Tooth decay is one of the most common health problems among children. If fluoride supplements taken by pregnant women can prevent tooth decay in their children, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. Fluoride tablets, drops, lozenges or chewing gums are sucked or chewed to provide topical fluoride and ingested to provide systemic fluoride.
What was the research?
A systematic review to look at the effectiveness and safety of fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing tooth decay in the baby teeth of their children. Fluoride supplements were compared with placebo (tablets or other forms of supplements without fluoride) or no treatment.
Who conducted the research?
The research was conducted by a team led by Rena Takahashi of Tokyo Medical and Dental University, Japan, on behalf of Cochrane Oral Health. Erika Ota, Keika Hoshi, Toru Naito, Yoshihiro Toyoshima, Hidemichi Yuasa, Rintaro Mori and Eishu Nango were also on the team.
What evidence was included in the review?
Authors from Cochrane Oral Health carried out this review of existing studies and the evidence is current up to 25 January 2017. It includes only one randomised controlled trial, in which 1400 pregnant women were randomly allocated to fluoride treatment or placebo. In this study, a daily dose of either 1 mg sodium fluoride tablets or placebo tablets were given to participants from the fourth month of pregnancy to delivery. Both groups were encouraged to use dietary fluoride supplements after delivery in the form of drops. A total of 1175 babies were born to participants in this study, and of this number, 938 children were followed up at 3 years (464 fluoride tablets versus 484 placebo tablets) and 798 children were followed up at 5 years (398 fluoride tablets versus 400 placebo tablets) of age. Published in 1997, this study took place in communities with unfluoridated drinking water in Southern Maine, USA.
What did the evidence say?
Baby tooth decay measured in children aged 3 and 5 years old was very low in both the fluoride supplement group and the placebo group. At 5 years of age, 92% of children remained decay-free in the fluoride supplement group and 91% remained decay-free in the placebo group, showing no difference between the two groups. The incidence of fluorosis at 5 years was similar between the group taking fluoride supplements (tablets) during the last 6 months of pregnancy and the placebo group.
There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.
How good was the evidence?
The included study was assessed as being at high risk of bias and the evidence was of very low quality.
What are the implications for dentists and the general public?
There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.
What should researchers look at in the future?
Careful consideration should be given to whether or not this is a priority topic for future research. The caries levels in the included study are far below those which cause concern. If future studies are undertaken they should focus on areas where young children are at high risk of developing caries.
Link
Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E. Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children. Cochrane Database of Systematic Reviews 2017 , Issue 10 . Art. No.: CD011850. DOI: 10.1002/14651858.CD011850.pub2 .
This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base
Cochrane Oral Health 