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Applying a fluoride varnish to the teeth of children as young as 6 months reduces the incidence of caries in early childhood, according to a new study. Investigators conducted a two-year trial of the varnish in 376 children from low-income families associated with two public health centers in the San Francisco area. Ranging in age from 6 to 44 months (mean 1.8 years), the children had at least four teeth and no caries, and lived in a community with fluoridated water. The children, whose families all received counseling about preventing cavities, were divided into three intervention groups: no fluoride varnish, fluoride varnish once a year, or fluoride varnish twice a year. Investigators examined the children's teeth before the trial began and one and two years into the intervention. Parental interviews also were conducted to assess factors that are associated with early childhood caries, potential confounders, and effect modifiers, such as the child's use of a bottle and diet.
Children in the group that received only counseling were significantly more likely to have caries than those who had fluoride varnish treatments in addition to counseling. And the varnish applications had a dose-response effect, with only 2% of the twice-a-year group having caries compared with 8% of the once-a-year group and 12% of the counseling-only group (Weintraub JA et al: J Dent Res 2006;85:172).
Commentary This may be the next new "vaccine" administered in pediatricians' offices. Studies, including those of cost effectiveness, are on-going. Incorporating this treatment into well-child visits may be the most practical approach. Reimbursement will need to cover required added time and supplies.