Efficacy of Dental Varnishes and Gels for the Prevention and Management of Dental Caries in Older Adults-A Systematic Review and Meta-Analysis.

ObjectiveTo assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults. Data/SourcesTwo independent researchers searched the English literature published up to 31st Dec 2021 in five databases (PubMed, Scopus, the Cochrane Library, EMBASE, and Web of Science) for clinical trials with a comparison group on professionally applied fluoride therapy for caries prevention or arrest at older adults aged ≥60 years with any follow-up period. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate. The Cochrane guidelines were used for the risk of bias assessment. Study selection/resultsFive hundred and twenty-seven studies were identified, and seven studies were finally included. Five studies were rated as having ‘low risk’. The root caries-prevented fraction of 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride (APF) gel were 25–71%, 64%, and 32%, respectively. Meta-analysis indicated a decrease in the number of new root caries by 0.55 (95% CI: 0.32–0.78; p < 0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33% to 49%; p < 0.001) after receiving 38% SDF application at the 24-month follow-up. ConclusionsAccording to the findings, 5% NaF varnish and 1.23% APF gel prevented root caries, whereas 38% SDF solution prevented and arrested root caries in older adults. More well-designed clinical trials should be conducted to investigate various methods in caries prevention and arrest in older adults. Clinical significance: Preventive measures effective in other age groups may not suit older adults, as caries type and associated risk factors vary. To date, no systematic review has evaluated professionally applied fluoride therapy in older adults. Evidence from clinical trials in older adults could aid clinical practice and public health measures. The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42022307025.

To summarize the effectiveness of non-invasive and minimally invasive root caries preventive interventions in older adults. An electronic search was conducted in PubMed up to February 18, 2021. Only randomized controlled trials (RCTs) published in English language with root caries outcomes measured on older adults were included in this review. Studies were eligible if assessing the efficacy of either topical fluoride varnish/gel, chlorhexidine (CHX), atraumatic restorative treatment (ART), or silver diamine fluoride (SDF) to prevent and/or arrest root caries in older adults. A total of 16 RCTs were included in this review. No significant differences were found between conventional therapy with rotary instruments and ART with hand instruments in survival rates of restorations in four studies. 1% CHX varnish (every 3 months), 5% sodium fluoride (NaF) varnish (every 3 months) and 38% SDF solution applied annually in addition to OHI were more effective preventing new root caries than OHI alone over a period of 3 years (with no differences between the 3 interventions). A 0.2% neutral NaF mouth rinse used daily reduced the incidence of caries among elders in long-term facilities and performed better than 0.12% CHX. The number of new lesions in the 1.2% acidulated phosphate fluoride (APF) gel group was significantly lower than in the placebo rinse group (P < 0.05), however the fluoridated mouth rinse group had more reversed root lesions. 38% SDF solution applied annually in combination with oral health education (OHE) every 6 months was efficacious in arresting and preventing root caries among older adults. The combination of Cervitec™ (1%CHX/1% thymol varnish) and fluoride varnish was successful in arresting exisiting root caries in a group of frail older adults compareed to fluoride varnish alone. Multiple minimally invasive interventions showed significant improvements in arresting and preventing root carious lesions in older adults compared to control groups, including the use of 0.2% neutral NaF mouth rinse, 1% CHX varnish, Cervitec™, APF gel and annual application of SDF combined with oral health education. However, further studies are needed to confirm these results as few studies could be found for each intervention.

Caries management in the modern era has shifted away from the traditional surgical method toward a medical paradigm, which often includes fluoride therapy. Fluoride used in various forms has been proven to be effective in dental caries prevention. Silver diamine fluoride (SDF) and sodium fluoride (NaF) varnish are effective in arresting caries in primary molars. This study aimed to evaluate the effectiveness of 38% SDF and 5% NaF varnish in arresting caries in primary molars. This study was a split-mouth randomized controlled trial. The randomized controlled trial comprised 34 children aged 6-9 years with teeth having caries in both right and left primary molars without pulpal involvement. Teeth were randomly allocated into two groups. In Group 1 (n = 34), 38% SDF + potassium iodide was applied and in Group 2 (n = 34), 5% NaF varnish was applied. The second application was done after 6 months in both groups. Children were recalled at 6- and 12-month intervals and evaluated for caries arrest. Chi-square test was used to analyze the data. Caries arresting potential was found to be higher in the SDF group compared to the NaF varnish group at both 6-month (SDF - 82% and NaF varnish - 45%) and 12-month intervals (SDF - 77% and NaF varnish - 42%) and the difference was found to be statistically significant (P = 0.002 and 0.004, respectively). SDF was more effective in arresting dental caries in primary molars compared to 5% NaF varnish.

