Which professionally applied topical fluoride agent is most effective for caries prevention in children and adolescents?

Objectives

To evaluate, through a systematic review and network meta-analysis, the effectiveness of professionally applied topical fluoride agents in preventing dental caries in children and adolescents aged ≤18 years with a minimum follow-up of 1 year.

Methods

A network meta-analysis was conducted using data from randomised controlled trials evaluating professionally applied topical fluoride agents for caries prevention in children and adolescents, using a frequentist random-effects model. Interventions included fluoride varnish, gel, foam, SDF, and fissure sealant, with the latter retained as an active non-fluoride comparator. Separate networks were constructed by outcome and dentition type. Risk of bias was assessed using the RoB 2. Sensitivity analysis was performed. Confidence in network estimates was assessed using CINeMA.

Results

Forty randomized trials involving 26,724 participants were included, of which 11 studies contributed to at least one network or supplementary quantitative analysis. High risk of bias was assessed in 12 trials. In the permanent dentition, fluoride varnish demonstrated the largest reduction in caries increment versus inactive control among topical fluoride agents, followed by APF gel. Fissure sealant ranked highest overall but was interpreted separately as a non-fluoride comparator. CINeMA confidence ranged from low- to-moderate.

Conclusions

Among topical fluoride agents, FV showed the most favourable estimate compared with inactive control in the permanent dentition/first permanent molar continuous CINeMA. Overall, the findings favoured active preventive interventions, but interpretation should remain cautious because several estimates were based on sparse, single-study, or indirect evidence

Clinical significance

Professionally applied topical fluoride agents generally favoured caries prevention compared with inactive control.