Monday, September 4, 2017

Topical Fluoride for caries prevention


Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Olga Raptis                                                                                    Date: 09/03/2017
Article Title: Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review
Author(s):  Weyant et al.
Journal: JADA, 144(11): 1279-1291
Date: 2013
Major Topic: Fluoride use, both in office and at home for caries prevention.
Type of Article: Systematic literature review
Main Purpose:  Establish guidelines for fluoride use
Key Points: (2 lines Max):
The ADA Council of Scientific Affairs sought out to answer two clinical questions and to update the guidelines from 2006
 1.   In primary and permanent teeth, does the use of a topical fluoride agent reduce the incidence of new lesions in coronal caries, root caries or both compared with no topical fluoride use?
       2.   Does the use of prophylaxsis before application of topical fluoride reduce the incidence of caries to a greater extent than the application of topical fluoride without prophylaxsis?

Results:
- The only topical fluoride recommended for Children under 6 is 2.26% Fluoride Varnish at least every 3-6months.

       For the groups A) Age 6-18  B) Older than 18 years C) Adult Root Caries; the panel recommends various topical fluorides including:
      -    2.26% Fluoride Varnish at least every 3-6 months
      -    1.23% APF for 4 mins every 3-6 months   (note 1.23% APF foam not recommended)
      -    0.09% fluoride mouthrinse at least weekly
      -  0.5% fluoride gel or paste twice daily
Remarks:
      1 - Summery article of fluoride guidelines
      2 - Only for high risk patient
Assessment of Article:  Level of Evidence/Comments: Systemic review

AGENTAGE GROUP (YEARS) OR DENTITION AFFECTEDEVIDENCE STATEMENTLEVEL OF CERTAINTYNET BENEFIT RATING
Varnish (2.26 Percent Fluoride)Younger than 6There is a benefit of 2.26 percent fluoride varnish application at least twice per year for caries prevention.ModerateBenefit outweighs potential harm
6-18There is a benefit of 2.26 percent fluoride varnish application at least twice per year for caries prevention.ModerateBenefit outweighs potential harm
Adult root cariesThere is a benefit of 2.26 percent fluoride varnish application at least twice per year for root caries prevention in adults.LowBenefit outweighs potential harm
Varnish (0.1 Percent Fluoride)Younger than 6There is no benefit of 0.1 percent fluoride varnish application twice per year for caries prevention.ModerateNo benefit
6-18There is no benefit of applying 0.1 percent fluoride varnish three times per year for caries prevention.LowNo benefit
APF* Gel (1.23 Percent Fluoride)Younger than 6There is a benefit of APF gel (1.23 percent fluoride) application up to every three months for four minutes for caries prevention.LowPotential harm outweighs benefit
6-18There is a benefit of APF gel (1.23 percent fluoride) application up to every three months for four minutes for caries.ModerateBenefit outweighs potential harm
Adult root cariesThere is a benefit of APF gel (1.23 percent fluoride) application twice per year for four minutes to prevent root caries.LowBenefit outweighs potential harm
Prophylaxis Before APF Gel (1.23 Percent Fluoride) ApplicationYounger than 6There is no benefit from conducting a prophylaxis prior to APF gel (1.23 percent fluoride) application for caries prevention.LowNo benefit
6-18There is no benefit from conducting a prophylaxis prior to APF gel (1.23 percent fluoride) application for caries prevention.ModerateNo benefit
APF Foam (1.23 Percent Fluoride)Younger than 6There is a benefit of APF foam (1.23 percent fluoride) application twice per year for four minutes for caries prevention.LowPotential harm outweighs benefit
6-18There is no benefit of 1.23 percent APF foam application twice per year for four minutes for caries prevention.LowNo benefit
Prophylaxis Pastes Containing FluorideYounger than 6There is no benefit of prophylaxis paste containing fluoride application for four minutes twice per year for caries prevention.LowNo benefit
6-18There is no benefit of prophylaxis paste containing fluoride application for four minutes twice per year for caries prevention.ModerateNo benefit
Prescription-Strength, Home-Use (0.5 Percent Fluoride) Gel or PasteYounger than 6There is a benefit of prescription-strength, home-use (0.5 percent fluoride) gel or paste application twice daily for caries prevention.LowPotential harm outweighs benefit
6-18There is a benefit of prescription-strength, home-use (0.5 percent fluoride) gel or paste application twice daily for caries prevention.LowBenefit outweighs potential harm
Adult root cariesThere is a benefit of prescription-strength, home-use (0.5 percent fluoride) gel or paste application twice daily in preventing root caries.LowBenefit outweighs potential harm
Prescription-Strength, Home-Use (0.09 Percent Fluoride) Mouthrinse6-18There is a benefit of using prescription-strength, home-use (0.09 percent fluoride) mouthrinse daily or weekly for caries prevention.ModerateBenefit outweighs potential harm
Adult root cariesThere is a benefit of using prescription-strength, home-use (0.09 percent fluoride) mouthrinse for root caries prevention among elderly people living in long-term care facilities.LowBenefit outweighs potential harm

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