Rational for Adult Fluoride Use

The topical application of fluoride to erupted teeth has been investigated since the early 1940's. Numerous clinical trials have evaluated the caries protection afforded by topical application of specific fluoride compounds, in various vehicles, and with different methods of application. Because the incidence of new cariuos lesions is the greatest during the first few years after eruption, most of the early caries studies specifically involved the permanent teeth of children. Clinical research confirmed the safety and efficacy of several preparations, and application regimens, to provide significant caries protection. Specific therapeutic formulations were subsequently approved for professional and home use by the US Food & Drug Administration. Although there have been only limited studies involving adults, the clinical results have been positive and there is every reason to believe that the same protective mechanisms that are active in children also apply to adults.

While children and adolescents in the US have shown a 40% decline in caries over the past 20 years, adults still exhibit significant tooth decay and so a continuing need for preventive measures exists. A recent National Institute of Dental Research (NIDR) survey found that adults had an average of 23 decayed and filled surfaces, with 30% of adults having more than 30 decayed or restored surfaces. Marginal leakage around restorations frequently leads to recurrent or secondary decay and this represents a major dental problem. Surveys demonstrate that 40 <ETH> 50% of replaced amalgam surfaces were caused recurrent caries.

With increasing age and gingival recession, root surfaces become exposed, providing a new group of susceptible sites not generally fond in children. In the US, adults are living longer and keeping a greater number of their teeth, so that the incidence of root caries in this population is steadily rising. Fifty four percent of people sixty years or older have one or more carious root surface lesions. On another related issue, dentin sensitivity now affects one in seven adults, or some 40 million Americans at one time or another. This article reviews some important clinical findings on the uses of topical fluoride to treat or prevent these oral care problems in your adult patient base.