Life expectancy is increasing worldwide with one in six people being aged ≥65 years by 2040. Improved oral health and awareness has resulted in greater retention of teeth into later life mean more potential risk of caries. Topical fluorides agents have been successful used in children and adolescents for some time and while recommended for adults to arrest caries fewer studies have been conducted.
The aim of this review was to assess the effectiveness of professionally applied fluoride therapy in preventing and arresting dental caries in older adults aged 60 years or above.
Methods
A protocol was registered on PROSPERO. Searches were conducted in the PubMed, Scopus, Cochrane Library, Enbase, and Web of Science databases. Clinical trials of Professionally applied fluoride therapy for caries prevention or arrest in adults aged 60 or above published in English were considered. Two reviewers independently searched and selected studies, extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate.
Results
- 7 studies (5 reporting caries prevention, 4 reporting caries arresting) were included.
- 6 of the studies investigated root caries and one study coronal caries.
- All 7 studies used visual and tactile caries detection.
- 5 studies involved community dwelling adults; 2 studies involved adults in long-term care.
- 5 studies were considered to be at low risk of bias and 2 to have some concerns.
- In the 5 studies investigating caries prevention the agents used were 5% NaF varnish, 38% SDF solution, and 1.23% APF gel, with all 3 showing significant effects on preventing new carious lesions.
- 3 studies investigated the of annual application of 38% SDF showing prevented fractions of 25–47% and 52–62% at 24 and 30 months respectively in community-dwelling older adults and 71% at 36 months in institutionalised older adults
- Meta-analysis of 38% SDF (3 studies) showed a statistically significant decrease in the mean number of new root caries by 0.55 (95% CI: 0.32 to 0.78) with annual applications
- 4 studies investigated the caries arresting effect using the agents 5% NaF varnish, 38% SDF solution, and 1.23% APF gel with arrest rates ranging from 24% to 93%.
- Meta-analyses of 38% SDF (2 studies) showed an overall proportion of root caries arrest after 38% SDF annually was 41% (95% CI: 33% to 49%) at 24 months
Conclusions
The authors concluded: –
5% NaF varnish, 38% SDF solution, and 1.23% APF gel are effective in preventing root caries in older adults, and no particular agent is superior. In addition, SDF is effective in arresting root caries in older adults, but it stains carious lesion black. Because only seven clinical trials were found in the literature, more well-designed clinical trials investigating the effectiveness of various methods for caries prevention and arrest in older adults should be conducted to provide more evidence for use in clinical practice and public health measures. Moreover, coronal and root caries have different mechanisms and risk factors; future clinical trials are essential to provide distinct evidence for their management.
Comments
As noted above the effectiveness of topical fluorides in preventing caries in children and adolescents is well evidenced. Much less research is available for older adults as this review demonstrates. The authors have searched 5 major databases although restricting inclusion to English only publication may have excluded some relevant papers. Only 7 papers were included and all but one of the papers addressed root caries so this should be borne in mind when considering the findings. While the findings demonstrated a beneficial effect for various topical fluoride agents there was also variation in the treatment protocols, intervention method and follow-up period consequently more high-quality research needs to be undertaken to determine the most effective and cost -effective approach to delivering caries prevention to this age group. Consideration of the diversity of the sector on the population from health active adults through those with co-morbidities to those in full time care.
Links
Primary Paper
Chan AKY, Tamrakar M, Jiang CM, Tsang YC, Leung KCM, Chu CH. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review. J Dent. 2022 Oct;125:104273. doi: 10.1016/j.jdent.2022.104273. Epub 2022 Sep 1. PMID: 36058347.
Other references
Dental Elf – 5th Nov 2022
Dental Elf – 17th Jul 2019
Dental Elf – 12th Jul 2013
Updated review confirms substantial reductions in caries from fluoride varnish applications
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