Highlighted review: Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children

Rena Takahashi, Erika Ota, Keika Hoshi, Toru Naito, Yoshihiro Toyoshima, Hidemichi Yuasa, Rintaro Mori, Eishu Nango

Plain language summary: Fluoride supplements taken by pregnant women for preventing dental caries in the primary teeth of their children

Review question
How effective and safe is the use of fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing tooth decay in the baby teeth of their children compared with placebo (tablets or other forms of supplements without fluoride) or no treatment?

Background
Tooth decay is one of the most common health problems among children. The condition has been decreasing among children in most parts of the world over the past few decades most likely due to the widespread use of fluoride toothpaste, followed by water fluoridation, oral health education and a slight decrease in sugar consumption.

If fluoride supplements taken by pregnant women can prevent tooth decay in their children, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. Fluoride tablets, drops, lozenges or chewing gums are sucked or chewed to provide topical fluoride and ingested to provide systemic fluoride.

Study characteristics
Authors from Cochrane Oral Health carried out this review of existing studies and the evidence is current up to 25 January 2017. It includes only one study in which 1400 pregnant women were randomly allocated to fluoride treatment or placebo. In this study, a daily dose of either 1 mg sodium fluoride tablets or placebo tablets were given to participants from the fourth month of pregnancy to delivery. Both groups were encouraged to use dietary fluoride supplements after delivery in the form of drops.

A total of 1175 babies were born to participants in this study, and of this number, 938 children were followed up at 3 years (464 fluoride tablets versus 484 placebo tablets) and 798 children were followed up at 5 years (398 fluoride tablets versus 400 placebo tablets) of age. Published in 1997, this study took place in communities with unfluoridated drinking water in Southern Maine, USA.

Key results
Baby teeth decay measured in children aged 3 and 5 years old was very low in both the fluoride supplement group and the placebo group. At 5 years of age, 92% of children remained decay-free in the fluoride supplement group and 91% remained decay-free in the placebo group, showing no difference between the two groups. The incidence of fluorosis at 5 years was similar between the group taking fluoride supplements (tablets) during the last 6 months of pregnancy and the placebo group.

There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.

Quality of the evidence
The included study was assessed as being at high risk of bias and the evidence was of very low quality.

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Citation: Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E. Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD011850. DOI: 10.1002/14651858.CD011850.pub2.