Title: 0575 - Is Fluoride Varnish Effectiveness Influenced by Preschoolers’ Baseline Caries Levels?
Ana Paula Santos (Presenter)
Rio de Janeiro State University
Fernanda de Sousa, Rio de Janeiro State University
Paulo Nadanovsky, Oswaldo Cruz Foundation
Philippe Hujoel, University of Washington
Joana Cunha-Cruz, University of Washington
Branca Oliveira, Rio de Janeiro State University
Objectives: To assess whether fluoride varnish (FV) effectiveness in preschoolers is influenced by baseline caries levels.
Methods: Systematic review with meta-analysis of controlled clinical trials comparing FV with placebo, usual care or no intervention. Relative risks (RR) of the child developing at least one new dentine caries lesion and baseline dentine caries levels (dmfs) were independently recorded for each study by two reviewers. Meta-regression was performed using the RR as the outcome variable and the baseline dmfs as the covariate. Numbers needed to treat (NNT) were calculated applying the pooled RR to three different caries scenarios.
Results: Comprehensive electronic and handsearching yielded 19 studies that met the inclusion criteria, and 14 displayed information that enabled us to calculate the RR. Meta-analysis showed substantial heterogeneity (I2=82%; P value chi2=0.000). Therefore, we estimated a pooled RR using a random-effects model (0.88; 95%CI 0.81-0.96) together with a 95% prediction interval (0.67-1.16). Baseline mean caries levels (dmfs) in each study varied from 0 to 21.35. Trials also differed regarding unit of randomization, type of interventions being compared, length of follow-up and risk of bias. Meta-regression showed that the increase in one unit of mean baseline decayed, missing or filled surface led to a non-statistically significant 1% increase in the RR (1.01; 95%CI 0.99-1.02). Adjusted R2 showed that baseline caries levels explained only 12.2% of between-study variance. When applied to scenarios of 20%, 50% and 70% caries prevalence, NNT were 42, 17 and 12, respectively.
Conclusions: There is no robust evidence that FV is effective overall and we found no evidence that children with high (or low) caries levels could especially benefit from it. NNT were too large; in the best scenario, where caries prevalence is very high, 12 children must be treated in order to avoid caries in one child.
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: NONE