Randomized clinical trial to compare three fluoride varnishes in preventing early childhood caries

ObjectivesTo compare the antibacterial effect of Nanosilver Fluoride varnish (NSF) varnish, P11-4 and Sodium Fluoride (NaF) varnish against salivary Streptococcus mutans (S. mutans) and Lactobacilli.Methods66 patients aged 10–24 years old were randomly assigned to receive single application of NSF, P11-4 or NaF varnish. Baseline unstimulated saliva samples were collected before the agents were applied and S.mutans and Lactobacilli colony forming units (CFU) were counted. After one, three and six months, microbiological samples were re-assessed. Groups were compared at each time point and changes across time were assessed. Multivariable linear regression compared the effect of P11-4 and NSF to NaF on salivary S. mutans and Lactobacilli log count at various follow up periods.ResultsThere was a significant difference in salivary S. mutans log count after 1 month between P11-4 (B= -1.29, p = 0.049) and NaF but not at other time points nor between NSF and NaF at any time point. The significant reduction in bacterial counts lasted up to one month in all groups, to three months after using P11-4 and NaF and returned to baseline values after six months.ConclusionIn general, the antimicrobial effect of P11-4 and NSF on salivary S. mutans and Lactobacilli was not significantly different from NaF varnish. P11-4 induced greater reduction more quickly than the two other agents and NSF antibacterial effect was lost after one month.Clinical relevanceNSF varnish and P11-4 have antimicrobial activity that does not significantly differ from NaF by 3 months. P11-4 has the greatest antibacterial effect after one month with sustained effect till 3 months. The antibacterial effect of NSF lasts for one month. NaF remains effective till 3 months.Trial RegistrationThis trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.

Indo-Trinidadians, predominantly from South-East Asia, and a Mixed population of Afro and Indo-Trinidadians. This study demonstrates increasing severity of tooth wear with age. The results suggest there may be a difference in the severity of wear noted between the dominant ethnic groups in Trinidad. Afro-Trinidadians, like African-Americans originated in the same geographical regions of Western Africa. In this Trinidadian patient population, persons of mixed ethnicity appeared to have the same protective effect as African ethnicity having higher prevalence rates of no and lower rates of mild, moderate, and severe wear compared to Indo-Trinidadians. sex, there were higher prevalence rates for males with moderate and severe tooth wear compared with mild wear. This work broadens the knowledge base on the relationship between demographic variables and tooth wear. https://www.frontiersin.org/journals/oralhealth/articles/10.3389/froh.2025.1516137/full The diagnosis of DH needs to be accurate to rule out other conditions such as caries and cracked tooth syndrome. The article titled "Cracked tooth syndrome: a diagnostic dilemma-a mini review" provides excellent insight and summarizes the current strategies and standardized protocols in diagnosing a cracked tooth. This literature review discussed the signs and symptoms of cracked tooth syndrome and the diagnostic methods used to identify the condition accurately. https://www.frontiersin.org/journals/oralhealth/articles/10.3389/froh.2025.1572665/full The other 3 articles featured in this research topic focus on treatment and management of DH. The article titled "Comparison of the effectiveness of diode laser, fluoride varnish, and their combination in treatment of dentin hypersensitivity: a systematic review of randomized clinical trials" aimed to evaluate and compare the effectiveness of sodium fluoride (NaF) varnish, Diode Laser (DL), and their combination in reducing DH. Dentin hypersensitivity has long been a challenging condition, with many treatment methods showing limited success. However, the emergence of laser therapy, particularly the significant potential of diode laser (DL) and sodium fluoride (NaF) varnish, has sparked new hope. This research is a significant step towards a more effective treatment for DH, aiming to evaluate the promising potential of DL in treating DH, both independently and in combination with fluoride varnish. Diode laser therapy, particularly when combined with NaF varnish, represents a promising treatment approach for DH, offering superior efficacy over NaF varnish alone. This study suggests that combination therapy may provide longer-lasting relief, with implications for improving clinical outcomes in DH management. https://www.frontiersin.org/journals/oralhealth/articles/10.3389/froh.2025.1550127/full The article titled "Buffer Solution Reduces Acidic Toothpaste Abrasivity Measured in Standardized Tests" tested whether an acidic toothpaste is indeed more abrasive than a neutral counterpart of otherwise identical composition, and whether this increased abrasivity is prevented by a buffered solution simulating saliva. It has been speculated that the diluent used to test toothpaste abrasivity in standard tests may have an impact on their results, especially in the context of acidic toothpastes. This study showed that using deionized water as a diluent for in vitro toothpaste assessment can create a nonrealistic pH environment. With acidic toothpastes, this can lead to systematic overestimation of abrasivity. In summary, the current study showed that in the context of acidic toothpastes, the current norm recommending deionized water as the diluent in toothpaste abrasivity tests may not yield clinically reliable results, as there appears to be an erosive component that is not corrected for. https://www.frontiersin.org/journals/dentalmedicine/articles/10.3389/fdmed.2020.612298/full The in-vitro study titled "Evaluating the protective effects of mouthguards with neutralizing agents against chlorinated water-induced enamel erosion" evaluated the effects of mouthguard use with or without neutralizing agents, compared to no mouthguard use, on the microhardness of dental enamel after a swimming simulation. Dental erosion is a common problem among swimmers. Mouthguards significantly reduced enamel microhardness loss compared to no mouthguard use. While no significant differences were found among mouthguard groups with or without neutralizing agents, those lined with arginine-fluoride toothpaste showed the least enamel loss, suggesting its potential protective effect. https://www.frontiersin.org/journals/oralhealth/articles/10.3389/froh.2024.1469228/full

