Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis

Abstract

The aim of this systematic review and network meta-analysis was to summarize the direct and indirect clinical evidence on the effectiveness of professionally applied and self-applied topical fluorides in preventing dental root caries. Controlled clinical trials with any follow-up duration were included. MEDLINE, PubMed, Embase, Scopus, and Cochrane Library were searched. Two reviewers independently carried out the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Fixed effects model and frequentist approach were used in the network meta-analyses. Nine clinical trials involving 4,030 participants were included. Five professionally applied and 7 self-applied topical fluoride agents or combinations were included in the meta-analyses. Compared to control group, 38% silver diamine fluoride solution, 5% sodium fluoride varnish, and 1.2% acidulated phosphate fluoride reduced root caries increment after 2 y (ranging from 0.59 to 0.85 mean decayed or filled root [DF-root]). Fluoride mouth rinse and fluoride toothpaste, used alone or in combination, reduced root caries increment after 1 y (ranging from 0.29 to 1.90 mean DF-root). Among the professionally applied topical fluorides reviewed, an annually applied 38% silver diamine fluoride (SDF) solution combined with oral health education is most likely to be the most effective in preventing dental root caries. Among the reviewed self-applied topical fluoride methods, daily use of a 0.2% sodium fluoride (NaF) mouth rinse is most likely to be the most effective, followed by 1100 ppm to 1500 ppm fluoride toothpaste plus 0.05% NaF mouth rinse, and 1100 ppm to 1500 ppm fluoride toothpaste.

Salivary fluoride concentration and retention after rinsing with 0.05 and 0.2% sodium fluoride (NaF) compared with a new high F rinse containing 0.32% NaF

“…Wierichs and Meyer-Lueckel [7] conclude, "since the findings for coronal caries showed a rather good efficacy, it seems plausible to recommend the daily use of NaF rinses to reduce not only the initiation of coronal caries lesions but also the initiation of root caries lesions". Among the reviewed self-applied topical fluoride methods, daily use of a 0.2% sodium fluoride (NaF) mouth rinse is most likely to be the most effective' [25]. Based on the literature reviews and the results of the present study, daily mouthrinsing with 900 ppm F, or preferably with 1450 ppm F, as a supplement to daily use of F toothpaste, has potential as a preventive measure for elderly people at risk of root caries.…”

Tooth Enamel and Its Dynamic Protein Matrix

“…The discussion and research on the benefits and risks of fluoride for enamel formation and mineralization is ongoing. It is well-stablished that fluoride in both topical application and low dose systemic exposure increases the caries resistance of enamel because fluoridated calcium phosphate is less soluble under acid exposure [ 96 , 97 , 98 ]. However, excessive systemic fluoride exposure during tooth development results in structural and compositional changes of the enamel, dental fluorosis [ 89 , 95 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ].…”

Contemporary Challenges and Management of Dental Caries in the Older Population

“…All have been shown to be effective at reducing the risk of future root caries in randomised controlled clinical trials. [30][31][32] The application of varnishes is simple, quick and noninvasive and can be used in a domiciliary setting. Furthermore, it reduces dependence on patient compliance for success, and treatment can be provided by a dentist or dental care professional.…”