Fluoride Therapy for Adult Patients
In the general population adult dental patients are more
likely to have established disease upon presentation to the office. Dental
caries creates an enormous economic burden and negatively impacts
dental-related quality of life. The challenge facing dentists is preventing
complications from developing rather than preventing primary disease.1 While adult teeth may already have decay,
fluoride in combination with other modalities can still contribute to
prevention and improved oral health.2
Caries disease in
Up to 90% of adults have caries and gingivitis3, known risk factors for infection, pain, and chronic
systemic inflammation. Gingival recession, poor oral hygiene, bad habits such
as smoking and high-sugar candies and drinks, comorbid conditions, and certain
medications contribute to this pathological process.4 The treatment goals in adults are significantly
different relative to those in children and adolescents given their differences
in physiology and stage of oral disease.
Primary vs. secondary
Primary prevention is aimed at preventing development of
disease, in this case caries in permanent teeth. Toothbrushing, interdental
cleaning5, professional examinations and cleanings, radiographs6, and patient education are tools
commonly used in primary prevention. Interventions are based on risk assessments
and surveillance in an effort to avoid subtractive methods of rehabilitation.
In contrast, secondary prevention is practiced in the presence of known disease
to prevent complications including decayed, missing, or filled teeth (DMFT).
Techniques include restorations, fillings, and extractions along with ongoing
surveillance and patient education. Sometimes secondary prevention may require
coordination of care with the patient’s primary care physician.
Barriers to care
In the US,
children receive more consistent dental care than do adults.7 Many Americans do not have dental
insurance and cannot afford the expense of even basic care.8 The lowest socioeconomic groups
typically have Medicaid which does include dental insurance,3 whereas people in the poor to middle class often
do not have dental insurance and might not present to the dentist for
preventive care. In addition, there is significant racial and ethnic group
variability with minorities typically having poorer access to care.9 Other burden of illness in an adult such as
cancer or dementia may make obtaining dental care an even lower priority.10 As a result of these socioeconomic factors,
dentists are more likely to see adult patients with more advanced disease and
less adherence to care guidelines.
Role of fluoride
Fluoride therapy has a significant role in the treatment of
common dental conditions in adults.
Even though adults have a limited capacity for
remineralization of thinned enamel, fluoride has a role in regulating oral
bacteria and reducing a pathogenic biofilm, diminishing the progression of
caries.11-13 (See Figure 1)
Again through its role in regulating the biofilm, fluoride
reduces progression of periodontal disease including periodontitis and
gingivitis11. Fermenting bacteria are reduced and higher pH is
When dentinal tubules become exposed through enamel erosion
and gingival recession the tooth becomes more sensitive to pain. (See Figure 2)
Various treatment modalities have been used including laser treatments,
tubule-sealing toothpastes, and enamels. Fluoride has been shown to provide
rapid and long-lasting relief of dentin hypersensitivity through the sealing of
dentinal tubules. Fluoride toothpastes, mouthwashes, and dental varnishes are
The Dentist’s role
In adults the dentist’s role involves appropriate risk
assessment and minimal intervention.7 Patients should be educated about
the benefits of fluoride treatment and surveillance with early intervention
continue to be important. Dentists may also screen for comorbid disease such as
HIV and cancer and may in fact see the earliest signs of these diseases, and
appropriate referrals to medical colleagues may be indicated. Restorative
treatments and fluoride varnishes can provide significant improvements in the
quality of life for adult patients.
Fluoride therapy continues to be beneficial for adult
patients even though adults are more likely to present with established
disease. The tenets of secondary prevention focus on avoiding complications of
disease, and the dentist has a powerful role in improving the quality of life
for adult patients even with known dental and periodontal disease. Screening,
surveillance, education, and early intervention will help to improve oral
health and reduce health care costs.
V. Dentistry and population approaches for preventing dental diseases. J
Dent. Dec 2011;39 Suppl 2:S9-19.
DL, Chan KC, Young BA. Poor oral health and quality of life in older U.S.
adults with diabetes mellitus. J Am Geriatr Soc. Oct
- Kim JK,
Baker LA, Seirawan H, Crimmins EM. Prevalence of oral health problems in
US adults, NHANES 1999–2004: exploring differences by age, education, and
race/ethnicity. Special Care in Dentistry. 2012;32(6):234-241.
- Lu HX,
Wong MC, Lo EC, McGrath C. Trends in oral health from childhood to early
adulthood: a life course approach. Community Dent Oral Epidemiol. Aug
D, Nickerson JW, Poklepovic T, et al. Flossing for the management of
periodontal diseases and dental caries in adults. Cochrane
Database Syst Rev. 2011;12(12):CD008829.
A. Radiographic Analysis of Acquired Pathological Dental Conditions. In:
Basrani B, ed. Endodontic Radiology. 2nd ed: Wiley;
F, Ng M-W. Into the future: keeping healthy teeth caries free: pediatric
CAMBRA protocols. Journal of the California Dental Association. 2011;39(10):723.
Ozturk G, Gallo W, Fahs M. Use of Preventive Care by Older Adults in New
York City: Income Related Disparities in Dental and Vision Care. Journal
of Health Behavior and Public Health. 2012;1(2):17-23.
D, Russell S, Parikh NS, Fahs M. Ethnic disparities in self-reported oral
health status and access to care among older adults in NYC. J
Urban Health. Aug 2011;88(4):651-662.
J, Wright S, Matthews AG, et al. Substance-use screening and interventions
in dental practices Survey of practice-based research network dentists
regarding current practices, policies and barriers. The Journal of
the American Dental Association. 2013;144(6):627-638.
R, Singh C, Yeluri R, Chaudhry K. Prevention of Dental Caries-Measures
beyond Fluoride. Oral Hyg Health. 2014;2(122):2332-0702.1000122.
Cate JM. Current concepts on the theories of the mechanism of action of
fluoride. Acta Odontol Scand. Dec 1999;57(6):325-329.
RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention:
executive summary of the updated clinical recommendations and supporting
systematic review. Journal of the American Dental Association. Nov
LG. The role of fluoride in the preventive management of dentin
hypersensitivity and root caries. Clin Oral Investig. Mar
2013;17 Suppl 1(1):S63-71.