Are topical fluorides effective for treating incipient carious lesions?: A systematic review and meta-analysis

Background: This systematic review and meta-analysis evaluated the effectiveness of professional topical fluoride application (gels or varnishes) on the reversal treatment of incipient enamel carious lesions in primary or permanent dentition.

Methods: Literature searching was carried out by the authors in PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, Turning Research Into Practice, and ClinicalTrials.gov to verify the clinical trials available about the outcome. From 754 potentially eligible studies, 21 were selected for full-text analysis, 5 were included for review, and 3 for meta-analysis. The statistical analysis was performed only for studies assessing fluoride varnish; there were insufficient data to perform it for fluoride gel studies. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Pooled-effect estimates were expressed as the weighted mean difference between groups.

Results: The therapeutic methods ranged considerably regarding the fluoride application protocols. There was a significant trend of effectiveness of fluoride varnish on the reversal of incipient enamel carious lesions (P < .05). High heterogeneity was found in the meta-analysis.

Conclusions: Fluoride varnish seems to be an effective treatment for the reversal of incipient carious lesions in primary and permanent dentition; however, further clinical trials concerning efficacy of topical fluorides for treating those lesions are still required, mainly regarding the fluoride gel.

Practical implications: Considering the scientific evidence on topical fluorides, pediatric dentists can use fluoride varnishes as an adjuvant for the treatment of active white-spot lesions in primary or permanent dentition.