Comparative Analysis of Fluoride Varnish vs. Sealing Agents in Caries Prevention

Thesis Abstract

This study investigates the comparative effectiveness of fluoride varnish and sealing agents in preventing dental caries across a cross-sectional population of school-aged children and young adults in urban clinics. The problem addressed concerns inconsistent outcomes in caries prevention between conventional fluoride varnish applications and pit-and-fissure sealing interventions, with limited concurrent comparative data across diverse socioeconomic groups. The aim is to determine whether fluoride varnish or sealing agents offer superior caries prevention, and to identify patient- and context-specific factors that moderate preventive efficacy. Specific objectives include (1) comparing caries incidence and progression between varnish-treated and sealant-treated cohorts; (2) assessing adherence, retention rates, and reapplication frequencies over a 24-month horizon; (3) evaluating secondary outcomes such as dentin hypersensitivity, patient satisfaction, and cost-effectiveness; and (4) exploring contextual moderators including age, socio-economic status, oral hygiene practices, and dietary patterns. The study adopts a cross-sectional analytic design with nested subgroup analyses to reflect real-world practice while enabling causal inference through triangulation with historical treatment data. The population comprises children aged 6–14 and young adults aged 15–24 attending five metropolitan dental clinics. A stratified random sample of 1,200 participants (600 varnish users and 600 sealant users) will be recruited, ensuring representation across age bands, gender, and socioeconomic strata. Data collection employs structured clinical examinations to record decayed, missing, and filled teeth (DMFT) indices, radiographic assessments where appropriate, patient-reported outcomes via validated questionnaires, and treatment records to verify intervention type and timing. Instruments include the International Caries Detection and Assessment System (ICDAS) for caries staging, a validated adherence scale for oral hygiene practices, and a cost-tracking instrument capturing direct and indirect costs associated with each preventive modality. Validity and reliability are ensured through calibration sessions for examiners (kappa ?0.80 for caries coding) and pilot testing of questionnaires (Cronbach’s alpha ?0.70). Data analysis will use multivariate regression models to estimate adjusted associations between intervention type and caries outcomes, controlling for covariates (age, sex, SES, diet, fluoride exposure, and oral hygiene). ANOVA will compare mean DMFT scores across groups, with post-hoc analyses to pinpoint subgroup differences. Propensity score matching will be employed to minimize selection bias due to non-randomized assignment. A conceptual framework integrating health behavior theories—specifically the Health Belief Model and the Theory of Planned Behavior—will guide interpretation of adherence and preventive behavior results, while cost-effectiveness analysis will be conducted from a healthcare payer perspective using incremental cost-effectiveness ratios (ICERs). The study anticipates that sealing agents may demonstrate superior long-term caries prevention in observational data due to superior retention and barrier effects in fissures, whereas fluoride varnish may show faster short-term reductions in lesion initiation in high-risk subgroups. The expected contribution to knowledge includes robust comparative, real-world evidence on the relative effectiveness and cost implications of varnish versus sealants, informing clinical decision-making, public health policy, and resource allocation in preventive dentistry. The main conclusion will synthesize efficacy, adherence, and economic considerations to provide context-specific recommendations for practitioners, with a nuanced suggestion that a combined or sequential preventive approach may be optimal for certain populations. Recommendations will emphasize standardized monitoring of lesion progression, patient-centered decision-making incorporating risk stratification, and iterative evaluation of preventive protocols in diverse community settings.