A multidisciplinary expert panel convened by the ADA's Council on Scientific Affairs has issued a report containing clinical recommendations that support the use of certain nonfluoride products as part of a caries prevention program (Journal of the American Dental Association, September 2011, Vol. 142:9, pp. 1065-1071).
Sugar-free chewing gum, lozenges, and hard candy that include xylitol or polyol combinations, could be beneficial in preventing cavities when used as adjuncts to a comprehensive cavity prevention program that includes the use of fluoride-containing products, the panel noted. The same clinical recommendations apply to the use of a prescription varnish with chlorhexidine and thymol.
These nonfluoride options could provide an extra benefit to prevent caries in patients at high risk for developing cavities when used in addition to products such as toothpaste, dental sealants, and varnishes that contain fluoride, as well as community water fluoridation and good eating habits, the panel wrote.
The ADA recommends that clinicians determine a patient's risk for developing cavities by conducting a caries risk assessment, which includes completing a caries risk assessment form that can be used as a communications tool with their patients.
In addition to a comprehensive cavity prevention program that includes the use of fluoride, the scientific panel recommended that clinicians consider applying a mixture of chlorhexidine-thymol varnish to the teeth of high-risk adults and the elderly every three months to reduce cavities developing in the root of the tooth.
The panel encouraged clinicians to consider advising parents and caregivers of healthy children older than 5 years who are at higher risk for cavities to chew sugar-free polyol gum after meals for 10 to 20 minutes to prevent cavities.
A polyol is a low-calorie sweetener such as xylitol, sorbitol, or mannitol that is not broken down by the bacteria in the mouth and therefore does not contribute to tooth decay. The panel also recommended that sucking xylitol-containing sugar-free lozenges or hard candy after meals may reduce cavities in children.
The panel's recommendations are based on a review of 71 published articles that described 50 randomized controlled trials and 15 nonrandomized studies to assess the effectiveness of various nonfluoride agents in preventing cavities.
