In 2006 the American Dental Association (ADA) published recommendations regarding professionally applied topical fluorides.  An update of these guidelines has just been published.  An executive summary is available from the Journal of the American Dental Association and the full report can be downloaded from the ADA – Centre for Evidence-based Dentistry (ADA-EBD) website (see links).   The aim of this report was to complete a 5-yearly update of the evidence supporting the recommendations on topical fluoride. The report addressed 3 questions

1. In primary and permanent teeth, does the use of a topical fluoride compared to no topical fluoride reduce the incidence of new lesions, or arrest or reverse existing coronal and/or root caries?
2. For primary and permanent teeth, is one topical fluoride agent more effective than another in reducing the incidence of, or arresting or reversing coronal and/or root caries?
3. Does the use of prophylaxis before application of topical fluoride reduce the incidence of caries to a greater extent than topical fluoride application without prophylaxis?

Searches were undertaken in two databases, Medline and the Cochrane Library clinical trials of professionally applied and prescription-strength topical fluoride agents-including mouthrinses, varnishes, gels, foams and pastes-with caries increment outcomes published in English. The review methodology followed the guidelines set out in the ADA Clinical Recommendations Handbook that is available at the ADA-EBD Clinical Recommendations webpage (see links).  The review panel considered 71 trials from 82 published papers with meta-analysis being undertaken where appropriate.

The review panel concluded

… some professionally-applied and prescription-strength topical fluoride agents are efficacious in preventing and controlling tooth decay. These products include 2.26% fluoride varnishes, 1.23% fluoride gels, prescription-strength, home-use 0.5% fluoride gels/pastes, and prescription-strength, home-use 0.09% fluoride mouthrinses. The panel did not find that 0.1% fluoride varnishes or prophylaxis pastes containing fluoride were efficacious in preventing tooth decay and found insufficient evidence on 1.23% fluoride foams. Efficacious means that the product is capable of preventing new carious lesions under the controlled setting of a clinical trial.

Summary of Recommendations for people at risk of developing caries

• For those under 6 years of age: –
  • Professionally apply :  2.26% fluoride varnish at least every 3-6months

• For those over the age of 6 either 
  • Professionally apply:  2.26 % fluoride varnish at least every 3-6months  or    1.23% fluoride (acidulated phosphate fluoride) gel for 4 minutes at least every 3-6months

• Home use  of:-  0.09%  fluoride mouthrinse  at least weekly  or  0.05 % fluoride gel or paste twice daily

This is an over simplification of the recommendations which provide more detail in relation to age groups. However, this detail is related to the levels of evidence to support the interventions being recommended rather than the interventions themselves. This is largely because the bulk of the studies undertaken to date have focused on children where the evidence base is more developed than in adults.

Links

ADA-EBD  website

ADA-EBD  Clinical Recommendations page

Weyant RJ, Tracy SL, Anselmo TT, Beltrán-Aguilar ED, Donly KJ, Frese WA, Hujoel PP, Iafolla T, Kohn W, Kumar J, Levy SM, Tinanoff N, Wright JT, Zero D, Aravamudhan K, Frantsve-Hawley J, Meyer DM; American Dental Association Council on Scientific Affairs Expert Panel on Topical Fluoride Caries Preventive Agents.  Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013 Nov;144(11):1279-91. PubMed PMID: 24177407.