Using the theory of evidence-based delivery of dental care, prescriptions for therapeutic medicaments should be based on the needs and preferences of the patient. In addition, the ADA “encourages every dental professional to utilize caries risk strategies” when treatment planning. Identified risk factors for decay include low socio-economic status, infrequent dental care, high proportions of decay-causing bacteria, lowered salivary flow, exposed root surfaces, etc. Developmental and musculoskeletal disorders (Parkinson’s, Alzheimer’s, stroke, multiple sclerosis) can place the patient at increased risk of caries and potential loss of teeth. Use of in-office fluoride should be based on these and other factors, including availability of centralized fluoride water supplies, consumption of bottled water, and home fluoride toothpastes, gels, and rinses. Fluoride has a significant effect on the reduction of smooth surface and interproximal decay due to its remineralization capacity from the saliva. All patients can benefit from use of a fluoride toothpaste containing approximately 1,000 ppm, used twice a day. Only 62% of municipal water systems nationwide are fluoridated, and even where they are, many people drink bottled water. Patients and children with high caries risk or evidence of multiple carious le-sions should take advantage of APF 1.23% or 2% sodium fluoride treatments in office. Clinical studies do not support the use of fluoride foams but do support the use of 4-minute gels. Fluoride varnish used “off label” is endorsed by the ADA but not approved for this application by the FDA. However, children tolerate varnish better and ingest it less often. Varnish should be applied at 6-month intervals for those at moderate risk of decay and more often for high-risk patients from ages 6 to 18 years. Also, the use of long-term fluoride in a lozenge is being tested. Benefits are seen topically and systemically when ingested. Reduction of decay-causing bacteria and a decrease in decay rates for high- and moderate-risk patients should be the focus of in-office and at-home healthcare plans.
(Source: Journal of Practical Hygiene, Nov/Dec 2006)
