This review systematically examined the safety and effectiveness of professionally applied fluoride treatments in preventing and halting dental caries among children in low- and middle-income countries (LMICs). We included randomized controlled trials from LMICs comparing professional fluoride applications with placebo, no treatment, health education alone, or standard care, with a minimum follow-up of one year. The review considered topical fluoride agents, including silver diamine fluoride (SDF), sodium, nano silver fluoride (NSF) and fluoride (NaF), acidulated phosphate fluoride. Searches were conducted in five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) in May 2022. A random-effects meta-analysis was performed where applicable. A total of 33 studies, comprising 16,375 children aged 1.5–14 years, were included in the qualitative synthesis. Quantitative meta-analysis included 17 studies with 4,067 participants. Adverse events were reported in 14 studies, none of which were serious. SDF and NSF significantly arrested caries in primary teeth (p < 0.05) relative to placebo or no intervention. Fluoride varnishes and gels effectively reduced new caries formation in primary teeth (p < 0.05) but did not significantly affect permanent teeth (p > 0.05). Overall, the certainty of evidence was low. Professionally applied fluorides appear effective and safe for caries prevention and arrest in children in LMICs, providing evidence to guide clinical recommendations. Nevertheless, the limited number of high-quality trials underlines the need for further rigorous research to confirm these outcomes.
