Recommendations for Patients Who Refuse Fluoride
In September 2011, expert panelists from the American Dental Association (ADA) Council of Scientific Affairs published “Clinical Practice Guidelines: Non-Fluoride Caries Preventive Agents: Evidence-Based Clinical Recommendations.” ebd.ada.org/ClinicalRecommendations.aspx. An update of these guidelines is anticipated to be released in 2020. The existing document provides weighted recommendations for specific nonfluoride caries prevention agents. Two agents were recognized by the panel: sucrose-free polyol and chlorhexidine thymol varnish.
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Xylitol Chewing Gum
Sucrose-free polyol (xylitol only or polyol combinations) chewing gum used for 10 minutes to 20 minutes after meals reduced the incidence of coronal caries, however, the panel stated the evidence level was “weak.”
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The guidelines noted there was enough evidence in support of 1:1 mixture of chlorhexidine thymol varnish applied every 3 months to reduce the incidence of root caries to rule “in favor” of providing this intervention.
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Assessing Caries Risk
If fluoride therapies are not an option, continual assessment of caries risk is a must. Dietary/nutritional counseling as well as sugar and carbohydrate reduction strategies are strongly encouraged to promote both oral and overall systemic health. Sealants are also highly recommended for pit and fissure caries prevention. Drinking water frequently is imperative for patients presenting with medication induced-xerostomia, which significantly increases caries risk.
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Professionally applied topical fluorides continue to be the gold standard in caries prevention. Per the ADA, nonfluoride agents should be used solely as adjuncts to an established caries prevention plan. Thank you for helping your patients achieve optimal health with customization for their holistic preferences. Please stay tuned for the upcoming ADA report on nonfluoride caries preventive agents for future updates on this topic.