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. 2025 Jul;69(1):107633.
doi: 10.1016/j.amepre.2025.04.003. Epub 2025 Apr 11.

Effectiveness of School Fluoride Delivery Programs: A Community Guide Systematic Review

Susan O Griffin  1 , Mei Lin  2 , Christina R Scherrer  3 , Shillpa Naavaal  4 , David P Hopkins  5 , Anita A Jones  6 , Tammy Alexander  7 , Virginia A Black  8 , Elizabeth Clark  8 , Lori K Cofano  9 , Raul I Garcia  10 , Anna Goddard  11 , Jane Grover  12 , Susan M Kansagra  13 , Thomas E Kottke  14 , Elizabeth C Lense  12 , Tooka Zokaie  15 ; Community Preventive Services Task Force
Affiliations

Effectiveness of School Fluoride Delivery Programs: A Community Guide Systematic Review

Susan O Griffin et al. Am J Prev Med. 2025 Jul.

Abstract

Introduction: Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs in preventing caries.

Methods: Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on school flouride varnish delivery program effectiveness in increasing fluoride varnish receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle- or high-income countries. Data synthesis conducted in 2024 used median RR and interquartile interval (IQI) to summarize findings across studies.

Results: Of 31 included studies with 60,780 students, 25 were randomized controlled trials-20 with good quality of execution. Most studies were conducted in low socioeconomic status areas among students at elevated caries risk. School flouride varnish delivery programs reduced caries initiation by 32% (IQI: 21%, 37%) in permanent teeth (19 studies, 25,826 students) and by 25% (IQI: 4%, 37%) in primary teeth (12 studies, 4,304 students). Stratified assessments indicated findings were largely applicable to different settings, populations, and intervention characteristics. Two studies found school flouride varnish delivery programs significantly increased the number of annual flouride varnish applications and 2 found that school flouride varnish delivery program effectiveness was inversely related to socioeconomic status.

Discussion: About 30% of states report having no school flouride varnish delivery programs. Possible barriers to implementation include that Medicaid in some states only reimburses dental and medical professionals and does not reimburse non-dental providers for flouride varnish delivered to children older than age 6 years.

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Figures

Figure 1.
Figure 1.
Search yield for included studies
Figure 2.
Figure 2.
Effectiveness of SFVDP relative to no program on caries initiation in permanent teeth IQI: Inter-quartile interval. n: Number of studies. RR: Relative risk/ratio. SFVDP: School fluoride varnish delivery programs. X-axis is in log-scale. Thin solid bar represents the median and dashed bars the IQI.* Significant effect at p<0.05 for RR, odds ratio, prevented fraction, difference in incidence or increment for SFVDP vs control, or p>0.05 at baseline and p<0.05 at follow-up for SFVDP vs control.
Figure 3.
Figure 3.
Effectiveness of SFVDP relative to no program on caries initiation in primary teeth IQI: Inter-quartile interval. n: Number of studies. RR: Relative risk/ratio. SFVDP: School fluoride varnish delivery programs. X-axis is in log-scale. Thin solid bar represents the median and dashed bars the IQI.* Significant effect at p<0.05 for RR, difference in incidence or increment for SFVDP vs control, or p>0.05 at baseline and p<0.05 at follow-up for SFVDP vs control.
Figure 4.
Figure 4.
Effectiveness of SFVDP relative to no program on caries progression RR: Relative risk/ratio. IQI: Inter-quartile interval. n: Number of studies. SFVDP: School fluoride varnish delivery programs. X-axis is in log scale. Thin solid bar represents the median and dashed bars the IQI. * Significant effect at p<0.05 for difference in incidence or increment for SFVDP vs control.
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References

    1. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. US Dept of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. Accessed: October 24, 2024. https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.sur...
    1. Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Centers for Disease Control and Prevention; 2019. Accessed: October 24, 2024. https://stacks.cdc.gov/view/cdc/154482/cdc_154482_DS1.pdf
    1. Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030. In: US Department of Health and Human Services. Accessed: October 24, 2024. https://odphp.health.gov/healthypeople
    1. Clark MB, Keels MA, Slayton RL. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2020;146(6). doi: 10.1542/peds.2020-034637 - DOI - PubMed
    1. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;2013(7): Cd002279. doiI: 10.1002/14651858.CD002279.pub2 - DOI - PMC - PubMed

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