Chapter 9.1: The Use of Fluorides in the Control of Coronal Caries.

Abstract

Fluoride is the main agent used to control dental caries, with a very successful history after its widespread implementation worldwide, resulting in significant caries declines around the globe. In this chapter, the mechanism of action and peculiarities of different methods of fluoride use are revised. Fluoride controls caries progression by interfering with the processes of mineral exchanges (demineralization, remineralization) to which teeth are frequently subjected upon exposure to dental biofilm and a diet rich in fermentable sugars. Because caries is a ubiquitous disease of modern societies, different strategies have been developed to successfully keep fluoride available in oral fluids: (1) community-based approaches, such as water fluoridation, in which fluoride is delivered to communities at very low levels; (2) individual-based approaches, such as fluoride toothpastes, in which fluoride is delivered at higher concentrations, directly into the oral cavity, in a convenient combination with the act of brushing teeth to remove dental biofilm; (3) professionally-delivered approaches, such as fluoride gels and varnishes, in which very-high concentration products react with teeth resulting in local fluoride reservoirs that release the ion for weeks/months; and (4) combinations of these approaches, such as the concomitant use of fluoridated water and toothpaste, or the use of professional fluorides in caries-active patients. In conclusion, this chapter reviews the different modalities of fluoride use for coronal caries control, and summarizes the combined application of these methods according to the best evidence available.