Arresting Dentine Caries in Children with Professionally Applied Fluorides

Objective:  Fluoride therapy has been shown effective in caries prevention in children and its use has been extended to arresting active dentine caries. This review aimed to evaluate the effectiveness of dental professional-applied fluoride agents in arresting active dentine caries in children. Method:  A systematic search of the publications in the PubMed database was conducted in March 2014 by using the key words (fluoride) AND (children caries or early childhood caries) AND (arresting OR remineralisation OR remineralization). The title and abstract of the identified publications were screened. Reviews, discussion papers, laboratory works, case reports, clinical treatment, non-English articles and irrelevant reports were excluded. Full texts of the remaining publications were retrieved. Manual search was performed on the bibliographies of these publications to identify relevant papers. Meta-analysis on the results of the finally included studies was performed to calculate the pooled proportion of active caries which had become arrested after the fluoride therapy. Result: The search identified 142 papers and 109 of them were excluded after screening. The remaining 33 papers were retrieved and 2 articles were identified from the bibliographies. After reviewing the full text of the 35 papers, 5 randomized clinical trials met the study inclusion criteria. Meta-analysis was performed on the extracted data from these papers. The results showed that topical applications of 38% silver diamine fluoride (SDF) solution could arrest dentine caries. No other agents showed such a capability. The overall proportion of active dentine caries that had become arrested after applications of SDF solution was 73% (95% Confidence Interval: 53% - 94%; p<0.001). Conclusion: There is evidence in the literature showing that 38% SDF solution applied by dental professionals is effective in arresting active dentine caries in children. The number of randomized clinical trials is small and more high-quality clinical trials should be conducted.