No evidence that slow release fluoride is effective for controlling tooth decay

Tooth decay or caries is not distributed evenly among the population, with certain groups being at greater risk than others.  In light of this, it has been suggested that some children could be offered targeted-caries prevention measures. One such preventive measure is the use of slow-release fluoride devices. Two types are available – the co-polymer membrane and slow dissolving fluoride glass beads. These devices are fitted inside the mouth and release low levels of fluoride constantly into the mouth. Are these devices a cost effective way to control tooth decay?

What was the research?

A systematic review of the evidence to find out whether slow-releasing fluoride devices are effective in controlling tooth decay.

Who conducted the research?

The research was conducted by a team led by Lee Yee Chong, on behalf of the Cochrane Oral Health Group. Jan Clarkson, Lorna Dobbyn-Ross and Smriti Bhakta were also on the team.

What evidence was included in the review?

Only one randomised controlled trial was found. A total of 174 children participated in the trial, and were randomly assigned to slow-releasing fluoride beads or a placebo.

What did the evidence say?

Less than half of the children were able to retain the beads on their teeth, and this meant that only 63 children could be analysed after two years. There was insufficient evidence that this method is effective, and obviously retaining the beads was a problem. Any harms that may arise from having the beads on the teeth were not reported in the trial.

How good was the evidence?

The only trial that we found was at high risk of bias. The body of evidence available is currently of very low quality and there is a potential overestimate of the benefit to the average child.

What are the implications for dentists and the general public?

The applicability of the findings of this trial to the wider population is unclear, as the study included children from a deprived area that had low levels of fluoride in drinking water and were considered at high risk of tooth decay. In addition, the evidence was only obtained from children who had the bead attached after 2 years

What should researchers look at in the future?

Much larger randomised controlled trials should be carried out. The cost-benefit of this approach should be carefully considered as part of any future trial. It may also be beneficial to establish how much fluoride should be released from the devices for optimal effect. The participants should be followed up for a minimum of one year.

Link

Chong LY, Clarkson JE, Dobbyn-Ross L, Bhakta S. Slow-release fluoride devices for the control of dental decay. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD005101. DOI: 10.1002/14651858.CD005101.pub3.