Aim. The aim of this study was to compare the effect of pH cycling on the microhardness of the enamel of primary human teeth treated with a conventional brown Sodium Fluoride (5% NaF) Varnish to those treated with a white Fluoride Varnish (5% NaF) enhanced with functionalized tricalcium phosphate (fTCP). Materials and Methods. Ninety extracted caries-free primary incisors were washed in a detergent and divided into three groups; group A received no treatment, teeth in group B were coated with Sodium Fluoride (5% NaF) Varnish, while teeth in group C were coated with 5% NaF varnish enhanced with functionalized tricalcium phosphate (fTCP). After ten days of pH cycling, the surface microhardness of the teeth was measured using a Knoop indenter. Results. The mean Knoop hardness number (KHN) of 5% NaF with fTCP was greater than that of 5% NaF alone while the control group had the lowest mean KHN. Conclusion. The results of this study suggest that the use of an additive such as fTCP to a fluoride varnish significantly improves the protective ability of the varnish on primary teeth in vitro.

Dental caries is a prevalent global disease, influenced by biofilm formation, dietary sugars, and host factors. Fixed orthodontic appliances increase the risk of noncavitated lesions, highlighting the need for effective prevention. Fluoride varnishes reduce demineralization and promote remineralization; however, their impact on the oral biofilm microbiome in high-caries-risk patients remains underexplored. To profile microbial biofilms involved in caries lesions after treatment with sodium fluoride (NaF) and titanium tetrafluoride (TiF4) varnishes using 16S rRNA sequencing of the oral biofilm microbiome. A randomized crossover study was conducted with 13 participants (12-18 y) with fixed orthodontic appliances and at least 1 active noncavitated lesion. Participants underwent 4 stages: G1 (nontreatment), G2 (professional prophylaxis; PP), G3 (PP + NaF varnish), and G4 (PP + TiF4 varnish). Clinical analyses (Nyvad and plaque indices) and supragingival biofilm sampling were performed. Bacterial DNA was extracted and amplified for 16S rRNA sequencing. Repeated-measures analysis of variance, Friedman/Wilcoxon with Bonferroni correction, Pearson chi-squared, and permutational multivariate analysis of variance tests were performed ( P < 0.05). Shannon diversity (median, 25%-75%) values were as follows: G1 (6.25, 6.21-6.27), G2 (5.81, 5.77-5.83), G3 (5.63, 5.64-5.71), and G4 (5.76, 5.72-5.78). G2, G3, and G4 differed significantly from G1, with no difference among them ( P < 0.05). The most abundant genera were Veillonella (G1: 7.6%, G2: 10.6%, G3: 9.4%, G4: 5.7%), Corynebacterium (G1: 8.2%, G2: 7.3%, G3: 6.8%, G4: 10.4%), and Neisseria (G1: 4.0%, G2: 9.2%, G3: 9.6%, G4: 9.6%). Significant reductions were observed in the Prevotella/Haemophilus, Prevotella/Neisseria, and Prevotella/Rothia log-ratios compared with G1 ( P = 0.001). G2 reduced Prevotella/Haemophilus. G3 reduced Prevotella/Haemophilus and Prevotella/Neisseria. G4 reduced Prevotella relative to all 3 genera, indicating broader microbiome modulation. PP, whether or not combined with fluoride varnishes, modified the biofilm microbiota. PP + TiF4 varnish affected a greater number of bacterial log-ratios associated with commensal-dysbiotic balance, although no significant differences were found between treatment groups.Knowledge Transfer Statement:The findings from this study can guide clinicians in selecting the most effective fluoride varnish for high-caries-risk patients. By understanding how sodium fluoride (NaF) and titanium tetrafluoride (TiF4) varnishes modulate the oral microbiome, clinicians can develop more targeted and effective prevention strategies. This knowledge has the potential to enhance patient outcomes by optimizing caries prevention during orthodontic treatment, allowing for more personalized and microbiome-focused approaches.

