Self-applied Fluoride Research Articles

Professionally and Self-Applied Fluorides are Effective in Preventing Dental Root Caries

Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis. Zhang J, Sardana D, Li KY, Leung KCM, Lo ECM. J Dent Res. 2020; 99(5):506-13. Other funding. The study was funded by the Tam Wah-Ching endowed professorship of the University of Hong Kong. Systematic review with meta-analysis.

Corrigendum to: Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

Corrigendum to: Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

The regular use of fluoride dentifrices is quite practical, widespread and linked to global decline of dental caries. However, the role of self-applied topical fluorides in prevention and reversal of Enamel White Spot Lesions (EWSLs) during multi-bracketed fixed orthodontic treatment is not yet explored. To systematically appraise the current literature on the effectiveness of self-applied topical fluorides in the prevention and reversal of EWSLs occurring during multi-bracketed fixed orthodontic treatment. Four electronic databases (Cochrane Library, Embase via Ovid, Medline via Ovid, and Scopus) and gray literature were searched using the broad MeSH terms and keywords. Only randomized/quasi-randomized controlled clinical trials evaluating the effectiveness of self-applied fluorides in the prevention of EWSLs during multi-bracketed fixed orthodontic treatment or reversal of post-orthodontic EWSLs were included. Two reviewers independently screened for studies, extracted data and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Due to substantial variations in the interventions, control groups, and the measurement of outcome among studies, quantitative synthesis could not be performed as planned. Only three studies could be included in the present review; two of them assessing prevention of EWSLs and one addressing reversal of post-orthodontic EWSLs. One of the studies was judged to be of low risk of overall bias, whereas 2 studies were adjudged to be of high risk of overall bias because of deviations from intended interventions. The certainty of evidence about the role of self-applied fluorides in prevention and reversal of EWSLs was found to be of low quality; hence, our confidence in the effect estimate is limited, and future well-conducted trials might alter the effect estimates. The inclusion of only English literature and inability to perform quantitative synthesis due to a limited number of studies. Although the review did not confirm the effectiveness of self-applied fluorides in the reversal of EWSLs, it did partially substantiate the positive role of self-applied fluorides in the prevention of EWSLs occurring during multi-bracketed fixed orthodontic treatment. The review recommends the need for well-designed randomized controlled trials evaluating the effectiveness of self-applied fluorides on the prevention and reversal of EWSLs during multi-bracketed fixed orthodontic treatment. PROSPERO database (Registration number: CRD42018108590) and is freely available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108590. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Radiation-induced dental caries, prevention and treatment - A systematic review.

Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation-related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self-applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation-induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.

Supplemental fluoride use for moderate and high caries risk adults: a systematic review

Multiple systematic reviews have evaluated fluorides for caries prevention in children, but a need to review the literature regarding supplemental fluoride use in adults still remains. The purpose of this systematic review is to evaluate the research regarding professional and/or supplemental self-applied fluoride for preventing and remineralizing caries in moderate and high caries risk adults. Utilizing multiple databases, a comprehensive search was undertaken in both foreign and English languages. Studies included were randomized control trials (RCT) or clinical trials conducted in moderate or high caries risk adult populations, evaluating self- or professionally applied fluoride with the outcomes of caries reduction/remineralization. Studies were excluded if they were in situ, in vitro, split mouth design, or with unclear outcomes specific to fluorides. A quality evaluation of the studies used a checklist of critical domains and elements for an RCT. Seventeen studies were included in the systematic review. Findings were categorized into the following groups: sodium fluoride (NaF) and amine/potassium fluoride mouthrinses of varying strengths, NaF gels and pastes, NaF varnish, and stannous fluoride. Quality evaluation scores varied from 50.2 percent to 88.9 percent. The strongest studies demonstrated the following modalities as moderately effective in higher caries risk adults: low strength NaF rinses [risk reduction (RRR) for carious lesions: 50-148 percent]; 1.1 percent NaF pastes/gels (RRR for root lesion remineralization: 35-122 percent); fluoride varnishes [RRR for RC remineralization: 63 percent; RRR for decrease in decayed, missing, and filled surfaces: 50 percent]. Evidence regarding 1.1 percent NaF and 5 percent NaF varnishes related primarily to root caries and older adults.

