John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The Cochrane Oral Health Group has produced many reviews relevant to the prevention of tooth decay and, in July 2016, they updated their investigation of fluoride mouthrinses for children and adolescents. Helen Worthington, Co-ordinating Editor of the Group from the University of Manchester in the UK and one of the authors of this review, tells us what they found in this Evidence Pod.
Helen: Tooth decay or dental caries is a significant health problem affecting the vast majority of adults and children. Treatment of decayed teeth is costly in both time and money, and preventing caries in children and adolescents is considered more cost-effective than treatment of subsequent caries.
Currently, the most common method for the prevention of caries is brushing with fluoride toothpaste, but fluoride can also be applied directly to teeth in varnishes, gels and mouthrinses. Fluoride mouthrinse has been used often in school-based programmes to prevent caries, with supervised or unsupervised fluoride mouthrinsing (depending on the age of the child) needing to be done regularly to have an effect.
Our review looks into how effective and safe fluoride mouthrinse is for preventing caries in children and adolescents, compared with placebo or no treatment. We found that it can reduce caries, but that there is limited evidence on its adverse effects or acceptability.
We included 37 randomized trials in the review, involving nearly 16,000 children from age six to 14. The studies had been done in several countries and had published their findings between 1965 and 2005. All studies assessed school-based supervised use of fluoride mouthrinse, with two studies also including home use. Most children received a sodium fluoride mouthrinse solution given at 230 parts per million of fluoride daily, or 900 parts per million weekly.
We were able to combine results from 35 of the trials, which showed a large reduction in caries increment in permanent teeth over two to three years with regular use of fluoride mouthrinse. We rated this evidence as moderate quality, and although it evaluated supervised rinsing in a school setting, the findings may be applicable to children in other settings with supervised or unsupervised use. There is also likely to be a caries-preventive benefit if children are using fluoride toothpaste or live in water-fluoridated areas.
Few studies reported on other outcomes of relevance to the review, including adverse effects such as tooth staining and mucosal irritation, and dropout which might indicate unacceptability of treatment, meaning that there were insufficient data to be certain about the effects on these outcomes.
In summary, school children being supervised to regularly swish fluoride mouthrinse for a couple of minutes and then spit it out, using either a low concentration mouthrinse on a daily basis or a stronger one on a weekly basis, are likely to have less caries after two to three years, at least. But the evidence on the likelihood of significant side effects is scarce, and information on acceptability is inconclusive.”
John: You can read the full version of this review online at Cochrane Library dot com, where you will find it with a search for ‘Fluoride mouthrinses for preventing dental caries’.
What about fluorosis?
A trial of children consuming less sugar would be more effective in proving it is sugar not lack of fluoride causing not just caries but many other long term illnesses including obesity and diabetes .