Aim: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. Methods: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. Results: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient’s individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.

Dentin hypersensitivity (DH) has long been a challenging condition, with many treatment methods showing limited success. However, the emergence of laser therapy, particularly the significant potential of diode laser (DL) and sodium fluoride (NaF) varnish, has sparked new hope. This research is a significant step towards a more effective treatment for DH, aiming to evaluate the promising potential of DL in treating DH, both independently and in combination with fluoride varnish. By delving into this research, you are investing your time in understanding a crucial advancement in the field of dentistry. A comprehensive search was conducted across the PubMed, Scopus, and Web of Science databases, including studies published up until May 2024. Randomized clinical trials that assessed DH using a visual analog scale (VAS) score were included. Data on participant demographics, treatment types, and VAS scores were extracted by two reviewers. The risk of bias was assessed using the revised Cochrane risk-of-bias instrument for randomized trials (RoB-2). Three studies met the inclusion criteria, comparing NaF varnish, DL, and their combination. Both DL and the combination of DL and NaF varnish were more effective than NaF varnish alone in reducing DH. The combined treatment showed marginally superior outcomes compared to DL alone. Significant reductions in DH were observed across all treatment groups, with the combination therapy demonstrating the most substantial and consistent improvement. Diode laser therapy, particularly when combined with NaF varnish, represents a promising treatment approach for DH, offering superior efficacy over NaF varnish alone. These findings suggest that combination therapy may provide longer-lasting relief, with implications for improving clinical outcomes in DH management.

The purpose of this study was to compare the remineralization effect of 38% silver diamine fluoride (SDF) and 5% sodium fluoride (NaF) varnish on artificially induced enamel caries.The present study standardized the physiochemical characteristics of the tooth structure using bovine teeth, realized the wash-off action of agents using a saliva, reproduced an environment similar to mouth through pH-cycling, and comparatively assessed the remineralization effect of 38% SDF and 5% NaF varnish in a non-destructive method using micro-CT. And the remineralized enamel surface structure was analyzed by scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS).In both SDF and NaF varnish, mineral density (△Hounsfield unit value) and the volume of enamel restored to normal mineral density through remineralization gradually increased with time. And the SDF showed a much higher level of increase in mineral density at all depths and remineralized volume than NaF varnish.According to SEM analysis, the surface roughness decreased in the order of artificial saliva, NaF varnish and SDF. In addition, EDS analysis showed that silver ion was precipitated on the enamel surface in SDF group.In conclusion, SDF had a greater remineralization effect than NaF varnish on demineralized enamel.