Anticariogenicity of Casein Phosphopeptide-amorphous Calcium Phosphate: A Review of the Literature

This review of the literature examines the role of the natural components of saliva in maintaining tooth mineralization and the role of different casein phosphopeptide amorphous calcium phosphate-based (CPP-ACP) compounds in controlling demineralization/remineralization and their clinical applications. A group of peptides, known as CPP, have been shown to stabilize calcium and phosphate preserving them in an amorphous or soluble form known as amorphous calcium phosphate (ACP). Calcium and phosphate are essential components of enamel and dentine and form highly insoluble complexes, but in the presence of CPP they remain soluble and biologically available. This CPP-ACP complex applied to teeth by means of chewing-gum, toothpaste, lozenges, mouth rinses, or sprays is able to adhere to the dental biofilm and enamel hydroxyapatite providing bioavailable calcium and phosphate ions. Significantly high levels of calcium and phosphate have been found in both biofilm and subsurface incipient caries lesions and in lower level demineralization of enamel or dentine surfaces previously treated with CPP-ACP based compounds. When placed on the surface of a tooth with early carious lesions, pastes with CPP-ACP complexes can prevent tooth demineralization and improve enamel remineralization and enhance fluoride activity. Remineralization of white spot lesions has been achieved clinically by applying pastes based on these compounds, and a similar effect to self-applied fluorides has been observed in reducing the appearance of new caries lesions in patients with xerostomia. Use of CPP-ACP based compounds offers a potential for use in the prevention of dental caries.

Topical Fluorides in Caries Prevention and Management: A North American Perspective

A review of evidence-based literature indicates incomplete evidence for the efficacy of most measures currently used for caries prevention, with the exception of fluoride varnishes and the use of fluoride-based interventions for patients with hyposalivation. Not all fluoride agents and treatments are equal. Different fluoride compounds, different vehicles, and vastly different concentrations have been used with different frequencies and durations of application. These variables can influence the clinical outcome with respect to caries prevention and management. The efficacy of topical fluoride in caries prevention depends on a) the concentration of fluoride used, b) the frequency and duration of application, and to a certain extent, c) the specific fluoride compound used. The more concentrated the fluoride and the greater the frequency of application, the greater the caries reduction. Factors besides efficacy, such as practicality, cost, and compliance, influence the clinician's choice of preventive therapy. For noncavitated smooth surface carious lesions in a moderate caries-risk patient, the appropriate fluoride regimen would be semiannual professional topical application of a fluoride varnish containing 5 percent NaF (22,600 ppm of fluoride). In addition, the patient should use twice or thrice daily for at least one minute a fluoridated dentifrice containing NaF, MFP, or SnF2 (1,000-1,500 ppm of fluoride), and once daily for one minute a fluoride mouthrinse containing .05 percent NaF (230 ppm of fluoride). If the noncavitated carious lesion involves a pit or fissure, the application of an occlusal sealant would be the most appropriate preventive therapy. The management of the high caries-risk patient requires the use of several preventive interventions and behavioral modification, besides the use of topical fluorides. For children over six years of age and adults, both office and self-applied topical fluoride treatments are recommended. For office fluoride therapy at the initial visit, a high-concentration agent, either a 1.23 percent F APF gel (12,300 ppm of fluoride) for four minutes in a tray or a 5 percent NaF varnish (22,600 ppm of fluoride), should be applied directly to the teeth four times per year. Self-applied fluoride therapy should consist of the daily five-minute application of 1.1 percent NaF or APF gel (5,000 ppm of fluoride) in a custom-fitted tray. For those who cannot tolerate a tray delivery owing to gagging or nausea, a daily 0.05 percent NaF rinse (230 ppm of fluoride) for 1 minute is a less effective alternative. In addition, the patient should use twice or thrice daily for at least 1 minute a fluoridated dentifrice as described above for treatment of noncavitated carious lesions. In order to avoid unintentional ingestion and the risk of fluorosis in children under six years of age, fluoride rinses and gels should not be used at home. Furthermore, when using a fluoride dentifrice, such children should apply only a pea-size portion on the brush, should be instructed not to eat or swallow the paste, and should expectorate thoroughly after brushing. Toothbrushing should be done under parental supervision. To avoid etching of porcelain crowns and facings, neutral NaF is indicated in preference to APF gels for those patients who have such restorations and are applying the gel daily. The rationale for these recommendations is discussed. Important deficiencies in our knowledge that require further research on topical fluoride therapy in populations with specific needs are identified.

