Sachin Seth DDS
A systematic review of 17 randomized controlled trials and clinical trials found supplemental topical fluoride use in moderate- to high-caries-risk adults is effective in preventing and/or remineralizing dental caries.
In adults with moderate to high caries risk, does supplemental topical fluoride help prevent and/or remineralize dental caries?
Four authors independently reviewed the titles and abstracts collected from an electronic database search with no language restrictions. Two reviewers independently evaluated the full text papers retrieved utilizing a pre-established screening form. The review included randomized controlled trials and clinical trials conducted on adult humans with moderate to high caries risk. Only studies evaluating a self- or professionally applied fluoride intervention and having defined outcomes of either reduction in carious lesions or high levels of caries remineralization were used. Split-mouth design studies were excluded. Four authors assessed the quality of the studies utilizing the 10 quality domains and their associated elements as reported by the Agency for Healthcare Research and Quality (AHRQ).
In this systematic review, 17 articles (N=2,953) fulfilled the predetermined inclusion criteria. Studies ranged from eight months to four years in duration. Six studies included populations older than 60 years and four involved populations that were post-head-and-neck radiation treatment. The authors categorized results by the type of fluoride used: 0.05-0.2% sodium fluoride (NaF) daily mouth rinses (relative risk reduction (RRR) for carious lesions 50 percent to148percent, Cohen's delta 0.23-0.83), 1.1percent patient-applied NaF pastes/gels (RRR for root lesion remineralization 35 percent to122 percent), professionally applied fluoride varnishes (RRR root caries remineralization 63 percent; RRR for decayed, missing filled surfaces 50 percent).
The use of supplemental topical fluoride in moderate- and high-caries-risk adults is effective in preventing and/or remineralizing dental caries.
Source of Funding:
Importance and Context:
The use of fluoride as a tool in reducing caries in children is widely accepted by the dental community. However, there is still some debate as to whether adults can likewise benefit from topical fluoride treatments. Previous studies generally have focused on fluoride use in the pediatric population with very little attention being placed on the adult population.
In the erupted dentition, fluoride can help prevent decay in three ways: inhibition of bacterial metabolism of fermentable carbohydrates, incorporation into the apatite lattice during remineralization and reduction of the solubility of the apatite to future acid attacks.(1)
1. Featherstone JD. The science and practice of caries prevention. J Am Dent Assoc. 2000;131(7):887-99. Epub 2000/08/01.
Strengths and Weaknesses of the Systematic Review:
The authors conducted a comprehensive search of multiple electronic databases with no language restrictions. The inclusion criteria were succinct and clear, and they excluded studies involving children or adolescents, ambiguous fluoride intervention and those in which outcomes were unclear. A major weakness in this review was a modification of the use of the AHRQ scale to assess the quality of the evidence. The four authors scored each domain from the scale separately and assigned an average score to each study. They deemed an average score greater than or equal to 75 to be of good quality. Although it is based on a validated scale, the method for quantification has not been validated and consequently the authors’ statements on the selected studies’ quality assessment cannot be authenticated.
Strengths and Weaknesses of the Evidence:
The authors based the quality of a study on the domains of randomization, blinding, interventions and statistical analysis. They rated 10 studies to be of overall good quality and scored the remaining seven as ‘fair.’ The authors scored all of the studies as ‘poor’ with regard to the description of the randomization process. They found seven studies to have good generalizability, however, this assessment is subjective and is better left for the clinician to make.
Implications for Dental Practice:
Although the reviewed clinical trials varied in design and quality assessment, all demonstrated that the use of supplemental and professionally applied fluoride is effective in preventing and/or remineralizing dental caries in moderate- and high-caries-risk adults from a variety of settings (i.e., community dwelling adults and those in residential care).