Patients at elevated risk for developing caries benefit from applying prescription fluoride directly to their teeth or having their dentist apply it, according to new recommendations published in the Journal of the American Dental Association (November 1, 2013).
Topical fluoride, used in conjunction with drinking optimally fluoridated water and using toothpaste with fluoride, helps prevent caries in these patients, according to the clinical recommendations from a multidisciplinary expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs.
The recommendations cover professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. This marks the first time that these evidence-based recommendations were updated based on a systematic review of clinical studies. The authors reviewed clinical studies on fluoride mouth rinses, varnishes, gels, foams, and pastes.
Evidence-based clinical recommendations are intended to provide dentists and other health professionals with a review of the latest scientific evidence on particular topics and are not considered a standard of care. Rather, healthcare professionals can consider clinical recommendations, patient preference, and their own clinical judgment when diagnosing and treating patients.
The panel concluded that additional research is needed, but recommended the following for patients at elevated risk of developing caries:
- Professionally applied 2.26% fluoride varnish or 1.23% fluoride gel every three to six months
- Home-use prescription-strength 0.5% fluoride gel or paste, or 0.09% fluoride mouth rinse (for patients 6 years old or older)
- A 2.26% professionally applied fluoride varnish every three to six months for children younger than 6 years old
In addition, the recommendations specify the fluoride concentrations that provide the best benefit, and indicate that acidulated phosphate fluoride foam not be used in children younger than 6 years old due to the potential of swallowing the foam. Foam is also not recommended for children older than 6 years old and adults due to a lack of evidence for benefit. In addition, the panel recommended that clinicians determine a patient's risk for developing cavities by conducting a caries risk assessment.
The ADA recommends the following oral hygiene habits to fight caries: brushing twice a day with fluoride toothpaste, flossing daily, eating a balanced diet, and regular dental checkups.
The full report of the clinical recommendations, a chairside guide for dentists to use to talk to their patients, and an audio podcast summary of the recommendations will be available November 1 on the ADA's evidence-based dentistry website.
