The Role of Fluoride in Caries Prevention
ANDRESR/E+/GETTY IMAGES PLUS
With a variety of concentrations, application types, and delivery methods, clinicians can recommend the right fluoride product for their patients' individual needs.
By Petal C. Leu-wai-see, AAS, RDH, BSDH, MA, and Cynthia J. Howard, RDH, BS, MS, CCRC
Dental caries remains the most common chronic disease of childhood.1
According to a National Center for Health Statistics data brief on dental
caries and dental sealant prevalence in the United States, 37% of children age
2 to 8 experienced caries in primary teeth and 60% of adolescents age 12 to 19
developed caries in permanent teeth from 2011 to 2012.2 The fight
against caries remains ongoing and multifaceted. To date, however, fluoride
remains the most effective tool in the caries prevention armamentarium.
available in different compounds, consistencies, and delivery methods.
Professionally applied fluorides include neutral sodium fluoride (NaF),
acidulated phosphate fluoride (APF), stannous fluoride (SnF2), and silver
diamine fluoride (SDF).3–5 These compounds are available in
different application methods, such as gel, foam, varnish, or liquid, as well
as varying percentages of fluoride concentration. There are also different
delivery methods such as trays, brush-on varnishes, or liquids.4 The
concentration of 5% NaF is available as a brush-on varnish for professional
application, while 2.0% NaF and 1.23% APF concentrations come in a gel or foam
that is applied via trays.3
In 2013, the
American Dental Association's Council on Scientific Affairs (ADA CSA) conducted
a systematic review and published clinical recommendations for the use of
professionally applied fluoride.6 The findings support a 4-minute
application of both NaF and APF.6 Limited
evidence was found to support the use of foam for coronal caries prevention in
all age groups.6 Studies have shown that 1.23% fluoride gel and 5%
NaF varnish are effective in reducing caries in high-risk children.7
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SDF is used
to arrest and prevent caries and reduce dentinal hypersensitivity.5,9,10
SDF is a colorless topical medicament composed of 25% to 29% silver, 5% to 6% fluoride, and
ammonia.8 The silver component acts as an antimicrobial agent, while
the fluoride aids in remineralization. The ammonia is used to stabilize the
solution.5 In vitro studies show that artificial lesions
treated with silver diamine fluoride become more resistant to biofilm formation
and additional caries formation.8-10
(OTC) self-applied fluoride compounds are NaF, APF, and SnF2. They
are available as gels, pastes, and liquids. The concentrations vary from a
low-potency solution of 0.0221% to a prescription-strength solution of 0.2% or
0.044%. The liquid is swished for 1 minute daily. NaF and APF are also
available as a 1.1% prescription gel or paste. Self-applied gels and pastes are
brushed-on or used in custom trays. The compound 0.4% SnF2 is a gel
that is brushed-on nightly after brushing with an OTC fluoride dentifrice. OTC
fluoride dentifrices contain 0.1% NaF or 0.1% sodium monofluorophosphate (MFP)
and are used twice daily. Table 1 provides details on fluoride compounds,
consistencies, and delivery methods.
Prevention is the best approach when addressing
dental caries in all age groups. Implementing an evidence-based approach that
utilizes caries risk assessment tools and protocols sets the stage for the best
possible oral health outcomes.11 Evidence shows that fluoride is a
safe and effective method of caries prevention, regardless of which type of
compound, consistency, or delivery method is implemented.12
- Benjamin RM. Oral health: the silent epidemic. Public Health Rep. 2010;125:158–159.
- Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS Data Brief. 2015;191:1–8.
- Wilkins EM, Wyche CJ, Boyd LD. Fluorides. Clinical Practice of the Dental Hygienist. 12th ed. New York: Wolters Kluwer; 2017:593–618.
- Walsh M, Darby ML. Dental Hygiene Theory and Practice. 4th ed. Philadelphia: Saunders; 2015.
- Rosenblatt A, Stamford T, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet.” J Dent Res. 2009;88:116–1125.
- Weyant RJ, Tracy SL, Anselmo TT, et al. American Dental Association Council on Scientific Affairs expert panel on topical fluoride caries preventive agents: Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013;144:1279–1291.
- American Academy of Pediatric Dentistry. Guideline on fluoride therapy. Pediatr Dent. 2013;35:E165.
- Featherstone J, Horst JA. Fresh approach to caries arrest in adults. Decisions in Dentistry. 2015;1:36–44.
- Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ. Inability to form a biofilm of streptococcus mutans on silver fluoride- and potassium iodide-treated demineralized dentin. Quintessence Int. 2009;40:155–161.
- Horst JA, Ellenikiotis H, Milgrom PM, UCSF Silver Caries Arrest Committee. UCSF protocol for caries arrest using silver diamine fluoride: Rationale, indications, and consent. J Calif Dent Assoc. 2016;44:16.
- Jenson L, Budenz AW, Featherstone JD, Ramos-Gomez FJ, Spolsky VW, Young DA. Clinical protocols for caries management by risk assessment. J Calif Dent Assoc. 2007;35:714–723.
- American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. Available at: aapd.org/media/Policies_Guidelines/G_fluoridetherapy.pdf. Accessed January 19, 2017.
From Dimensions of Dental Hygiene. February 2017;15(2):21-22.