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Unlabelled: The method of applying fluoride varnish is described and the evidence of its effectiveness in the prevention and control of caries is summarized.The application of fluoride varnish should be an integral part of caries preventive programmes., Clinical Relevance: This paper describes how to apply fluoride varnish and reviews its effectiveness in preventing caries.

Unlabelled: This paper reviews the clinical evidence for the effectiveness of two, prescription only, toothpastes which contain 2800 and 5000 ppm F. The potential benefit of these toothpastes for high caries risk adolescents, adults and the elderly are discussed., Clinical Relevance: Dentists are now able to prescribe two high fluoride toothpastes for high caries risk individuals.

This cluster randomised controlled study assessed the effectiveness of twice-yearly applications of fluoride varnish as a public health measure to reduce dental caries in children living in relatively deprived communities. The test (n = 334) and control (n = 330) children in 2 school years (unit of randomisation) attended 24 state primary schools and were 6-8 years of age at the start. Good baseline balance was found. Duraphat varnish was applied at school on 5 occasions over 26 months, by dental therapists. A combined visual and fibre-optic transillumination examination included all surfaces of primary and first permanent molars at baseline and after 26 months for small and large enamel and dentine lesions. At the final examination the only statistically significant difference was in the caries increment for small enamel lesions in the primary dentition, with the test children having fewer lesions. This study failed to demonstrate that the twice-yearly application of fluoride varnish provided at school reduced dental caries in children living in this community. The low level of response and a lower than expected caries increment had a major impact on the effectiveness of the intervention, since the children who participated were least likely to have benefited from the programme, whereas those who might have benefited did not consent., (2007 S. Karger AG, Basel)

This study compared fluorosis in the upper central incisors of children from socially diverse backgrounds who had received either 440- or 1,450-ppm F toothpaste from 12 months of age. The children were resident in non-fluoridated districts in the north-west of England. They received either 440- or 1,450-ppm F toothpaste and advice regarding its use until the age of 5-6 years. Dental fluorosis (TF index) was assessed on digital images of dried teeth when the children (n = 1,268) were 8-10 years old. In the less deprived districts the prevalences of fluorosis (TF >or=0) for the 1,450- and 440-ppm F groups were 34.5 and 23.7% (p = 0.006). In the deprived districts the prevalences of fluorosis were 25.2 and 19.5% (p = 0.2). Overall the prevalences of TF >or=2 were 7 and 2.1% for the 1,450- and 440-ppm F groups and 2.2 and 0.2% for TF >or=3. These differences were statistically significant (p < 0.003). There was a strong association between the deprivation status of wards and fluorosis. Only 1 subject with a TF score of 3 was identified in the two most deprived quintiles of the Townsend score. It is concluded that careful targeting of programmes of this type to children living in high caries risk deprived communities carries only a small risk of aesthetically objectionable fluorosis (TF >2) whether low or high fluoride toothpastes are used. High fluoride (1,450 ppm F) toothpastes should not be provided on a community basis to very young children in less deprived communities.

Objective: To compare levels of caries experience in children attending schools in Wirral that have a fluoridated milk programme with children in a similar community which does not have a fluoridated milk programme., Study Design: A cross sectional study measuring caries experience in first permanent molars. Children were examined on an 'intention to treat' basis and the effect of clustering of children within schools was taken into account., Participants: 690 children in Wirral (test group) and 1,835 children in Sefton (comparison group) were examined for caries experience (DMFT/DT/DFS) in 2003. The mean ages of the children examined in the test and comparison groups were 10.79 and 10.83 years respectively., Results: Mean DMFT/DT/DFS values were 1.01/0.59/1.20 respectively in the test group and 1.46/1.02/1.89 respectively in the comparison group. Multiple linear regression analysis taking clustering of children within schools into account and with the Index of Multiple Deprivation 2000 as an explanatory variable gave the coefficients and p-values for DMFT/DT/DFS of 0.49 (p < 0.001)/0.43 (p < 0.001)/0.74 (p < 0.001) respectively., Conclusion: A difference in children with caries experience of 13% and a difference in children with active decay of 16% was found when a district with a community fluoridated milk programme was compared with a district without a fluoridated milk programme.

