(RxWiki News) Tooth decay can become very serious if not treated. Special fluoride treatments may be necessary for those who are at high risk for cavities.
A recent review recommended certain types of professionally-applied fluoride varnish or gel and a prescription-strength, home-use fluoride gel, paste or mouthrinse for people over the age of 6 who are at high risk for cavities (dental caries).
"Go to a dentist if you notice you have tooth decay."
The lead author of this review was Robert J. Weyant, DMD, DrPH, from the Department of Dental Public Health in the School of Dental Medicine at the University of Pittsburgh in Pittsburgh, Pennsylvania.
This review included 71 clinical trials from 82 previously published articles on the effectiveness of both professionally-applied and prescription-strength, home-use topical fluoride agents — including varnishes, gels, foams, mouthrinses and prophylaxis (preventive) paste.
The professionally-applied fluorides included a 2.26 percent fluoride varnish, 1.23 percent fluoride gel, prophylaxis before 1.23 percent fluoride gel, 1.23 percent fluoride foam and prophylaxis pastes containing fluoride. The prescription-strength, at-home fluorides included 0.5 percent fluoride gel or paste and 0.09 percent fluoride mouthrinse.
All articles were published before October 2012 and only considered sodium, stannous and acidulated phosphate fluoride.
The review addressed two questions about fluoride use:
- Does the use of topical fluoride decrease the rate of decay in coronal caries (surface of tooth), root caries (exposed root) or both?
- Does it make a difference if prophylaxis is applied before the fluoride instead of applying fluoride without prophylaxis?
The researchers reviewed the studies and developed statements on each type of fluoride based on the evidence. The researchers then graded their level of certainty in each statement as low, moderate or high.
Next, the researchers formulated clinical recommendations on each type of fluoride and then graded the strength of each recommendation as:
- Strong — evidence strongly supports the recommendation
- In favor — evidence favors the recommendation
- Weak — evidence supports the recommendation only after any alternatives have been considered
- Expert opinion for — evidence is lacking and certainty is low, but expert opinion supports the recommendation
- Expert opinion against — evidence is lacking and certainty is low, and expert opinion does not support the recommendation
- Against — evidence does not support the recommendation
The researchers then determined the net benefit by weighing the potential benefits of each fluoride with the potential harm.
The findings showed that 2.26 percent varnish was the only fluoride in either category that was recommended for children younger than 6 years old. It should be applied at least every three to six months.
The researchers were "in favor" of this recommendation with moderate certainty, and the benefit was found to outweigh the potential harm.
For people between the ages of 6 and 18, the researchers recommended using 2.26 percent fluoride varnish at least every three to six months, or using 1.23 percent fluoride gel for four minutes at least every three to six months. Both recommendations were determined to be "in favor", with moderate certainty and with the potential benefits outweighing the potential harms.
It was also recommended that adults over 18 use 2.26 percent fluoride varnish at least every three to six weeks or 1.23 percent fluoride gel for four minutes at least every three to six months. However, the researchers determined that both of these recommendations were "expert opinion for" and with low certainty. The benefits were still found to outweigh the potential harms.
For prescription-strength, home-use fluorides, the review recommended that people between the ages of 6 and 18 use either 0.09 percent fluoride mouthrinse at least weekly or 0.5 percent fluoride gel or paste twice daily.
The researchers were "in favor" of the 0.09 percent fluoride with moderate certainty, but the 0.5 percent was determined to be "expert opinion for" with low certainty. The benefits were found to outweigh the potential harms for both.
The review also recommended that people over 18 use 0.09 percent fluoride mouthrinse at least weekly or 0.5 percent fluoride gel or paste twice daily.
For adults over 18 who have root caries, the researchers recommended upping the 0.09 percent fluoride use to daily; recommended use of the 0.5 percent fluoride stayed the same for those with root caries. All of these recommendations were rated "expert opinion for" with low certainty and with the benefits outweighing the potential harms.
The researchers determined that all other fluorides considered were not recommended, with either no benefits or with the harms outweighing the potential benefits.
Overall, the researchers argued that decisions to use a fluoride treatment should be made on a case-to-case basis. They also suggested that more research is needed.
"Fluoride has been an important part of dental prevention for years. Fluoride varnish works to deposit large amounts of fluoride onto demineralized tooth enamel. Fluoride varnish is applied under the guidance of a Dental Health Care Professional," Terese Andino, DDS, told dailyRx News.
"However, possible risks must be assessed prior to application. Should it be applied 2x/year or more? Ask your Dentist today, said Dr. Andino."
This review was published in the November edition of The Journal of the American Dental Association.
The Centers for Disease Control and Prevention (CDC) provided funding.