Professionally applied topical fluoride: Evidence-based clinical recommendations
Think about these questions while you consume your science Sunday article breakdown!
What type of fluoride are you currently using? Is the method you use well accepted by patients? If you are using gel or foam, are you applying it for four minutes as recommended by the panel? Has your office implemented a caries risk assessment to help with decision making about topical fluoride applications?
Evidence-based dentistry is defined as “an approach to oral health care that requires the judicious integration of systematic assessment of clinically relevant scientific evidence relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences”. Though evidence-based dentistry does not establish a standard of care, it may help guide decision making. One such area is the use of professionally applied topical fluoride. In 2006 the American Dental Association Council on Scientific Affairs convened the Expert Panel on Professionally Applied Topical Fluoride to review systematic reviews and clinical trials. After assessing the collective body of evidence, the panel provided recommendations that are highlighted in Vol. 137 of JADA.1
The goal of the panel was to decide whether the existing practices for professionally applied fluoride in dental offices are supported by current scientific evidence and whether recommendations need to be strengthened. Professionally applied topical fluoride is approved by the FDA for treatment of dentin hypersensitivity however there is an increasing body of evidence that fluoride varnish is effective in caries prevention. The panel focused on evidence for the use of professionally applied topical fluoride for the primary prevention of dental caries.
The forms of professionally applied topical fluoride that were included in the review were gel, foam, and varnish. The Panel came to multiple conclusions after reviewing the evidence. Examples of a few of the conclusions included, “Two or more applications of fluoride varnish per year are effective in preventing caries in high-risk populations”, “Fluoride varnish applications take less time, create less patient discomfort and achieve greater patient acceptability than does fluoride gel, especially in preschool-aged children”, “There are considerable data on caries reduction for professionally applied topical fluoride gel treatments for four minutes”, and “In contrast, there is laboratory, but no clinical equivalency, data on the effectiveness of one-minute fluoride gel application”.
Additionally, the panel encourages the use of a caries risk assessment when making the decision on the frequency of topical fluoride applications. The panel put together a system that outlines caries risk. It is broken into 3 different criteria: low risk, moderate risk, and high risk. Low-risk patients present with no incipient lesions or cavitated primary or secondary lesions in the last three years and no factors that might increase caries risk. Moderate risk for patients under age 6 would include no incipient or cavitated lesions, but the presence of at least one factor that may increase caries risk, over age 6 criteria includes one or two incipient or cavitated lesions in the past three years and/or no incipient or cavitated lesions but the presence of at least one risk factor that increases caries risk. High-risk criteria include the presence of multiple factors increasing caries risk, suboptimal fluoride exposure, and xerostomia. Patients under age 6 with any incipient lesions or cavitated lesions in the past 3 years and patients over age 6 with three or more incipient lesions or cavitated lesions in the past three years also fall into the high-risk criteria.
Using the risk assessment criteria will help determine the frequency of topical fluoride treatments for each patient. Patients that fall into the low-risk category may not receive additional benefits from professionally applied topical fluoride treatments Patients under age 6 with moderate risk should receive fluoride varnish applications at 6-month intervals, and high-risk patients should receive fluoride varnish applications every 3 to 6 months. The same applies to patients age over 6 with the exception that gel can be used instead of varnish if the patient and clinician prefer. Fluoride foam is lacking clinical evidence of its effectiveness; therefore, the panel was reluctant to add it to the list of recommended delivery method. The application of gel should be four minutes, a one-minute fluoride application is not endorsed by the panel.
- American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride: evidence-based clinical recommendations. J Dent Educ. 2007;71(3):393–402.