November/December 2007, Volume 3, Issue 10
Published by AEGIS Communications
Effectiveness of Fluoride in Preventing Caries in Adults
Howard E. Strassler, DMD
Griffin SO, Regnier E, Griffin PM, Huntley V. J Dent Res. 2007;86(5):410-415.
To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self- and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for all adults aged 20+ years and for adults aged 40+ years. Twenty studies were included in the final body of evidence. Among studies published after/during 1980, any fluoride (self- and professionally applied or water fluoridation) annually averted 0.29 (95% CI: 0.16-0.42) carious coronal and 0.22 (95% CI: 0.08-0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95% CI: 19%-34%). These findings suggest that fluoride prevents caries among adults of all ages.
All dental professionals are taught early in their training that fluorides both professionally applied and self-applied are a magic bullet against dental caries. Almost all research with fluoride and caries has focused on the prevention of dental caries for children and adolescents. Our patients are keeping their teeth longer, meaning that teeth are at risk over a patient’s lifetime for getting caries. Fluoride therapies for the prevention and treatment of caries need to be a lifetime regimen. The focus should not be the age of the patient, but rather the risk factors. Older adults with decreased salivary flow from medications or the effects of aging have a high caries risk. Also, any patient (including adults) who is having orthodontic treatment moves into the high-risk category regardless of risk before orthodontic treatment because of the difficulties orthodontic hardware causes in oral hygiene and removing plaque. As patients have kept their teeth longer and have had their teeth restored, every margin or every restoration is at risk for recurrent caries. This study brings to the forefront the importance of fluoride treatment for adults.
In the analysis of 20 studies, the evidence is crystal clear. Fluoride prevents caries for adults. When evaluating your adult patients for risk factors, consider what preventive treatment recommendations you or your dental hygienist will need to make. For patients with moderate and high caries risk, consider the variety of fluoride treatments that are available, including professionally applied topical fluorides and fluoride varnishes, and for patient-applied fluorides consider prescription-strength fluorides, fluoride rinses, and what toothpaste would be best for a patient based on his or her needs.
Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore,Maryland