The cost-effectiveness of fluoride varnish applications from the standpoint of dental providers and payers may remain uncertain, casting a possible shadow over its value. The review was recently published in the Journal of Dentistry.
More research may be needed to aid decision-making, especially with low- and upper-middle-income populations, to gain a more complete picture, the authors wrote.
“The synthesized results from existing studies indicate that the cost-effectiveness of fluoride varnish application is uncertain at the given willingness-to-pay threshold in high-income countries,” wrote the authors, led by Ram Surath Kumar of the Postgraduate Institute of Medical Education and Research in India (J Dent, February 6, 2026, 106562).
The study’s objective was to synthesize the incremental net monetary benefit (INMB) of fluoride varnish (FV) application compared with other caries prevention interventions in children. A literature search of electronic databases identified relevant studies published from inception to January 2024, yielding 836 records, of which 23 studies met the inclusion criteria.
Most FV studies compared the intervention with oral health education, treatment as usual, pit and fissure sealants, toothbrushing, or no intervention. Only model-based studies conducted in high-income countries from a healthcare provider or payer perspective and comparing FV with oral health education, treatment as usual, or no intervention were eligible for pooled analysis.
In the overall meta-analysis, the pooled total INMB for 2024 was $124.1 for FV compared with other caries preventive interventions in children from a healthcare provider or payer perspective in high-income countries. The analysis found no significant difference in cost-effectiveness between FV and other preventive approaches regardless of setting, dentition type, or time horizon, and all nine included modeling studies showed no heterogeneity (I² = 0%).
Furthermore, despite being relatively resource-intensive, FV consistently demonstrated greater effectiveness than oral health education, treatment as usual, and no intervention. Specifically, caries reduction ranged from 2.6% to 18.2% compared with oral health education, 9.8% to 27.2% compared with no intervention, and mean caries reductions of 0.1 to 0.9 compared with treatment as usual.
However, the study had limitations. A meta-analysis could not be performed for upper middle income countries because too few studies were available. Therefore, the findings are largely limited to high-income countries and may not be broadly generalizable, they wrote.
“More robust research is needed to support confident decision-making,” Kumar and colleagues concluded.
