Effectiveness of Various Fluoride Varnishes in Preventing Dental Caries in Children and Adolescents: A Systematic Review of Evidence From Educational Settings.

Abstract

Dental caries is a chronic oral disease that affects children and adolescents worldwide, significantly impacting oral health and quality of life. Fluoride varnish (FV) application is an effective preventive intervention to reduce the incidence and increment of caries, particularly when delivered within educational settings. This systematic review collates evidence from 14 randomized controlled trials (RCTs) conducted across diverse geographic and socioeconomic contexts. The primary objective is to assess the efficacy of various fluoride interventions delivered in educational settings. PubMed, Cochrane Controlled Register of Trials (CENTRAL), and Google Scholar databases were searched for studies that met the inclusion criteria of focusing on FV application in children in educational settings with a minimum six-month follow-up. The Risk of Bias 2 (RoB 2; Cochrane, London, United Kingdom) tool was used to evaluate methodological quality, and Review Manager (RevMan), Version 7.12.0 (2024; Cochrane) was used for quantitative synthesis. The combined data from more than 13,000 children who received FV showed a consistently lower risk of dental caries than that of the controls, with risk ratios strongly supporting the intervention. School-based FV delivery systems are feasible, and their economic value appears to vary depending on program design and local resources. The preventive impact of FV was strong, despite differences in study designs, caries evaluation techniques, and follow-up times. However, to maximize policy implementation, long-term assessments using standardized outcomes such as child-level caries incidence, DMFT (Decayed, Missing, and Filled Teeth) increments, and Dental Fear Survey (DFS) scores reported at common time points are needed. In summary, this review offers compelling data supporting the use of FV as a safe and successful method for preventing dental cavities in children and adolescents in educational settings. The results support the widespread inclusion of FV in school-based health services worldwide and reaffirm its importance as a component of comprehensive oral health promotion programs.