Effectiveness of topical fluorides in prevention of radiation caries in adults: A systematic review and meta- analysis

• This systematic review pools the evidence on efficacy of topical fluorides on prevention of radiation caries and bacterial count for the first time. • Fluorides are effective in prevention of radiation caries to a variable extent depending upon several factors like fluoride agent used, fluoride delivering method, patient compliance and patient’s general oral hygiene. • Sodium fluoride is the most commonly used agent in the form of gel, mouth wash or varnish for prevention of radiation caries. Topical fluoride is used for prevention of dental caries. However, its effectiveness and more specifically its formulation and frequency of application in patients undergoing head and neck radiotherapy are still debatable . The aim of this systematic review was to pool the evidence of effectiveness of various topical fluorides in preventing radiation caries or change in bacterial growth in adult patients of head and neck cancer. Three databases (PubMed and Google Scholar and Cochrane) were searched for randomized controlled or uncontrolled trials or quasi randomised trials published till February 2021. Two independent reviewers screened 346 abstracts finally 14 articles were included in the current systematic review. Primary outcome evaluated was the prevention of radiation caries or change in bacterial growth in saliva. Meta-analysis was performed for the sub groups formed on the basis of fluoride formulations and adjuncts used with it. Results: Studies included were highly heterogeneous. Majority of studies found different fluoride formulations to be effective in controlling radiation caries to a variable extent up to 70% depending upon the intervention, patient compliance, rate of attrition and follow up period. Sodium fluoride was the most commonly used caries preventive agent. Meta-analysis showed no significant difference between sodium fluoride formulations and other fluoride agents. Fluoride treatment when incorporated with re-mineralising agent had no significant effect on caries prevention Fluoride prevents radiation caries. However, to delineate its exact formulation, dosage or frequency, there is need for more well conducted randomised controlled trials.