Review of fluorosis risk of self-applied topical fluorides: dentifrices, mouthrinses and gels.

The literature on the risks of dental fluorosis and the benefits from the use of fluoride dentifrices, mouthrinses and self-applied gels has been briefly reviewed. While there are several studies that have investigated the impact of dentifrices on the development of dental fluorosis, results are mixed. Although there is far less research investigating the relationship between the use of mouthrinses and dental fluorosis, the available evidence generally fails to identify this technology as one of the major causes of dental fluorosis. Although there is little direct evidence to suggest that the use of self-applied fluoride gels contributes to the development of dental fluorosis, ingestion of fluoride from these systems is of genuine concern and their use by preschool age children is not recommended.

Evaluation of the use of topical fluoride gel.

Professionally applied topical fluoride should be used judiciously and is indicated only in patients with moderate or high caries activity. While the anti-caries effectiveness of acidulated phosphate fluoride gels has been clinically documented, the 2% neutral NaF gel has not been adequately tested, and further clinical verification is needed. Daily use of a self-applied fluoride gel is recommended for patients undergoing orthodontic treatment or to those affected with xerostomia as a result of disease or head and neck radiation therapy. The dental profession and the public should be well informed on the proper use of clinically proven products to achieve optimum effectiveness and minimize the risk of fluoride ingestion.

Caries incidence and costs of prevention programs.

Data on caries increments and costs of prevention programs are presented as background information for participants in the workshop. Estimates of annual caries increments were derived from control groups in clinical trials, epidemiologic studies, and national surveys. Cost data were obtained from dental public health directors, program administrators, fluoridation engineers, and water plant operators in different parts of the US. Caries incidence data are reported for age groups: 5-17 years (fluoridated and nonfluoridated areas), 18-44 years, 45-64 years, and 65 and over. Program costs include direct costs primarily and do not allow for program inefficiencies, nor have they attempted to include social costs. All cost data are expressed in 1988 dollars. Direct program costs are included for community water fluoridation, fluoride supplements, fluoride mouthrinses, school fluoridation, and sealant programs. For professionally and self-applied fluoride programs, only material and salary costs are included because total costs could not be located in the literature nor obtained from program directors. All factors and necessary assumptions included in the cost assessments are described.

Topical fluoride therapy: discussion of some aspects of toxicology, safety, and efficacy.

Although ingestion of an acute toxic dose of fluoride is extremely rare in dental treatments, practitioners should be familiar with the signs and symptoms and with emergency measures of treating accidental overdosage. The amount of fluoride ingested chronically from the use of self-applied topical fluoride can be reduced to safe limits by instructing parents to dispense small amounts of toothpaste for their young children and to ensure that fluoride dentifrices and mouthrinses are fully expectorated. Similarly, when custom-fitted trays are used, only minimal amounts of fluoride gels are necessary. The minimal amount of such gels that can be dispensed appears to be influenced by their viscosity. Clinical efficacy does not support a reduction in the concentration of fluoride in commercial dentifrices.

Plasma fluoride levels in 9 children with acute lymphatic leukaemia using daily self-applied fluoride gels.

Many patients with acute lymphatic leukaemia apply 1% NaF gel daily. Plasma fluoride levels and urinary excretion of 9 children using this regimen were followed in this study. Patients with a high dai