Objective: To assess the impact of a programme regularly supplying free fluoride toothpaste to children on the prevalence and severity of fluorosis and other developmental defects of enamel., Design: Randomised, controlled, parallel three-group clinical trial. Two groups received toothpaste containing either 440 or 1450 ppm F; the third group received no intervention. Children were supplied with toothpaste and advice on its use from the age of 12 months until they were 5-6 years old. The participants were a sub sample of those involved in a study that considered the caries benefits of providing free fluoride toothpaste. They were eligible if they completed the main study, lived in four of the nine districts involved and attended schools with 6 or more eligible participants., Setting: Children from the north west of England consuming drinking water containing less than 0.1 ppm F were examined in primary schools., Participants: 3731 children completed the main study. Of the 1833 children in the four selected districts, 927 were from schools with six or more participants., Method: Digital images encompassing the upper and lower anterior sextants were taken of each child when they were 8-9 years old., Main Outcome Measures: Developmental defects of enamel and dental fluorosis (TF index) were recorded on upper central incisors from wet and dry images., Results: A total of 703 children were included in the data analysis. In the 1450 ppm F (n=218), 440 ppm F (n = 226) and control (n = 259) groups the prevalence of dental fluorosis (TF > 0) was 17%, 15% and 12% for the wet (p > 0.05) and 26%, 24% and 25% for the dry (p > 0.05) photographs respectively. The prevalence of TF scores 2 or 3 (highest score) was 5%, 4% and 2% and for the wet (p > 0.05) and 7%, 4% and 5% for the dry (p > 0.05) photographs respectively. All subjects identified with TF score 3 were found in the group using the 1450 ppm F toothpaste (3 wet and 4 dry) and there were statistically significant differences between the three groups for both wet (p = 0.03) and dry photographs (p < 0.01). However, the pairwise comparisons between the groups failed to attain statistical significance. The highest prevalence and severity of demarcated opacities was seen in the control group and for the wet photographs the difference between the three groups attained statistical significance (p = 0.04). For both the wet and dry photographs the prevalence of any enamel defects (including fluorosis) and large demarcated or TF score 3 was similar for the three groups (p > 0.05)., Conclusion: Previously it has been reported that only the provision of 1450 ppm F toothpaste provides anticaries benefits in a programme of this type. This benefit is accompanied by a slight increase in prevalence of TF score 3 but not the overall prevalence of developmental defects of enamel. Careful targeting and implementation of a programme of this type is required to maximise benefits and minimise risks of fluoride exposure.

Fluoride varnishes have been available for over 30 years but there may be clinicians and dental public health practitioners who are unaware of the true level of effectiveness they provide in caries control. Under the headings of effectiveness, ease of application and safety the available evidence is digested and summarized to inform the reader about the indications, method of use and alternative options for caries control.

Objective: To determine the effectiveness of providing free toothpaste containing either 1450 or 440 ppm F on caries experience in 5-year-old children living in areas with different levels of material deprivation., Design: Five-year, examiner-blind, randomized, controlled, parallel-group, clinical trial. Children were randomly assigned to three groups., Setting: Health Districts in the north-west of England with high levels of dental caries. Clinical examinations were performed in schools during the period October 1999 to April 2000 when the children were 5-6 years old., Participants: Children from 3-month birth cohorts resident in nine, nonfluoridated health districts., Interventions: Toothpaste containing either 440 or 1450 ppm F and dental health literature posted at 3-month intervals and toothbrush provided annually from the age of 1-5 years. Comparison group received no intervention., Main Outcome Measures: Mean dmft and proportion of participants with dmft > 0, dmft > or = 4, upper primary incisor caries and extraction of one or more primary teeth. Outcomes tabulated for quartiles of participants based on the distribution of the Townsend index of material deprivation., Results: A total of 3467 children were included in the final data analysis. The Townsend index was found to be useful in identifying groups of children with increased caries risk. Overall, participants in the programme using the high-fluoride toothpaste had significantly (P < 0.002) less caries than the comparison group with similar absolute reductions in mean dmft for the most- and least-deprived groups. Relative to the comparison group the association between deprivation and dental caries was changed so that in the most-deprived quartile those using the low-fluoride toothpaste tended to have less dental caries than the comparison group whereas in the least deprived they tended to have more. This difference in the association (slope) was statistically significant (P < 0.05). Provision of both low- and high-fluoride toothpaste appeared to reduce the risk of extractions for participants in the most-deprived quartile (P < 0.05)., Conclusion: The relative benefits of the programmes supplying the two toothpastes considered in this study are different depending on the deprivation status of the participants. For the most-deprived groups postal provision of either a low- or high-fluoride toothpaste provides similar levels of benefit. In the less deprived groups only provision of the high-fluoride toothpaste provided a benefit. The absolute caries reduction seen for provision of the high-fluoride toothpaste was not related to the deprivation status and hence the programme did not reduce deprivation-related health inequalities. Targeting the programme using the methods employed in this study is unlikely to improve the effectiveness of the programme., (Copyright Blackwell Munksgaard, 2004)

