High Fluoride Dentifrices for Elderly and Vulnerable Adults: Does It Work and if So, Then Why?

Abstract

The primary aim of this work is to present the available evidence that toothpastes containing >1,500 ppm fluoride (2,500-2,800 and 5,000 ppm F) provide an additional caries preventive effect on root caries lesions in elderly patients compared to traditional dentifrices (1,000-1,450 ppm F). The secondary aim of this paper is to discuss why high fluoride dentifrices in general should perform better than traditional F-containing toothpaste. When examining the few studies that have considered the preventive benefits of high fluoride products on root caries the relative risk appears to be around 0.5, and the risk can thus be halved by exchanging traditional F-containing toothpaste for toothpaste containing 5,000 ppm F. There is reasonable evidence that high fluoride dentifrices significantly increase the fluoride concentration in saliva during the day and the fluoride concentration in plaque compared to traditional F toothpaste. Furthermore, the use of toothpaste with 5,000 ppm F significantly reduces the amount of plaque accumulated, decreases the number of mutans streptococci and lactobacilli and possibly promotes calcium fluoride deposits to a higher degree than after the use of traditional F-containing toothpaste.

Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults

“…Brushing with fluoride toothpaste at least twice a day is recommended. In individuals with high caries risk, root caries incidence, may decrease by changing a conventional toothpaste (1450 ppm fluoride) to a 5000 ppm fluoride toothpaste, when prescribed by a dentist [41][42][43] . For primary and secondary prevention of root caries lesions, a recent meta-analysis revealed that regular use of dentifrice containing 5000 ppm fluoride and quarterly professionally applied chlorhexidine or silver diamine fluoride varnishes may inactivate the existing and/or reduce the initiation of new root caries.…”

Root dentine demineralisation according to frequency of sucrose exposure using high‐fluoride dentifrice

“…28 This outcome was expected since it is already established that 5000 ppm F-dentifrice provides a better prevention and arrestment of carious root lesions. [29][30][31][32] Nevertheless, it has an important clinical relevance because with the population ageing in many countries, 33 root caries will be increasingly present in the routine of dental practices and the use of high-fluoride dentifrice could be an option to manage root caries in those particular patients. To the best of our knowledge, this is the first study that evaluates the role of high-fluoride dentifrice on root caries using different frequencies of sucrose exposure.…”

Guidelines for use of fluorides in Australia: update 2019

“…The international evidence for adult use of 1.5 mg/g fluoride (or 1500 ppm) toothpaste is supportive of the benefits to adults and older persons, but care should be taken in the interpretation of the effectiveness and efficiency given the variability in populations and the scarcity of dedicated, longitudinal clinical trials specifically controlling for enumerable confounding factors. Evidence for the use of 5 mg/g fluoride (5000 ppm) toothpaste, specifically in populations at high risk is more compelling and could guide good practice in most situations specific to older dentitions at elevated risk to caries . Allied health practitioners, registered or enrolled nurses and Indigenous health workers who have been trained and are competent might be engaged in the provision of toothbrushing and toothpaste advice to individuals and groups of older Australians.…”

“…Evidence for the use of 5 mg/g fluoride (5000 ppm) toothpaste, specifically in populations at high risk is more compelling and could guide good practice in most situations specific to older dentitions at elevated risk to caries. 38,39 Allied health practitioners, registered or enrolled nurses and Indigenous health workers who have been trained and are competent might be engaged in the provision of toothbrushing and toothpaste advice to individuals and groups of older Australians.…”