Prevention of Root Caries in Vulnerable Elders: A literature review

Objectives: The goal was to conduct a systematic review on the effectiveness of 7 agents (fluoride, chlorhexidine, xylitol, amorphous calcium phosphate (ACP), sealants, saliva stimulators, and silver diamine fluoride (SDF)) on the prevention of primary and secondary root caries in vulnerable elders.

Methods: Using Pubmed and Cochrane databases (as well as References cited within identified publications), articles were selected which met specific study eligibility criteria including being: 1) an original research study; 2) an English-language publication between 1979-2010; and 3) conducted on an older adult, if not exclusively vulnerable elderly population.

Results: Of 340 reviewed articles, 30 articles describing 31 studies met all eligibility criteria. For primary prevention, the most effective agents were: 38% SDF varnish, 225 ppm NaF rinse, 960 ppm SnF2 gel, triclosan + 1100 ppm NaF toothpaste, and ACP + 250 ppm NaF toothpaste, with reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo, although each agent was supported only a by single RCT. For secondary prevention, only two effective agents were identified (22,500 NaF varnish, ~ 80% arrested and 4,500-5,000 ppm NaF toothpaste, ~ 67% arrested) but the supporting evidence was stronger with 3 and 6 clinical studies, respectively.

Conclusion: Based on effectiveness and feasibility of use in the ‘vulnerable elderly', the recommended choices are: 1) 38% SDF varnish applied annually for primary prevention; and 2) NaF varnish applied 4 times a year for secondary prevention. Clearly, additional clinical studies are needed, especially for primary prevention agents for root caries.