Efficacy of Dental Varnishes and Gels for the Prevention and Management of Dental Caries in Older Adults-A Systematic Review and Meta-Analysis.

INTRODUCTION

To evaluate the efficacy of dental varnishes/gels in the prevention/management of dental caries in older adults.

METHODS

Cochrane, PubMed, Web of Science and EMBASE were searched through March 2024 for randomized controlled trials (RCT) including patients aged ≥ 60 years (or average age ≥ 60 years) utilizing varnish or gel interventions. Outcomes included caries incidence and lesion progression or reversal.

RESULTS

Of 112 abstracts reviewed, 10 RCTs (unclear or high risk of bias) were included. One study showed 1% chlorhexidine (CHX)-1% thymol varnish applied 7 times over 12 months significantly reduced carious/filled surfaces versus placebo (p < 0.001) and improved active lesions (RR = 2.00, p = 0.018). Monthly 5% sodium fluoride (NaF) varnish with professional brushing significantly improved outcomes versus standard fluoride toothpaste and oral hygiene instructions [OHI] (RR = 1.63, p = 0.002). When professional cleaning and OHI were provided quarterly, adding varnishes (1% CHX-1% thymol or 5% NaF) showed no significant additional benefit. Evidence quality was low to moderate due to heterogeneity and bias.

CONCLUSION

Quarterly professional cleaning with OHI was as efficacious as adding either the 1% CHX-1% thymol or 5% NaF varnishes. Applying dental varnishes in the office every 3 months could be a more practical option for the delivery of preventive modalities to older adults who could have cognitive or physical limitations that negatively impact the frequency of daily or weekly use at home of toothpaste or rinses. Future research should evaluate cost-effectiveness and adherence to preventive protocols across different patient functional and behavioural abilities and care settings.

TRIAL REGISTRATION: PROSPERO ID: CRD42024585284.