, missing, or filled teeth (d3t).
• The number needed to treat was 21, with a cost of GBP 686 per prevented d3mft worsening.

Conclusions:

• Nursery-based FV application did not demonstrate significant effectiveness in reducing the worsening of d3mft in young children.
• The intervention is unlikely to be a cost-effective addition to the existing Childsmile program.
• Further evaluation may be needed for specific subgroups or alternative delivery methods.