A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies.
Types of Studies Reviewed
The authors conducted a search of MEDLINE and the Cochrane Library for 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 through October 2012.
The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research.
The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.05 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from ”in favor“ to ”expert opinion for.“ As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.
*Original abstract online at https://doi.org/10.14219/jada.archive.2013.0057
The American Dental Association Council on Scientific Affairs Expert Panel on Topical Fluoride Caries Preventive Agents acknowledges the efforts of the following people and their commitment in helping complete this project:
• Dr. Rocky Napier, Aiken, S.C., American Dental Association (ADA) Council on Access, Prevention, and Interprofessional Relations (CAPIR) liaison;
• Ms. Jane McGinley, manager, Fluoridation and Preventive Health Activities, CAPIR, ADA, Chicago, ADA CAPIR staff liaison;
• Douglas B. Torbush, Conyers, Ga., ADA Council on Dental Practice liaison;
• Dr. C. Rieger Wood, Tulsa, Okla., ADA Council on Dental Benefit Programs liaison;
• Dr. William F. Robinson, Tampa, Fla., ADA Council on Dental Education and Licensure liaison;
• Mr. Antanas Rasymas, formerly with ADA Library, Chicago;
• Mr. Tom Wall, ADA Health Policy Resources Center, Chicago;
• Mr. Sam Cole, ADA Health Policy Resources Center, Chicago.
The panel thanks the following people and organizations whose valuable input during external peer review helped improve this report:
• Dr. Elliot Abt, Advocate Illinois Masonic Medical Center, Chicago;
• Dr. James Bader, School of Dentistry, University of North Carolina at Chapel Hill;
• Dr. William H. Bowen, School of Medicine and Dentistry, University of Rochester, N.Y.;
• Dr. Albert Kingman, Center for Clinical Research, National Institute of Dental and Craniofacial Research, Bethesda, Md.;
• Dr. Stephen J. Moss, College of Dentistry, New York University, New York City;
• Dr. David G. Pendrys, School of Dental Medicine, University of Connecticut, Farmington;
• Dr. Philip A. Swango, private dental consultant, Albuquerque, N.M.;
• Dr. Gary M. Whitford, School of Dentistry, Georgia Regents University, Augusta;
• Dr. Helen Worthington, Cochrane Oral Health Group, School of Dentistry University of Manchester, England;
• the American Academy of Pediatric Dentistry;
• the American Dental Hygienists Association;
• the American Association for Dental Research;
• the National Institute of Dental and Craniofacial Research;
• the ADA Council on Communications; and
• the ADA Council on Dental Practice.
The panel also thanks the following people whose valuable input helped improve table and the chairside guide:
• Dr. Paul Fischl, Evanston, Ill.;
• Dr. Bob Kaspers, Northbrook, Ill.;
• Dr. Dave Lewis, Glenview, Ill.;
• Dr. Dave McWhinnie, Skokie, Ill.;
• Dr. Peter Neuhaus, Wilmette, Ill.; and
• Dr. Maria Simon, Evanston, Ill.
The American Dental Association Council on Scientific Affairs Expert Panel on Topical Fluoride Agents commissioned this study, which was supported in part by the Centers for Disease Control and Prevention, Atlanta. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
- 1 Dr. Weyant is a professor and the chair, Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh. He was the chairman of the panel.
- 2 Dr. Tracy is an assistant director, Center for Evidence-Based Dentistry, Division of Science, American Dental Association, 211 E. Chicago Ave., Chicago, Ill. 60611. Address reprint requests to Dr. Tracy.
- 3 Ms. Anselmo is the Oral Health Program Manager, San Luis Obispo Health Agency, Calif. She represented the American Dental Hygienists Association on the panel.
- 4 Dr. Beltrán-Aguilar is a senior epidemiologist and an advisor to the director, Division of Oral Health, Centers for Disease Control and Prevention, Atlanta. He represented the Centers for Disease Control and Prevention on the panel.
- 5 Dr. Donly is a professor and the chair, Pediatric Dentistry, University of Texas Health Science Center at San Antonio. He represented the American Academy of Pediatric Dentistry on the panel.
- 6 Dr. Frese is an assistant professor, Department of Pediatrics, University of Illinois at Chicago. He represented the American Academy of Pediatrics on the panel.
- 7 Dr. Hujoel is a professor of periodontics, Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle.
- 8 Dr. Iafolla is a public health analyst, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md. He represented the National Institute of Dental and Craniofacial Research on the panel.
- 9 Dr. Kohn is vice president of dental science and policy, Delta Dental Plans Association, Oak Brook, Ill.
- 10 Dr. Kumar is the director, Oral Health Surveillance and Research, Bureau of Dental Health, New York State Department of Health, Albany; and an associate professor, School of Public Health, University at Albany, State University of New York.
- 11 Dr. Levy is the Wright-Bush-Shreves Endowed Professor of Research, Department of Preventive and Community Dentistry, College of Dentistry, and a professor, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
- 12 Dr. Tinanoff is a professor and the division chief, Pediatric Dentistry, School of Dentistry, University of Maryland, Baltimore.
- 13 Dr. Wright is a professor and the chair, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill.
- 14 Dr. Zero is a professor and the chair, Department of Preventive and Community Dentistry, the director, Oral Health Research Institute, and an associate dean for Research, Indiana University School of Dentistry, Indianapolis.
- 15 Dr. Aravamudhan is a senior manager, Office of Quality Assessment and Improvement, Division of Dental Practice, American Dental Association, Chicago.
- 16 Dr. Frantsve-Hawley is the senior director, Center for Evidence-Based Dentistry, Division of Science, American Dental Association, Chicago.
- 17 Dr. Meyer is the senior vice president, Science and Professional Affairs, American Dental Association, Chicago
*Original abstract online at https://doi.org/10.14219/jada.archive.2013.0057