Commentary

Caries is one of the most common chronic childhood diseases and a significant public health problem. All countries are affected with decay being present in between 30-50% of five- to six-year-old children. While there have been improvements in the levels of decayed, missing and filled teeth in recent decades dental caries is a major problem.

The aim of this Cochrane review was to assess whether fluoride supplementation for pregnant women could prevent caries in their children's primary teeth.

Searching, study selection, data extraction and assessment of risk of bias have been undertaken using Cochrane's standard methodological approaches. However only one low quality randomised controlled trial involving 1400 women met the inclusion criteria. Of the 1175 children born 934 (79%) were followed up at three years and 798 (68%) at five years. No differences were seen in either the proportion of children with caries or the number of decayed or missing primary teeth.

While fluoride can be transported across the placenta altering the enamel matrix and strengthening the properties of the enamel, the exact mechanism of the transfer is uncertain. The review authors highlight than no new studies on placental transfer of fluoride have been undertaken during the past two decades. Potential risks associated with fluoride exposure have also been reported.1,2

Given the well established positive benefits of the use of topical fluorides such as toothpastes, gels, varnishes and rinses for caries prevention,3,4,5,6,7 the lack of evidence of a positive effect from the one trial that was included and little supporting evidence from other observational data discussed supports the authors' view that careful consideration should be given to future research in this area.