Aim This systematic review aimed to critically summarise the results of clinical studies investigating agents able to: stop the progression of carious lesions; stop the development of new root carious lesions; preserve the vitality of the infected dental tissues; and increase the surface hardness or change of surface texture, in middle-age and older adults.Methods PubMed, Scopus, and Web of Science were searched systematically, following PRISMA guidelines. Clinical trials published from 2011 to 2020 (March) were included. This systematic review is registered in the PROSPERO database (CRD42018104399). Languages were restricted to English.Results Thirteen of 312 studies were eligible for this review. Eight agents were identified in the studies and their efficacy was assessed using different methods. The agents that presented valuable results on preventing or arresting root caries were 38% silver diamine fluoride (SDF), arginine-containing toothpaste and high-fluoride toothpastes.Conclusions Based on the selected studies' findings, annual applications of 38% SDF could be the most effective treatment for root caries in older adults. In addition, the daily use of a 1.5% arginine toothpaste or a high-fluoride toothpaste could also be recommended. More research on root caries-specific diagnostic methods, especially at very early stages, is necessary.

Patients with multi-bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation. To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. Ninety-nine patients were randomly allocated into three intervention groups: Group A-standard oral hygiene instructions (OHI); Group B-5% sodium fluoride (NaF) varnish with standard OHI; and Group C-NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6-monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent-samples Kruskal-Wallis test was used to compare the means of fluorescent values among different groups at p=.05. Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p < .001), whereas there was no significant difference among the three intervention groups (p=.305) using clinical assessment or photographic assessment (p=.599). At the 18-month follow-up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p=.200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p=.327). The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow-up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment.

##Statement of the problem The population is ageing and the proportion of older adults retaining their natural teeth is increasing. This means that there are increasing numbers of older adults at risk of and from dental caries for longer. This challenges traditional concepts of care delivery for older adults. With advances in the understanding of the pathogenesis of dental caries, there is increasing evidence to support a shift from traditional mechanical ’drill and fill’ techniques to the management of dental caries biologically as a complex ecological process. Minimum intervention dentistry (MID) has become an increasingly mainstream model of caries management, which minimises the need for treatment that destroys dental tissues. In contrast to traditional management of caries, MID focuses on prevention and risk reduction, while surgical intervention is limited to cases where it is absolutely necessary. This paper reviews the evidence to support adoption of MID, particularly for older adults in Ireland. ##Purpose of the study To review the evidence regarding aspects of MID for caries management among older adults. ##Materials and methods A structured search strategy was undertaken using PubMed, Google Scholar and the Cochrane Library, with additional searching of reference lists. A total of 25 articles were deemed relevant to this literature review. The data was extracted and tabulated. The outcomes and quality of the studies were reported narratively. Weaknesses and clinical implications are discussed. ##Conclusions MID can be recommended for older adults. This review supports the use of topical fluorides in varnish, rinses and high-fluoride toothpaste to prevent dental caries in older adults, and the restoration of caries adopting the atraumatic restorative technique (ART). There was insufficient evidence regarding the effectiveness of oral health education. No studies were identified looking at the effectiveness of caries removal techniques, the resin infiltration technique, or the repair rather than replacement of restorations for older patients.

Dental caries remains highly prevalent in older adults and represents a growing public health concern due to increased tooth retention, polypharmacy, hyposalivation and functional limitations. Silver diamine fluoride (SDF) is widely used for caries arrest in this population but causes undesirable tooth staining. Nano Silver Fluoride (NSF) has emerged as a potential alternative, combining antimicrobial and remineralizing properties with improved aesthetics. However, its applicability in geriatric dentistry remains unclear. This scoping review aimed to identify and map existing evidence on the use of Nano Silver Fluoride for the prevention or management of dental caries in older adults. The review followed the PRISMA-ScR guidelines framework. A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and SciELO for articles published between January 2020 and December 2024. Studies were eligible if they involved human participants aged ≥ 60 years, evaluated NSF for caries prevention or treatment and were published in English, Spanish or Portuguese. Invitro studies, animal models, case reports, reviews, and studies on children or young adults only were excluded. A total of 157 records were identified; 14 full-text articles were assessed. None met the inclusion criteria, as all clinical studies involving NSF were conducted in paediatric or young adult populations, lacked older adult participants, or were laboratory-based. No clinical trials, observational studies, or reviews evaluating NSF in older adults were found. This scoping review reveals a complete absence of clinical evidence regarding the use of Nano Silver Fluoride in adults aged 60 years or older. Although NSF has shown promising results in younger populations and is chemically related to SDF, its effectiveness and safety in geriatric dentistry remain unknown. High-quality clinical studies in older adults are urgently needed.