Effectiveness of School Fluoride Delivery Programs: A Community Guide Systematic Review

Area of Science:

• Public Health
• Pediatric Dentistry
• Preventive Medicine

Background:

• Dental caries remains a prevalent, yet preventable, childhood disease.
• Many children lack routine access to preventive dental services in clinical settings.
• School-based fluoride varnish programs offer a strategy to increase service delivery.

Purpose of the Study:

• To systematically review the effectiveness of school-based fluoride varnish programs in preventing dental caries.
• To assess the impact of these programs on fluoride varnish receipt and caries incidence.

Main Methods:

• Systematic review following Community Guide methods.
• Searched databases for studies published through December 2023.
• Included English-language, peer-reviewed studies from upper-middle- or high-income countries; data synthesized using median RR and IQI.

Main Results:

• 31 studies involving 60,780 students were included; 25 were randomized controlled trials.
• School fluoride varnish programs reduced caries initiation by 32% in permanent teeth and 25% in primary teeth.
• Effectiveness was largely consistent across settings, though inversely related to socioeconomic status in some cases.

Conclusions:

• Approximately 30% of states lack school fluoride varnish programs.
• Barriers include Medicaid reimbursement limitations for non-dental providers for children over age 6.
• School-based programs are a proven method for caries prevention, but implementation challenges persist.