Effectiveness of Fluoride Varnish Versus Conventional Glass Ionomer in Preventing Occlusal Caries: A Systematic Review and Meta-Analysis

TL;DR

This study compares fluoride varnish and glass ionomer sealants for preventing tooth decay in children and finds both are equally effective.

Contribution

A systematic review and meta-analysis comparing the effectiveness of fluoride varnish and glass ionomer cement in preventing occlusal caries.

Findings

Fluoride varnish and glass ionomer sealants are similarly effective in preventing occlusal caries.

Fluoride varnish showed slightly higher plaque accumulation compared to glass ionomer sealants.

Both treatments had comparable effects on anxiety, pain, and second molar caries.

Abstract

Fluoride varnish (FV) and conventional glass ionomer cement (GIC) sealants are widely used strategies for the prevention of occlusal caries in newly erupted permanent molars. However, their comparative effectiveness remains unclear. We aimed to evaluate the preventive efficacy of FV versus GIC sealants in pediatric populations. PubMed, Web of Science (WoS), Scopus, and Cochrane CENTRAL were systematically searched through January 2026 to identify randomized controlled trials (RCTs) comparing FV and GIC sealants. The primary outcome was the incidence of occlusal caries involving dentin ( International Caries Detection and Assessment System (ICDAS) ≥4). Secondary outcomes included caries development on adjacent second molars, plaque accumulation measured by the Visible Plaque Index (VPI), and patient-reported levels of anxiety and pain during application. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were computed using random-effects models. Five RCTs including 1,626 patients and 5,060 teeth met the inclusion criteria. The incidence of occlusal caries and second molar caries, as well as anxiety and pain levels, was comparable between the FV and GIC groups. Patients receiving FV had modestly higher plaque scores compared to those receiving GIC (SMD = 0.11, 95% CI: 0.01 to 0.21, p = 0.03). Both FV and GIC sealants provide effective protection against occlusal caries in newly erupted permanent molars, with FV demonstrating a slight disadvantage in plaque accumulation. These findings suggest that clinicians can select either modality based on logistical considerations, patient preference, and resource availability, without compromising clinical effectiveness.

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