Fluoride Action Network



  • Topical applications of fluoride varnish have demonstrated the strongest evidence for clinical effectiveness in preventing early childhood caries.

  • This study shows that fluoride varnish is also more cost effective than usual dental care.

  • Fluoride varnish programs should continue to focus on children in disadvantaged areas and potentially expand to include all school-aged children.


Objective: This project compares the cost effectiveness of a preventive fluoride varnish (FV) program with usual dental care (surgery under general anesthesia [GA]) for preschool children in 2 low-income communities in Winnipeg, Canada.

Methods: Program impact is described in terms of cost, cavities avoided, and reductions in surgery volume. Aggregate data for 873 children ages 1 to 6 years old enrolled in the Winnipeg Regional Health Authority Daycare Fluoride Varnish Program in January 2018 were analysed using a Markov model.

Results: The program was found to save approximately $822.98 per child over 5 years versus usual dental care. There were 4.38 cavities avoided per child and a savings of $187.71/cavity for the FV group. Participants’ need for dental surgery under GA was reduced from 19.1% in the usual care group to 1.6% in the FV group (92% reduction) over 5 years. Sensitivity analyses using a Monte Carlo simulation showed that the program was cost effective over usual care 100% of the time. Finally, it was estimated that the program had saved $753,000 since its inception, or approximately $41.15 per FV application.

Conclusion: The FV intervention had better health outcomes, lower costs, and was less invasive than usual care involving dental surgery under GA for children enrolled in the program.

Keywords: Markov model; cost effectiveness; early childhood caries; fluoride varnish; low income area; prevention.

*Full study online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668277/