Griffin Susan O, Lin Mei, Scherrer Christina R, Naavaal Shillpa, Hopkins David P, Jones Anita A, Alexander Tammy, Black Virginia A, Clark Elizabeth, Cofano Lori K, Garcia Raul I, Goddard Anna, Grover Jane, Kansagra Susan M, Kottke Thomas E, Lense Elizabeth C, Zokaie Tooka
Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Prev Med. 2025 Jul;69(1):107633. doi: 10.1016/j.amepre.2025.04.003. Epub 2025 Apr 11.
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.
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.
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.
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.
尽管龋齿是可预防的，但仍然非常普遍。许多儿童在临床环境中没有定期接受预防性牙科服务。本综述研究了学校（从幼儿园到高中）氟化物涂漆项目在预防龋齿方面的有效性。
采用《社区指南》的系统综述方法。2024年，检索数据库，查找截至2023年12月发表的关于学校氟化物涂漆项目在增加氟化物涂漆接受率和减少龋齿方面有效性的研究。纳入的研究必须用英文撰写，发表在同行评审期刊上，并在中高收入国家进行。2024年进行的数据综合使用中位数相对危险度和四分位间距（IQI）来总结各项研究的结果。
在纳入的31项研究中的60780名学生中，25项为随机对照试验，其中20项执行质量良好。大多数研究在龋齿风险较高的学生中的低社会经济地位地区进行。学校氟化物涂漆项目使恒牙（19项研究，25826名学生）的龋齿发病率降低了32%（IQI：21%，37%），乳牙（12项研究，4304名学生）的龋齿发病率降低了25%（IQI：4%，37%）。分层评估表明，研究结果在很大程度上适用于不同的环境、人群和干预特征。两项研究发现，学校氟化物涂漆项目显著增加了每年氟化物涂漆的应用次数，两项研究发现学校氟化物涂漆项目的有效性与社会经济地位呈负相关。
约30%的州报告没有学校氟化物涂漆项目。实施的可能障碍包括，一些州的医疗补助仅报销牙科和医疗专业人员的费用，而不报销向6岁以上儿童提供氟化物涂漆的非牙科提供者的费用。
