Purpose This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly. Method Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English-language articles between 1979–2010 Results In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67–80%. Conclusion For 1° prevention of root caries the recommended ‘best choice’ is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended ‘best choice’ is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.