Root caries is commonly found in older adults, with nearly half of the global older adult population affected. However, there is not one type of fluoride therapy that is superior to other types when it comes to preventing root caries in this age group, according to a review published on September 1 in the Journal of Dentistry.
With an aging population and life expectancy increasing worldwide, dentists will see older patients with root caries in their practices. Although caries has been recognized as the most common oral disease, and prevention of caries has been emphasized, little attention has been given to caries prevention among older adults.
Preventive measures that have proven to be effective for other age groups may not apply to older adults, as the types of caries and associated risk factors differ. Most clinical trials investigating the use of fluoride for caries prevention focus on children and adolescents.
The review sought to overcome this gap in knowledge by compiling data from numerous trials in which professionally applied fluoride was used to prevent or stop caries in adults age 60 or older. However, only a handful of studies met the criteria for the target patient population.
"Further clinical trials are required to compare their effectiveness and determine the better choice for preventing root caries in older adults in clinical practice and public health policy," wrote the study authors, led by Alice Kit Ying Chan of the University of Hong Kong (J Dent, October 2022, Vol. 125, 104273).
To conduct the review, two independent researchers searched the literature across five databases for clinical trials on the effectiveness of professionally applied fluoride to prevent or arrest caries in adults age 60 and older. Of the 525 studies they found, only seven were included in the final analysis.
The study findings indicate that 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride gel were effective in preventing root caries, but no particular agent was superior. Although both 38% SDF solution and 5% NaF varnish were effective in preventing root caries, no statistically significant differences were detected between the two agents.
One study reported that an annual application of 38% SDF solution combined with an oral health education program significantly prevented new root caries. The program was delivered by a hygienist to evaluate and change oral healthcare daily practices.
Because only seven clinical trials were ultimately included in the analysis, more clinical trials evaluating the effectiveness of various methods for preventing root caries in older adults are necessary to provide more evidence for use in clinical practice and public health measures.
The study authors suggest that cost-effectiveness should be considered before adopting the program in public health interventions, especially as behavioral factors, such as oral hygiene practices and dietary habits, are associated with caries. The authors also cautioned that SDF stains carious lesions black and may cause aesthetic concerns.
"An effective strategy to relieve the global burden of dental caries in older adults is to change the principle of caries management from an intervention-oriented approach to a prevention-oriented approach," wrote the authors of the review.
