Caries Reduction With Topical Fluoride
Topical application of fluoride—which is available in gels, varnishes, and liquids—is the most effective way to use fluoride in the prevention of dental caries.
Topical Application
Topical application of fluoride—which is available in gels, varnishes, and liquids—is the most effective way to use fluoride in the prevention of dental caries. To determine a patient’s most appropriate fluoride regimen, a caries risk assessment must be performed. Patient compliance is also an important factor when determining the form and frequency of fluoride treatment. Fluoride usage can play a significant role in dental caries management; therefore, oral health professionals need to understand the different treatment options available.
Photo Credit: AlfaOlga / iStock / Getty Images Plus
Gel
Professional fluoride gels, available in 1.23% concentration of acidulated phosphate fluoride (APF) and 2% concentration of neutral sodium fluoride, are applied with a tray. Fluoride gels are generally applied for 4 minutes, and they are effective in reducing caries in children’s permanent teeth. After fluoride gel application, patients are instructed to delay eating and drinking for 30 minutes. The American Dental Association (ADA) Council on Scientific Affairs recommends the use of 1.23% APF gel for patients older than 6 at least every 3 months to 6 months to prevent caries.
Photo Credit: Ildo Frazao / iStock / Getty Images Plus
Varnish
Fluoride varnishes are available in sodium fluoride and difluorsilane preparations in various viscosities. They are brushed on with a tacky consistency that allows them to adhere to the tooth surface, providing more time for fluoride uptake into the enamel. After fluoride varnish application, patients can eat and drink but should avoid hot foods and beverages for 4 hours. Additionally, they should abstain from brushing their teeth the same day of varnish application. The ADA Council on Scientific Affairs recommends the use of 2.26% fluoride varnish for patients younger than 6, and 2.26% fluoride varnish for patients age 6 and older at least every 3 months to 6 months.
Photo Credit: BanksPhotos / iStock / Getty Images Plus
Silver Diamine Fluoride
Silver diamine fluoride (SDF) is the newest addition to the caries armamentarium, and it is used to arrest and prevent caries lesions. SDF combines silver, ammonia, fluoride, and water into a clear liquid that is applied topically. It was approved for the treatment of dentinal hypersensitivity by the United States Food and Drug Administration (FDA) in 2014. However, in 2016, the FDA granted SDF a designation of “breakthrough therapy” for its use in the treatment of caries lesions. In 2017, the American Academy of Pediatric Dentistry recommended the use of 38% SDF for “children and adolescents, including those with special healthcare needs.” The ADA recommends the use of SDF to reverse or arrest noncavitated caries lesions.
Photo Credit: LucaDAddezio / iStock / Getty Images Plus
Application Method
Applying SDF is quick and easy. Once the clinician has determined that SDF is the best course of action and informed consent has been obtained, debris from around the treatment area must be removed. The area must also be isolated and gently dried. A single drop of SDF should be placed in a disposable dappen dish and applied with a microbrush. This amount should treat up to five lesions. After waiting 1 minute to 3 minutes for SDF’s mechanism of action to take place, the remaining liquid is soaked up using a cotton roll or 2×2 gauze. The patient can return to eating and drinking immediately following completion of the procedure.
Photo Credit: Bobby Coutu / E+
Risk of Staining
If SDF contacts the skin, it can create a temporary staining that lasts up to 14 days. SDF permanently stains clothes, equipment, and other surfaces after contact. To avoid staining surfaces in the dental operatory, the clinician should directly dispose of the plastic dappen dish, microbrush, cotton rolls/gauze, and gloves immediately after application. A good technique is to gather all disposable items in one gloved hand upon completion of the application procedure, and then pull the gloves off and over those items, encapsulating them in the gloves for easy disposal.
