Occlusal caries prevention in newly erupted permanent molars is a major focus in pediatric dentistry, as these teeth are highly susceptible during early eruption. Fluoride varnish and glass ionomer cement sealants are commonly used preventive measures, but their comparative benefits have remained uncertain. The new systematic review and meta-analysis published in the
Cureus Journal of Medical Science provides updated evidence on their relative effectiveness.
The study, led by Abdullah Dh Alharbi from the Department of Dentistry, Taima Polyclinic, Ministry of Health, Al-Jahra, Kuwait, evaluated randomized controlled trials comparing fluoride varnish and conventional glass ionomer sealants in children. The researchers searched PubMed, Web of Science, Scopus, and Cochrane CENTRAL for relevant studies published up to January 2026.
Five randomized controlled trials involving 1,626 pediatric patients and 5,060 teeth were included in the analysis. The primary outcome was the development of occlusal caries extending into dentin, defined as an ICDAS score of 4 or higher. Secondary outcomes included caries formation in adjacent second molars, plaque accumulation assessed using the Visible Plaque Index, and patient-reported anxiety and pain during treatment.
The key findings were as follows:
- Both fluoride varnish and glass ionomer sealants were similarly effective in preventing dentin-level occlusal caries in newly erupted permanent molars.
- No significant difference was observed between the two groups in the development of caries on adjacent second molars.
- Patient-reported anxiety and pain levels during application were comparable for fluoride varnish and glass ionomer sealants, indicating similar tolerability.
- Plaque accumulation was slightly higher in children treated with fluoride varnish compared with those receiving glass ionomer sealants.
- Although the difference in plaque scores was statistically significant, it was modest and unlikely to outweigh the practical benefits of fluoride varnish, including easier application and lower technique sensitivity.
The authors noted several limitations. Only a limited number of trials reported outcomes related to anxiety, pain, and second molar caries, which reduced statistical power. Differences in operator experience, assessment methods, and clinical settings may have introduced measurement bias. Additionally, indices used to assess caries and plaque, while validated, are operator-dependent and subject to variability.
Overall, the findings indicate that both fluoride varnish and conventional glass ionomer sealants provide effective and comparable protection against occlusal caries in newly erupted permanent molars. Although fluoride varnish may be associated with slightly higher plaque accumulation, its preventive efficacy remains similar to that of glass ionomer sealants. The study supports the continued use of either modality in clinical practice, allowing clinicians to tailor preventive strategies based on patient needs, logistical considerations, and available resources.
Reference:
Dh Alharbi A, Almasoud M, Alfadhli F, et al. (January 27, 2026) Effectiveness of Fluoride Varnish Versus Conventional Glass Ionomer in Preventing Occlusal Caries: A Systematic Review and Meta-Analysis. Cureus 18(1): e102436. doi:10.7759/cureus.102436
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