Well-formulated fluoride toothpastes are clinically proven to prevent and control dental caries. They may also be a risk factor in the aetiology of dental fluorosis. This review considers the available evidence to support the appropriate use of fluoride toothpaste to maximise the benefit and minimise the risk. Three factors have an important influence on the anticaries efficacy of fluoride toothpaste, namely concentration, frequency of brushing and post brushing rinsing behaviour. The evidence suggests that low-fluoride (<600 ppm F) toothpastes provide less caries protection than standard (1,000 ppm F) or high (1,500 ppm F) concentration formulations. However, low-fluoride toothpastes are appropriate for very young children (under 7 years) at low caries risk, particularly if living in fluoridated areas. For other young children, higher concentrations of fluoride should be used. Brushing should be recommended twice daily, whilst rinsing with large volumes of water should be discouraged. Small amounts of toothpaste are comparable in efficacy to large amounts. The risk of fluorosis is associated with the ingestion of high doses of fluoride during tooth development and consequently only young children are at risk. The variability in the dose of fluoride ingested is mainly a function of the amount used, less so its concentration. To minimise fluorosis risk, parents should be advised to use only a pea-sized amount of toothpaste and encourage spitting out of excess. It is concluded that by using fluoride toothpastes appropriately, the benefits can be maximised and the risks of fluorosis minimised.

Objective: To assess the impact of regularly supplying free fluoride toothpaste regularly to children, initially aged 12 months, and living in deprived areas of the north west of England on the level of caries in the deciduous dentition at 5-6 years of age. A further aim was to compare the effectiveness of a programme using a toothpaste containing 440 ppmF (Colgate 0-6 Gel) with one containing 1,450 ppmF (Colgate Great Regular Flavour) in reducing caries., Design: Randomised controlled parallel group clinical trial. Clinical data were collected from test and control groups when the children were 5-6 years old., Setting: A programme of posting toothpaste with dental health messages to the homes of children initially aged 12 months. Clinical examinations took place in primary schools., Participants: 7,422 children born in 3-month birth cohorts living in high caries areas in nine health districts in north west England. Within each district children were randomly assigned to test or control groups., Interventions: Toothpaste, containing either 440 ppmF or 1450 ppmF, and dental health literature posted at three monthly intervals to children in test groups until they were aged 5-6 years., Main Outcome Measures: The dmft index, missing teeth and the prevalence of caries experience., Results: An analysis of 3,731 children who were examined and remained in the programme showed the mean dmft to be 2.15 for the group who had received 1,450 ppmF toothpaste and 2.49 for the 440 ppmF group. The mean dmft for the control group was 2.57. This 16% reduction between the 1,450 ppmF and control group was statistically significant (P<0.05). The difference between the 440 ppmF group and control was not significant. Further analyses to estimate the population effect of the programme also confirmed this relationship., Conclusion: This study demonstrates that a programme distributing free toothpaste containing 1,450 ppmF provides a significant clinical benefit for high caries risk children living in deprived, non-fluoridated districts.