ADA clinical recommendations on topical fluoride for caries prevention

Abstract

Scope and purpose: This guideline is intended to assist practitioners with decision making about the use of topical fluoride caries-preventive agents. It presents evidence-based clinical recommendations on professionally applied and prescription strength, home-use topical fluoride agents for caries prevention. Three clinical questions on the use of topical fluoride caries-preventive agents are addressed: In primary and permanent teeth, does the use of a topical fluoride compared to no topical fluoride reduce the incidence of new lesions, or arrest or reverse existing coronal and/or root caries? For primary and permanent teeth, is one topical fluoride agent more effective than another in reducing the incidence of, or arresting or reversing coronal and/or root caries?Does the use of prophylaxis before application of topical fluoride reduce the incidence of caries to a greater extent than topical fluoride application without prophylaxis? Sodium, stannous and acidulated phosphate fluoride for professional and prescription home use, including varnishes, gels, foams, rinses and prophylaxis pastes were evaluated.

Methodology: The previous version of this review (2006 ADA policy) was based on assimilation of evidence from systematic reviews. However, this update synthesises primary evidence collected through systematic review and appraisal of the literature.The Cochrane Library and Medline (via PubMed) were searched. Relevant systematic reviews and other selected articles were hand-searched.Two reviewers independently screened titles and abstracts, with one reviewer assessing all manuscripts in full for meeting the inclusion criteria. Two different members of the expert panel then approved the exclusion list. Discrepancies were resolved through discussion with the Chair of the workgroup. The USPSTF grading system was used.

Review and updating: Five-year interval update in line with the ADA policy.

Recommendations: For individuals at risk of dental caries: 2.26% fluoride varnish or 1.23% fluoride (APF) gel, or prescription strength, home-use 0.5% fluoride gel or paste, or 0.09% fluoride mouth rinse for children who are aged six or over.The panel judged that the benefits outweighed the potential for harm for all professionally applied and prescription strength, home-use topical fluoride agents and age groups except for children aged under six years. Only 2.26% fluoride varnish was recommended for children less than six years old, as the panel considered the risk of adverse events (particularly nausea and vomiting) associated with swallowing all other professionally applied topical fluoride agents outweighed the potential benefits.There was insufficient data to answer the question on arresting and reversing coronal and/or root caries, so these outcomes were not addressed in the clinical recommendations.

Research recommendations: These focused on development of standard methodologies for well-designed trials with standardised reporting and trial registration. Specific areas for research included: investigation of mechanisms of fluoride action and effects against a background fluoride exposure; investigation of specific sub-groups such as high-risk elderly; research on specific products; measure and outcome development for arrested caries; economics and dissemination/implementation to realise guideline use.