Eight-year evaluation of a combined fluoride program in a nonfluoride area

The purpose of this study is to measure the long-term effects of a combination of self-applied fluoride methods among schoolchildren living in a rural area with low concentrations of fluoride in drinking water. Participating children rinse weekly with a 0.2% sodium fluoride solution and ingest daily a 1-mg fluoride tablet in school under supervision of their teachers, and received fluoride toothpaste and toothbrushes for use at home. In 1980, dental examinations of children ages 6-14, who had continuously participated in the program for 1 to 8 years, depending on their school grade, had an overall mean caries prevalence of 3.22 DMFS, 49% lower than the corresponding mean score of 6.31 DMFS for children of the same ages at the baseline examination. The preventive program inhibited decay in all types of tooth surfaces: 37% in occlusal, 41% in buccolingual, and a striking 86% in mesiodistal. At each succeeding follow-up survey, benefits have continued to improve; the reductions in caries prevalence were 18% after 2 years, 35% after 4 years, 45% after 6 years, and 49% after 8 years. Findings in approximal tooth surfaces have also continued to improve as the length of the program has increased; reductions in caries in mesiodistal surfaces were 32%, 69%, 85%, and 86% after 2,4,6, and 8 years, respectively. Internal analyses of data indicate that the decline in dental caries prevalence resulted from the fluoride program and not from an unexplained natural decline in caries prevalence. The self-applied combined fluoride regimen used in this program has been shown to produce a pronounced anticaries effect.

Working With Non‐Dental Groups to Influence Adoption of Self‐Applied Fluoride Programs in Schools: One Approach

Although the use of self-applied fluorides in schools has been proven safe and effective, thousands of children are not benefiting from these procedures. This paper describes a dual promotional approach designed to increase the awareness of the need for school-based self-applied fluoride programs. A manned exhibit providing consultation and educational materials was displayed during the entire meeting of a state PTA and was supplemented by a presentation scheduled on the formal program. The workshop participants were parents of school-age children; most held decision-making positions in their local PTAs. Results of the workshop to date include: one participant prevented the demise of an established fluoride mouthrinsing program in her community; and the workshop leaders presented the merits of school-based self-applied fluoride programs to a local PTA and a county school health council. The same programs were described in a county PTA newsletter. These actions suggest that, given the appropriate information and assistance, parents of school children through their PTA can influence adoption of school-based fluoride programs. Furthermore, strategies directed toward members of other groups with an interest and decision-making role in children's health may be effective methods of influencing adoption of school-based self-applied fluoride programs and ultimately promoting children's oral health.

The Prevention of Dental Caries: Ten Years Later

By any standards, progress toward caries prevention has been impressive during the past decade. It is arguable that more information on the precise etiology of caries and on potential new preventive methods has been acquired during the 1970s than in any comparable period previously. Substantial advances have been made toward the understanding of the complex interaction among oral microorganisms, host resistance, and dietary substrate in the initiation and progression of a caries lesion. The various mechanisms of action of the fluoride ion have been further elucidated; vaccination against caries and a reduction in the cariogenic potential of sweet foods have both become realistic possibilities. Conspicuous successes have also been achieved in the application of existing knowledge. At least 12 million more children than in 1971 are receiving partial protection against caries through self-applied fluoride programs. Other effective preventive methods, including adhesive sealants and, possibly, antimicrobial agents, could be widely and advantageously utilized if manpower and regulatory constraints were overcome, as their scientific feasibility has, for the most part, already been demonstrated. Of course, it would be naive to predict the early disappearance of dental caries as a major health problem. This will occur only gradually, and will require a much more extensive use of preventive methods--those already available as well as those still being developed by research. Nevertheless, a major step toward the goal of caries prevention has already been taken, and there is good reason to expect even more rapid progress during the 1980s.

The Future for Self‐Applied Fluorides*

The Future for Self‐Applied Fluorides*

An agenda for the eighties: self-applied fluorides.

An agenda for the eighties: self-applied fluorides.

Achievements of the seventies: self-applied fluorides.

Achievements of the seventies: self-applied fluorides.

Short intensive topical APF applications and dental caries in a fluoridated area

Three groups of approximately 200 children, consuming fluoridated water since birth, were given either 5, 10 or 25 consecutive topical applications with an APF gel (1.2% F, pH 3.2) in mouthpieces. After 1 year, mean DMFS increments were 7.2%, 30.4% and 35.3% less respectively for the three groups as compared with untreated control groups. Although enamel fluoride levels remained high after the 1st year, differences in dental caries increments between treated and control groups were too small to show group differences. The results suggest that in a fluoridated area, when caries activity is low, it would be difficult to show a long-term anticaries effect by increasing the fluoride concentration in sound enamel by a short series of self-applied topical fluoride applications.

Self-applied fluoride paste; effect on dental caries.

The experience of this writer with supervised brushing of school children's teeth by a fluoride‐bearing prophylactic paste, twice a year, was discouraging.