Topical fluoride guidance

Abstract

Scope and purpose To review the scientific evidence and develop clinical recommendations on professionally applied topical fluoride.MethodologyMedline and the Cochrane Database of Systematic Reviews were searched for systematic reviews published in the English language that dealt with professionally applied topical fluoride, including gel, foam or varnish, at any time up to October 2005. Seventeen systematic reviews were identified. Clinical studies published after January 2004 and thus not included in the systematic reviews were also identified through Medline. The American Dental Association (ADA) Council on Scientific Affairs formed a panel of experts to evaluate the identified systematic reviews and clinical trials. The panellists were provided with the identified publications and asked to identify any additional systematic reviews or other relevant published trials. One additional publication was included that had been accepted for publication. The individual studies were assessed at a workshop and a draft document was submitted for review to scientists with expertise in fluoride and caries, relevant ADA agencies and the external reviewers. The comments received were considered by the expert panel and the clinical recommendations were approved by the ADA Council on Scientific Affairs. The evidence (Table 1) and strength of recommendations (Table 2) were graded as shown.Review and UpdatingA date for the review of the recommendation is not provided.RecommendationsThe panel produced a number of evidence statements (Table 3) and recommend planning topical fluoride applications based on an assessment of a patient's clinical risk (Table 4): a summary of the main clinical recommendations is shown in Table 5. The full document and an executive summary can be downloaded (www.ada.org/prof/resources/topics/evidencebased.asp).Research recommendationsA number of areas were identified as requiring additional research:A systematic review on the effectiveness of fluoride varnish and gel in high-risk people and/or groups and the effects of varied frequencyThe effects of frequency and mode of application (varnish, gel and foam) of fluoride products in adults and especially in populations with special needsThe use of fluoride varnish and gel for the prevention of root caries and recurrent cariesStrategies, especially for appropriate intervals of fluoride varnish and gel in high-risk groups, including consideration of multiple applications over short time intervalsThe best fluoride regimen to assist in the remineralisation of early carious lesionsClinical trial on the effects of fluoride foam versus gel in various target populationsClinical trial on the effectiveness of 1-min versus 4-min gels in various target populationsDevelopment of slow-release fluoride systems that are responsive to changing pH levels in plaque fluid and/or salivaMethods of assessing caries riskThe safety and effectiveness of chewable topical fluoride supplements or troches for adultsEvaluation of whether the caries-prevention effect of topical fluoride treatments is influenced by fluoridated water and toothpastes. © 2006 EBD.